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Acquired platelet dysfunction: causes, symptoms, diagnosis, treatment
Last reviewed: 23.04.2024
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Acquired platelet dysfunction may be the result of taking aspirin, other non-steroidal anti-inflammatory drugs, or systemic diseases. Acquired platelet dysfunction is a fairly typical phenomenon. The most common are aspirin. Other drugs can also induce platelet dysfunction. Numerous diseases (eg, myeloproliferative diseases, myelodysplastic syndrome, uremia, macroglobulinemia and multiple myeloma, cirrhosis, SLE) can damage the function of platelets. Acquired platelet dysfunction is suspected in the presence of isolated prolongation of bleeding time in cases where other possible diagnoses are excluded. The study of platelet aggregation is not necessary.
Aspirin and non-steroidal anti-inflammatory drugs prevent cyclooxygenase-mediated production of thromboxane A. The effect can last 5-7 days. Aspirin moderately prolongs the bleeding time in healthy people, but can significantly prolong it in patients with platelet dysfunction or severe secondary hemostasis (for example, in patients receiving heparin or having severe hemophilia). Platelets can acquire dysfunctional disorders, which will lead to an increase in bleeding time during blood circulation through the oxygen pump during cardiopulmonary bypass surgery. The mechanism of the disorder is the activation of fibrinolysis on the platelet membrane with the loss of the glycoprotein Ib-IX, which connects the points for von Willebrand factor. Despite the platelet level in the blood, patients with increased bleeding and prolonged bleeding time after cardiopulmonary bypass require transfusions of platelets. The appointment of aprotinin (a protease inhibitor neutralizing plasmin activity) during shunting can prevent the disruption of platelet function, prevent the prolongation of bleeding time and reduce the need for transfusions.
The mechanism of lengthening the bleeding time with uremia is unknown. In the presence of bleeding, it can be corrected by hemodialysis, the introduction of cryoprecipitate or desmopressin infusion. In the presence of anemia, transfusion of erythrocyte mass or erythropoietin can be performed, which also shortens the bleeding time.
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