PLATELET DYSFUNCTION Document sites, duration and amount of bleeding especially epistaxis, menorrhagia and mucosal bleeding, History of systemic illness, medications, family history. Examine and document bleeding and signs of systemic disease CBC and smear, PTT, PT, TT Normal platelet count and morphology Normal to slightly low Platelet count and small Platelet size Normal to slightly Low platelet count And large size ew onset bleeding Lifelong bleeding Platelet inhibiting drugs Yes Drug-induced Underlying Platelet dysfunction Stop drug If possible No Liver & Renal tests Abnormal Normal Uremia Liver disease Abnormal CBC and Blood smear MDS Manage Underlying disease BMA BMB PTT FVIII,vWF Ag,vWF:RCo Normal Abnormal Repeat Von Willebrand’s disease Normal Platelet aggregation studies Abnormal Intrinsic platelet Dysfunction Glanzmann DDAVP Rarely platelet transfusion vW multimer assay Normal Abnormal Type I vWD DDAVP Challenge Type 2A,2B, 3, Platelet type---vWF replacement. Platelet transfusion for latter Recurrent infection, Eczema, lymphoreticular Malignancies, males No Yes X-linked thrombocytopenia Amegakaryocytosis Wiskott- Aldrich Splenectomy may reduce bleeding BMT Specific morphologic abnormality Yes No Brenard-Soulier: Very large platelets Abnormal ristocetin aggregation May-Hegglin: Large platelets+Dohle bodies Gray platelet syndrom: Large, pale platelets ITP,Other macrothro m- bocytopen ias Platelet dysfunction Can be seen in ITP But low count is mor important P r o v i s i o n a l I n v e s t i g a t i o n Other investigation M a n a g e m e n t D i a g n o s i s

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PLATELET DYSFUNCTION

Document sites, duration and amount of bleeding especially epistaxis, menorrhagia and mucosal bleeding, History of systemic illness, medications, family history.Examine and document bleeding and signs of systemic disease

CBC and smear, PTT, PT, TT

Normal platelet count and morphology Normal to slightly lowPlatelet count and smallPlatelet size

Normal to slightlyLow platelet countAnd large size

New onset bleeding Lifelong bleeding

Platelet inhibiting drugs

Yes

Drug-inducedUnderlyingPlatelet dysfunction

Stop drugIf possible

Liver & Renal tests

Abnormal Normal

UremiaLiver disease

AbnormalCBC andBlood smear

MDS

ManageUnderlyingdisease

BMABMB

PTTFVIII,vWF Ag,vWF:RCo

Normal Abnormal

RepeatVon Willebrand’sdisease

Normal

Platelet aggregationstudies

Abnormal

Intrinsic plateletDysfunctionGlanzmann

DDAVPRarely platelettransfusion

vW multimer assay

Normal Abnormal

Type I vWDDDAVP Challenge

Type 2A,2B, 3, Platelet type---vWF replacement.Platelet transfusion for latter

Recurrent infection, Eczema, lymphoreticularMalignancies, males

No Yes

X-linked thrombocytopeniaAmegakaryocytosis

Wiskott-Aldrich

Splenectomy mayreduce bleedingBMT

Specific morphologicabnormality

Yes No

Brenard-Soulier: Very large plateletsAbnormal ristocetin aggregationMay-Hegglin: Large platelets+Dohle bodiesGray platelet syndrom: Large, pale platelets

ITP,Other macrothrom-bocytopenias

Platelet dysfunctionCan be seen in ITPBut low count is moreimportant

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