Differential Diagnosis
Acquired causes of platelet dysfunction:
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Ingestion of aspirin or aspirin-like compounds or NSAIDs
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Impaired renal function
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Myeloproliferative disease
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Exposure to cardiopulmonary bypass
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Presence of a paraprotein
Congenital causes of platelet dysfunction:
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Storage pool disease
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Glanzmann thrombasthenia
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Bernard-Soulier syndrome
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Disorders of thromboxane production or action
Suggested Additional Lab Testing
Platelet aggregation studies with characteristic response patterns for the different agonists help identify Glanzmann thrombasthenia, Bernard-Soulier disease, aspirin ingestion, and defects in thromboxane production or action.
Plasma or serum BUN and creatinine and urinalysis to assess renal function should be ordered.
If aspirin ingestion is suspected but denied by patient, measurement of salicylates (metabolites of aspirin) may prove useful.
Bone marrow biopsy may be useful if myeloproliferative disease is suspected.
Serum protein electrophoresis can reveal a paraprotein. To identify platelet granule storage pool disease, assays for the granular contents of platelets can be performed, but these are complex, costly, and rarely performed.
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