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

No

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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