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Thromb Haemost 2000; 84(01): 88-92
DOI: 10.1055/s-0037-1613973
Commentary
Schattauer GmbH

Comparison of the O’Brien Filter Test and the PFA-100 Platelet Analyzer in the Laboratory Diagnosis of von Willebrand’s Disease

Agota Schlammadinger
1   From the 2nd Department of Medicine, University Medical School of Debrecen, Hungary
,
Adrienne Kerenyi
2   Department of Clinical Biochemistry and Molecular Pathology, University Medical School of Debrecen, Hungary
,
Laszlo Muszbek
2   Department of Clinical Biochemistry and Molecular Pathology, University Medical School of Debrecen, Hungary
,
Zoltan Boda
1   From the 2nd Department of Medicine, University Medical School of Debrecen, Hungary
› Author Affiliations
Further Information

Publication History

Received 10 June 1999

Accepted after resubmission 28 February 2000

Publication Date:
10 December 2017 (online)

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Summary

Von Willebrand’s disease (vWD) is the most common congenital haemorrhagic diathesis, characterized by the quantitative or qualitative disorder of von Willebrand factor (vWF). A number of methods have been used for the diagnosis of the disease, and the bleeding time determination is widely accepted as a screening test in spite of its low sensitivity. Our aim was to evaluate and compare the performance of two high shear systems (the O’Brien filter test and the PFA-100 device) in the screening and diagnosis of vWD. Thirty patients (n=13 type 1 with mild symptoms, n = 9 type 1 with severe symptoms, n = 2 type 2A, n = 3 type 2B and n = 3 type 3 vWD) and twenty controls were investigated. In mild vWD the platelet retention in the second phase of the filter test with citrated blood showed the highest sensitivity (91.6%). The sensitivity of the PFA-100 method with collagen-epinephrine cartridges in this group was 76.9%, while the bleeding time was prolonged only in 15.4% of the cases. In severe type 1, in type 2A and type 3 all functional tests reflected the bleeding tendency of the patients. In type 2B disease the bleeding time was prolonged only when the patient was thrombocytopenic, but both high shear systems revealed the disease independently of the presence of thrombocytopenia. The overall sensitivity of the bleeding time determination was 50% compared to the 80-90% sensitivity of the O’Brien filter test and the PFA-100 system. The sensitivity values of the filter test and the PFA-100 device with collagen-epinephrine cartridges were in the same range, but the collagen-ADP cartridges showed a lower (65.5%) sensitivity, though the results were specific and had high positive predictive value. We conclude that both high shear systems are suitable for the screening of vWD, and that they are superior to the traditional bleeding time determination in case of mild disease or type 2B vWD.

Key words

von Willebrand’s disease - high shear induced platelet activation - O’Brien filter test - PFA-100 system
 

  • References

  • 1 Rodeghiero F, Castaman G, Dini E. Epidemiological investigation of the prevalence of von Willebrand’s disease. Blood 1987; 69: 454-9.
    PubMedGoogle Scholar
  • 2 Legaz ME, Schmer G, Counts RB, Davie EW. Isolation and characterization of human factor VIII (antihemofilic factor). J Biol Chem 1973; 248: 3946-55.
    PubMedGoogle Scholar
  • 3 Ruggeri ZM, Ware J. von Willebrand factor. FASEB J 1993; 07: 308-16.
    CrossrefPubMedGoogle Scholar
  • 4 Savage B, Saldivar E, Ruggeri ZM. Initiation of platelet adhesion by arrest onto fibrinogen or translocation on von Willebrand factor. Cell 1996; 84: 289-97.
    CrossrefPubMedGoogle Scholar
  • 5 Goto S, Ikeda Y, Saldivar E, Ruggeri ZM. Distinct mechanisms of platelet aggregation as a consequence of different shearing flow conditions. J Clin Invest 1998; 101: 479-86.
    CrossrefPubMedGoogle Scholar
  • 6 Sadler JE. A revised classification of von Willebrand disease. Thromb Haemost 1994; 71: 520-5.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 7 Rodgers RP, Levin J. A critical reappraisal of the bleeding time. Semin Thromb Hemost 1990; 16 (01) 1-20.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 8 Ruggeri ZM. Mechanisms initiating platelet thrombus formation. Thromb Haemost 1997; 78: 611-6.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 9 O’Brien JR, Salmon GP. Shear stress activation of platelet glycoprotein IIb/IIIa plus von Willebrand factor causes aggregation: filter blockage and the long term bleeding time in von Willebrand’s disease. Blood 1987; 70: 1354-61.
    PubMedGoogle Scholar
  • 10 Kundu SK, Heilmann EJ, Sio R, Garcia M, Davidson RM, Ostgaard RA. Description of an in vitro platelet function analyzer – PFA100. Semin Thromb Hemost Suppl 2 1995; 21: 106-12.
    PubMedGoogle Scholar
  • 11 Mannucci PM. Treatment of von Willebrand’s disease. J Intern Med Suppl 1997; 740: 129-32.
    PubMedGoogle Scholar
  • 12 Phillips MD, Santhouse A. Von Willebrand disease: recent advances in pathophysiology and treatment. Am J Med Sci 1998; 316 (02) 77-86.
    PubMedGoogle Scholar
  • 13 Lind SE. The bleeding time does not predict surgical bleeding. Blood 1991; 77: 2547-52.
    PubMedGoogle Scholar
  • 14 De Catarine R, Lanza M, Manca G, Strata GB, Maffei S, Salvatore L. Bleeding time and bleeding: an analysis of the relationship of bleeding time test with parameters of surgical bleeding. Blood 1994; 84: 3363-70.
    PubMedGoogle Scholar
  • 15 Kroll H, Hellums JD, McIntire LV, Schafer AI, Moake JL. Platelets and shear stress. Blood 1996; 88: 1525-41.
    PubMedGoogle Scholar
  • 16 Siedlecki CA, Lestini BJ, Kottke-Marchant K, Eppell SJ, Wilson LD, Marchant RE. Shear-dependent changes in the three-dimensional structure of human von Willebrand factor. Blood 1996; 88: 2939-50.
    PubMedGoogle Scholar
  • 17 Pareti FI, Cattaneo M, Carpinelli L, Zighetti ML, Bressi C, Mannucci PM, Ruggeri ZM. Evaluation of the abnormal platelet function in von Willebrand disease by the blood filtration test. Thromb Haemost 1996; 75: 460-8.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 18 Boda Z, Tornai I, Rák K. Studies of the platelet filter test (shear induced platelet aggregation) in patients with uncommon haemorrhagic disorders. Blood Coagul Fibrinolysis 1996; 07: 162-4.
    CrossrefPubMedGoogle Scholar
  • 19 Rejtõ L, Schlammadinger Á, László P, Kiss A, Telek B, Boda Z. Use of a platelet filter test in patients with thrombocytosis. Platelets 2000; 11: 38-42.
    CrossrefPubMedGoogle Scholar
  • 20 Fressinaud E, Veyradier A, Truchaud F, Martin I, Boyer-Neumann C, Trossaert M, Meyer D. Screening for von Willebrand disease with a new analyzer using high shear stress. A study of 60 cases. Blood 1998; 91: 1325-31.
    PubMedGoogle Scholar
  • 21 Harrison P, Robinson MSC, Mackie IJ, Joseph J, McDonald SJ, Liesner R, Savidge GF, Pasi J, Machin SJ. Performance of the platelet function analyser PFA-100™ in the testing abnormalities of primary haemostasis. Blood Coagul Fibrinolysis 1999; 10: 23-31.
    CrossrefPubMedGoogle Scholar
  • 22 Marshall PW, Williams AJ, Dixon RM, Growcott JW, Warburton S, Armstrong J, Moores J. A comparison of the effects of aspirin on bleeding time measured using the Simplate™ method and closure time measured using the PFA-100™, in healthy volunteers. Br J Clin Pharmacol 1997; 44: 151-5.
    PubMedGoogle Scholar
  • 23 Mammen EF, Comp PC, Gosselin R, Greenberg C, Hoots WK, Kessler CM, Larkin EC, Liles D, Nugent DJ. PFA-100 system: a new method for assessment of platelet dysfunction. Semin Thromb Hemost 1998; 24: 195-202.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 24 Fressinaud E, Veyradier A, Sigaud M, Boyer-Neumann C, Le Boterff C, Meyer D. Therapeutic monitoring of von Willebrand disease: interest and limits of a new platelet function analyser at high shear rates. Br J Haematol 1999; 106: 777-83.
    CrossrefPubMedGoogle Scholar
  • 25 Cattaneo M, Federici AB, Lecchi A, Agati B, Lombardi R, Stabile F, Bucciarelli P. Evaluation of the PFA-100™ system in the diagnosis and therapeutic monitoring of patients with von Willebrand disease. Thromb Haemost 1999; 82: 35-9.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 26 Favarolo JE, Facey D, Henniker A. Use of a novel platelet function analyzer (PFA-100™) with high sensitivity to disturbances in von Willebrand factor to screen for von Willebrand’s disease and other disorders. Am J Hematol 1999; 62: 165-74.
    CrossrefPubMedGoogle Scholar