Correlations of Platelet Survival and Function with the Results of Two in vitro Tests

McGill, Manley

doi:10.1111/j.1423-0410.1981.tb00743.x

Cited by 11 publications

(4 citation statements)

References 24 publications

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“…McGill has previously questioned the validity of studies that use the bleeding time and the linear relationship of Harker and Slichter to evaluate the efficacy of stored platelet concen trates after transfusion. 138…”

Section: There Is No Evidence That the Utility Of The Bleeding Time Hmentioning

confidence: 99%

A Critical Reappraisal of the Bleeding Time*

Rodgers¹,

Levin²

1990

Semin Thromb Hemost

609

292

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Since its initial invention by the French worker Milian in 1901, the bleeding time has been put forward as a clinically useful test in three contexts: diagnosis (particularly of platelet disorders), prediction of clinically important bleeding, and assessment of the adequacy of various forms of therapy. Attempting a complete review of the published experience with this test, we assessed 862 articles. Original bleeding time data appeared in 664 of these articles, from which we tabulated 1083 distinct studies in humans. ROC analysis, which characterizes the sensitivity and specificity of the test, was applied in every instance in which published data were adequate (34 studies). ROCs from 27 studies of the bleeding time in association with aspirin ingestion reveal high variability in the ability of the bleeding time to detect aspirin intake, and provide evidence against claims that recently devised bleeding time methods have improved discriminatory ability based on improved reproducibility. Two ROCs from surgical studies, in which the bleeding time was used to try to predict abnormal bleeding, were statistically indistinguishable from that of a completely noninformative test. In ROCs from five studies of abnormal bleeding in uremia, the test performed approximately the same as the platelet count or hematocrit (taken singly); in one of these studies, prothrombin consumption was determined and was a better predictor of bleeding than bleeding time, hematocrit, or platelet count. In the settings of renal biopsy (one study) and massive transfusion (one study), data allowed estimation of predictive value: in no instance was there evidence that the bleeding time significantly altered a priori estimates (based on prevalence) of the risk of bleeding. Linear regression analysis was applied to data from 23 studies relating platelet count to bleeding time, to assess published claims that the bleeding time and platelet count follow a predictively useful linear relationship. In 22 of 23 instances, the inverse relationship between bleeding time and platelet count was associated with broad statistical scatter, making it impossible to predict precisely one variable given the other. The pathophysiology of an abnormal bleeding time remains poorly understood. The bleeding time is affected by a large number of diseases, drugs, physiologic factors, test conditions, and therapeutic actions, not all of them platelet-related. The test is likely to remain widely used for the diagnosis of inherited disorders of platelet function, such as von Willebrand's syndrome, despite the lack of clear criteria for its use in this context.(ABSTRACT TRUNCATED AT 400 WORDS)

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Section: There Is No Evidence That the Utility Of The Bleeding Time Hmentioning

confidence: 99%

A Critical Reappraisal of the Bleeding Time*

Rodgers¹,

Levin²

1990

Semin Thromb Hemost

609

292

View full text Add to dashboard Cite

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Section: Discussionmentioning

confidence: 99%

A Critical Reappraisal of the Bleeding Time

Rodgers,

Levin

2023

Semin Thromb Hemost

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Seminars in Thrombosis and Hemostasis (STH) celebrates 50 years of publishing in 2024. To celebrate this landmark event, STH is republishing some archival material. This manuscript represents the second most highly cited paper ever published in STH. The manuscript published without an abstract, and essentially represented a State of the Art Review on the bleeding time, a relatively invasive procedure that required an incision on the skin or earlobe of a patient, and timing how long it took for the incision to stop bleeding. The bleeding time test was first described in 1901 by the French physician Milian, who presented three studies of bleeding from stab wounds made in the fingertips of healthy and diseased subjects. In 1910, Duke observed the duration of bleeding from small incisions of the ear lobe, and pointed out that the duration of bleeding was increased in instances of reduced platelet counts. The test was subsequently repeatedly modified, and numerous variants of the test, including semiautomated methods, were described by several workers. The most frequently utilised test reflected one described by Ivy and coworkers, who shifted the location of the incision to the volar aspect of the forearm and applied a blood pressure cuff to the arm to maintain a standard venous pressure. The bleeding time has been proposed for use as a diagnostic test for platelet-related bleeding disorders, a measure of efficacy in various forms of therapy, and as a prognosticator of abnormal bleeding. The authors to the current review reevaluated the bleeding time literature using methods to assess the performance of the test in 1990, locating 862 printed documents that discussed the bleeding time, the majority in peer-reviewed professional journals. As this is a republication of archival material, transformed into a modern format, we apologise in advance for any errors introduced during this transformation.

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“…12 [t may well be that those platelets which survive longer have the most inhibited function and, that on the other hand, platelets which survive for only a short time may, during this brief interval, be functionally effective. 11 The test of in vitro function which most closely correlates with platelet survival is probably the discoid shape of the platelets and their ability to regain this shape when incubated under more optimal conditions. 8 The spiny sphered platelets which form during storage at 4 QC survive for.…”

Section: Discussionmentioning

confidence: 99%

Platelet Function in Platelet Concentrates and in Whole Blood

Rodgers

Lloyd

Russell

1985

Anaesth Intensive Care

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Platelet function was studied in CPD whole blood stored at 4QC for one and three days and in platelet concentrates stored at room temperature for the same periods of time. Comparisons were made of platelet shape, nucleotide content, (3-thromboglobulin ((3TO) liberated during storage, and platelet aggregation in response to ADP, collagen, sodium arachidonate and ristocetin. It was found that in whole blood the shape of the platelets was less discoid than in platelet concentrates. However, platelet aggregation in response to ADP, collagen, and sodium arachidonate was preserved better in whole blood than in platelet concentrates. Platelet nucleotides were the same in whole blood as in platelet concentrates, but the plasma levels of (3 TO were less in whole blood. The results show that as judged by aggregation, (3 TO release and nucleotide content, platelets from whole blood were at least as functional as those from platelet concentrates. However, platelets from whole blood had lost their discoid shape, which suggests that they would have a short survival in the circulation.

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Correlations of Platelet Survival and Function with the Results of Two in vitro Tests

Cited by 11 publications

References 24 publications

A Critical Reappraisal of the Bleeding Time*

A Critical Reappraisal of the Bleeding Time*

A Critical Reappraisal of the Bleeding Time

Platelet Function in Platelet Concentrates and in Whole Blood

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