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Whole Blood Impedance Aggregometry: A Usefool Tool but Still Not the Gold Standard

S. Ellouze1, C. Lavenu-Bombled2, A. Perrier-Cornet2, S. Combe2, A. Blandinieres2, T. Lambert3, R. D'Oiron3, V. Proulle1

1Service Hématologie Biologique, Hôpital Cochin, APHP, Université de Paris, Paris, France, 2Service Hématologie Biologique, Hôpital Bicêtre, APHP, Université Paris Saclay, Le Kremlin Bicêtre, France, 3Centre de Référence pour le Traitement des Maladies Hémorragiques Hôpital Bicêtre, APHP, Le Kremlin Bicêtre, France

Abstract Number: LPB0126

Meeting: ISTH 2021 Congress

Theme: Platelet Disorders, von Willebrand Disease and Thrombotic Microangiopathies » Platelet Function Disorders, Hereditary

Background: Light transmission aggregometry (LTA) is the gold standard to diagnose inherited platelet function disorders (IPFD) and von Willebrand disease type 2B (VWD2B). LTA is a time-consuming method requiring large blood volumes. In contrast, whole blood impedance aggregometry (WBIA) is a quicker and simpler method requiring limited volume of blood.

Aims: We evaluate the ability of WBIA to identify already diagnosed IPFD and VWD2B. We also compare the results of both methods in patients referred for unexplained bleeding tendency.

Methods: One hundred sixty patients were studied (Table 1). LTA was performed on platelet-rich plasma according to international recommendations (SSC/ISTH). WBIA was performed on hirudin-anticoagulated blood using the Multiplate® analyzer (Roche) according to manufacturer’s instructions. Normal ranges were calculated in 30 healthy individuals.

N= Gendre (F/M) Age (years±SD) Platelet Count (x 109L-1±SD)
Glanzmann Thrombasthenia 18 10/18 31±17 146±83
Bernand-Soulier Syndrome 3 2/1 24±3 27±6
MYH9-related disease 7 1/6 21±18 61±24
VWD type 2B 14 9/5 36±21 146±83
Platelet-type VWD 3 2/1 35±20 190±25
VWD 29 22/7 28±16 295±188
Gray Platelet Syndrome
Scott Syndrome
Wiscott-Aldrich Syndrome
1
1
1
1/0
0/1
0/1
37
28
46
41
208
57
Unexplained bleeding tendency 83 62/21 29±18 234±90
Healthy individuals 30 15/15 39±14 245±80

Characteristic of the 160 patients studied. VWD: von Willebrand disease.

Results: WBIA correctly diagnosed all patients with Glanzmann Thrombasthenia, Bernard-Soulier Syndrome, platelet-type VWD as well as 13/14 patients with VWD2B, whatever the platelet count. Thrombocytopenic patients with MYH9-related disease had sub-normal results with all agonists. However, VWD patients were poorly detected (15/29, 51.7%). Among 83 patients referred for unexplained bleeding tendency, WBIA and LTA gave concordant results in 48/83 (57.8%) patients: 29 had normal results and 19 had abnormal results with one or more agonists using both methods. Discrepant results were observed in 35/83 (42.1%) patients (Table 2).

LTA
WBIA Abnormal Normal PPV NPV Sensitivity Specificity
Abnormal 19 30 0.38 0.85 0.79 0.49
Normal 5 29

Agreement between WBIA and LTA in patients referred for unexplained bleeding tendency (n = 83). PPV: positive predictive value. NPV: negative predictive value.

Conclusions: Our study shows that WBIA 1/ is able to properly characterize patients with severe IPFD and VWD2B, including those with thrombocytopenia 2/ is less sensitive/specific in detecting mild platelet abnormalities compared to LTA. The negative predictive value of 0.85 suggests that it might be a useful quick and easy-to use screening test while it cannot avoid further testing by LTA in patients with unexplained bleeding tendency.

To cite this abstract in AMA style:

Ellouze S, Lavenu-Bombled C, Perrier-Cornet A, Combe S, Blandinieres A, Lambert T, D'Oiron R, Proulle V. Whole Blood Impedance Aggregometry: A Usefool Tool but Still Not the Gold Standard [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/whole-blood-impedance-aggregometry-a-usefool-tool-but-still-not-the-gold-standard/. Accessed October 1, 2023.

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