title: Venous stasis and whole blood platelet aggregometry: a question of data reliability and patient safety.
abstract: The assessment of platelet function by multiple electrode aggregometry (MEA) (Multiplate, Roche Diagnostics GmbH) is common in laboratory hematology. As regards the ISO 15189:2012 international standard, appropriate use of laboratory equipment requires appropriate pre-examination activities (e.g., blood collection). Venous stasis can influence several blood analytes, but the tourniquet time is rarely regarded as a source of variability. Aim of the present study was to evaluate the impact of venous stasis on platelet function by MEA. A total of 6 ml of blood was collected from 20 volunteers into two 3.0 ml Hirudin vacuum tube (Roche Diagnostics GmbH), and subjected to two procedures: procedure 1 (no stasis) - collection after localization of forearm vein by subcutaneous tissue transilluminator device without tourniquet; procedure 2 (stasis) - collection after localization of vein by prior 60 s tourniquet application. Samples were processed on Multiplate, for: ADP-test (without prostaglandin E1), ADP HS-test (with prostaglandin E1), ASPI-test, COL-test, RISTO H-test (high concentration, 0.77 mg/ml), RISTO L-test (low concentration, 0.20 mg/ml), and TRAP-test. The significance of the differences between samples was assessed by Wilcoxon ranked-pairs test. Surprisingly, the results of ADP HS-test, ASPI-test, COL-test, and RISTO H-test appeared unbiased by venous stasis. RISTO L-test, ADP-test, and TRAP-test were significantly biased; the mean percent difference between stasis and no stasis were -7.2% (P = 0.040), -28.4% (P = 0.015), and 1.1% (P = 0.031), respectively. In conclusion, the tourniquet should be avoided when assessing platelet function by MEA.
authors.affiliation: aLaboratory of Clinical Biochemistry, Department of Life and Reproduction Sciences, University of Verona, Verona, Italy bPost-Graduate Program of Pharmaceutical Sciences, Department of Medical Pathology Federal University of Parana, Curitiba, Parana cCAPES Foundation, Ministry of Education of Brazil, Brasília - DF, Brazil dPathology and Laboratory Medicine, Clinical Chemistry and Hematology Laboratory, Academic Hospital of Parma, Parma, Italy.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Lima-Oliveira
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Lippi
authors.forename: Gian Luca
authors.initials: GL
authors.lastname: Salvagno
authors.forename: Stefania
authors.initials: S
authors.lastname: Gaino
authors.forename: Giovanni
authors.initials: G
authors.lastname: Poli
authors.forename: Matteo
authors.initials: M
authors.lastname: Gelati
authors.forename: Geraldo
authors.initials: G
authors.lastname: Picheth
authors.forename: Gian Cesare
authors.initials: GC
authors.lastname: Guidi
mesh_terms: D000328:Adult; D001792:Blood Platelets / Q000378:metabolism*; D005260:Female; D006801:Humans; D008297:Male; D061214:Patient Safety; D018962:Phlebotomy / Q000379:methods*; D010974:Platelet Aggregation / Q000187:drug effects*; D054070:Postthrombotic Syndrome / Q000378:metabolism*