What Is an Acquired Platelet Function Disorder?
Acquired platelet function disorder is a type of blood disorder that is inherited but acquired throughout a lifetime. The term acquired means that these conditions were not present at birth. Platelets play an important role in healing injuries and stopping bleeding. They are made in the bone marrow (a sponge center inside the bones) and help form a plug or clot that closes up the damaged site. Failure of the platelets to function as they should leads to platelet function disorder. Acquired platelet dysfunction is frequently encountered in clinical practice with clinical manifestations like mucosal bleeding, epistaxis (nosebleed), and superficial epidermal bleeding.
What Are the Causes of Acquired Platelet Function Disorder?
Platelet disorders can affect the number of platelets, their function, or both. There can be changes in how the body signals to platelets, or they may become less sticky. Some of the common causes of acquired platelet dysfunction include
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Medications - Long-term use of anti-inflammatory medications, like Aspirin, Ibuprofen can interfere with platelet function. These medications inhibit cyclooxygenase I (COX-1) conversion of arachidonic acid to thromboxane and inhibit platelet function by preventing the enhancement and propagation of agonist-induced platelet signaling. Beta-lactam antibiotics (including Penicillin) and cephalosporins can inhibit platelet function and aggregation. Nitrates, calcium-channel blockers, and selective serotonin reuptake inhibitors (SSRIs) prevent platelet aggregation and affect platelet function.
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Diseases - Systemic disorders, like idiopathic thrombocytopenic purpura (a bleeding disorder where the immune system attacks platelets), chronic myelogenous leukemia (cancer that starts inside the bone marrow), primary myelofibrosis (a disorder where marrow is replaced by fibrous scar tissue), multiple myeloma (a blood cancer in the plasma cells involving the bone marrow), and polycythemia vera (abnormal increase in the number of blood cells, primarily red blood cells) impair platelet function. Blood disorders, like thrombotic thrombocytopenic purpura (blood clots in small blood vessels) and primary thrombocythemia (bone marrow disorder that causes the production of too many platelets), can lead to problems in platelet function. Other causes may include renal failure.
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Foods or Supplements - Herbal supplements, foods, and alcohol can inhibit platelet function. Several reports of bleeding have been seen in individuals taking Ginkgo biloba. Ginkgo is likely to exert an antiplatelet effect and increase symptoms in patients with underlying platelet function disorders or on antiplatelet therapy. Other foods that may exhibit platelet inhibitory activity are garlic, ginger, American ginseng, turmeric, willow, and black tree fungus. The use of alcohol is associated with decreased platelet function.
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Procedures - Platelet dysfunction may accompany cardiac valvular disease, cardiopulmonary bypass, and extracorporeal membrane oxygenation.
What Are the Symptoms Seen in Acquired Platelet Function Disorder?
The symptoms may include the following
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Abnormal vaginal bleeding.
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Bleeding under the skin.
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Heavy menstrual bleeding for a prolonged time.
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Nosebleeds.
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Easy bruising.
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Small red bumps on the skin (petechia).
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Blood in the urine.
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Gastrointestinal bleeding may result in dark black, bloody stools or blood in the vomit.
Acquired platelet function disorder can be dangerous if not diagnosed within the correct time. It can cause complications, such as bleeding that does not stop easily and anemia (due to excessive blood loss).
How to Diagnose Patients With Suspected Platelet Dysfunction?
An approach to diagnosing patients with suspected platelet function disorder may include
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History - The doctor may ask about bleeding problems and medications one may take. The doctor may also ask about other medical conditions that may cause platelet dysfunction, any bleeding episodes, such as easy bruising, prolonged bleeding from cuts or injuries, heavy menstrual bleeding, nosebleeds, or bleeding after dental procedures or surgery.
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Physical Examination - After a brief history, the doctor might perform a physical examination to check for bleeding spots on the skin. The doctor will include a detailed assessment of the skin mucous membranes.
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Blood Tests - A basic laboratory evaluation should include a complete blood count, a review of a peripheral blood smear, prothrombin time (to test blood clotting), aPTT (to measure all clotting factors of the clotting cascade), and renal and thyroid functions. The bleeding time test will show the duration it takes for the bleeding to stop after an injury. In addition, platelet aggregation studies can be done to check the stickiness (adhesion) of the platelets.
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Specialized Tests: In some cases, additional specialized tests may be necessary to diagnose platelet dysfunction, such as flow cytometry or genetic testing.
How Is Acquired Platelet Function Disorder Treated?
There are several treatments for acquired platelet function disorder. The doctor’s choice of treatment may depend on how quickly the bleeding must be stopped, the condition that caused the problem, or to reduce the risk of bleeding during surgery.
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Medication - The doctor may prescribe a clotting factor to make the blood clot. Desmopressin (DDAVP) is often used to help the blood clot by elevating the plasma concentration of von Willebrand factor, factor VIII, and plasminogen activator. The doctor may give an infusion of donated platelets to enhance clotting. The use of cryoprecipitate (that supplies factor VII) can be used to correct bleeding and may shorten the bleeding time.
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Underlying Conditions - It is important to diagnose and treat underlying illnesses that may cause clotting problems. Chemotherapy might be utilized for treating an underlying condition. For example, platelet function caused by kidney failure can be treated with dialysis.
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Surgery - It is recommended to boost natural clotting factors and platelets with medication before, during, and after surgery. Medications that can increase the bleeding risk must be avoided before and after the surgery.
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Lifestyle Changes - Consumption of alcohol and tobacco products can damage bone marrow and cause it to make fewer platelets than normal. Adopting healthy lifestyles and avoiding these habits can reduce the risk of a low platelet count.
Conclusion:
Platelet function disorders are caused by congenital or acquired disorders that may lead to bleeding. Acquired bleeding disorders are not present at birth and can occur because of platelet deficiency or dysfunction, deficiency of coagulation factors, or vascular structural abnormalities.
Acquired platelet function disorders can be prevented by using medicines as directed by the doctor. Treatment of underlying conditions that increase the risk of bleeding should be diagnosed and treated as soon as possible.
