4% (VWD 17 9%; platelet function defect 23 2%; mild clotting fact

4% (VWD 17.9%; platelet function defect 23.2%; mild clotting factor deficiencies 3.9%); 11.5% had combined defects. However, 59.6% of these patients had abnormal bleeding of unknown pathogenesis. Prolonged bleeding time (BT) was found as an isolated laboratory abnormality in 18.6% of these patients. Neither differences in bleeding pattern, nor in the relationship between bleeding severity and any haemostatic measurement, Tanespimycin clinical trial were found [45]. A related study in patients with inherited MCB showed that light transmittance aggregometry was highly reproducible if properly standardized. Both normal and abnormal platelet

aggregation in 213 patients were reproducible in 93.3% and 90.4% of the cases respectively [46]; 13.7% of healthy controls had combined abnormalities of platelet aggregation with 10 μm epinephrine and 4 μm ADP. This combination, therefore, was not considered a useful criterion for diagnosing a platelet function disorder [46]. The finding that platelet function defects

were at least as prevalent as VWD, supports the recommendation that an initial laboratory workup should include AZD3965 supplier investigations for both diseases [45]. In a complementary study, the contradictory reports on the influence of gene polymorphisms on platelet function have been addressed. We analysed the genotype–phenotype relationship for six common polymorphisms [ITGB3 1565T>C (HPA-1), GP1BA variable number tandem repeat and 524C>T (HPA-2), ITGA2 807C>T, ADRA2A 1780A>G, and TUBB1 Q43P] in 286 controls and 160 patients with MCB of unknown cause. We found no effect of these polymorphisms on platelet aggregation, secretion, PFA-100® closure times, or thrombin generation in platelet rich plasma. Thus, they appear

to have no impact on platelet function assessed by these commonly employed assays Carbohydrate [47]. Other studies have also identified significant numbers of patients with inherited MCB and no discernible cause, but these observations and their relevance in clinical practice have not been adequately highlighted. Associations of low VWF, platelet function defects and mild clotting factor deficiencies were more frequent than predicted by chance: any combination of these defects occurred in 11.5% of the patients. Combined abnormalities could unmask or increase the bleeding tendency, similar to the multi-factorial risk for thrombosis. Furthermore, the analysis of the BT is also illustrative: 18.6% of patients with bleeding of unknown cause had prolonged BTs; this proportion increased to 39% and 41% in those with platelet function defects and VWD, respectively, and to 55.6% in those with combined abnormalities of VWF and platelet function. These results suggest that low plasma VWF levels, most platelet function defects, and mild to moderate clotting factor deficiencies should be considered risk factors rather than unequivocal bleeding causes.

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