Platelet function assays in diagnosis: an update

INTRODUCTION: Hemorrhagic diseases associated with platelet dysfunction include inherited platelet function disorders (IPFD) and a large number of non-hereditary conditions, defined as acquired platelet function disorders (APFD). Their identification requires a careful clinical evaluation and a rational use of diagnostic laboratory assays. Areas covered: Here we describe the laboratory techniques currently available for the assessment of platelet function, including new and experimental laboratory assays, and their alterations in platelet function disorders. Although useful and very widely used in diagnostics, none of them replicates thoroughly the in vivo setting. Expert commentary: The goals of platelet function testing are to provide a rapid and precise diagnosis to every patient bleeding due to a platelet disorder, to assess the individual bleeding risk and potentially to monitor the efficacy of prohemostatic interventions. Most of the tests currently available do not fulfill these needs due to lack of standardization, complexity, and inability to reproduce the multiple reactions involved in the role of platelets in primary hemostasis. These goals can in perspective be achieved by a continuous effort to standardize, improve and expand platelet function assays, by the generation of standardized diagnostic algorithms and, for IPFD, by the implementation of next-generation sequencing-based methods in the diagnostic practice.