title: The use of regression analysis in determining reference intervals for low hematocrit and thrombocyte count in multiple electrode aggregometry and platelet function analyzer 100 testing of platelet function.
abstract: Low platelet counts and hematocrit levels hinder whole blood point-of-care testing of platelet function. Thus far, no reference ranges for MEA (multiple electrode aggregometry) and PFA-100 (platelet function analyzer 100) devices exist for low ranges. Through dilution methods of volunteer whole blood, platelet function at low ranges of platelet count and hematocrit levels was assessed on MEA for four agonists and for PFA-100 in two cartridges. Using (multiple) regression analysis, 95% reference intervals were computed for these low ranges. Low platelet counts affected MEA in a positive correlation (all agonists showed r2≥ 0.75) and PFA-100 in an inverse correlation (closure times were prolonged with lower platelet counts). Lowered hematocrit did not affect MEA testing, except for arachidonic acid activation (ASPI), which showed a weak positive correlation (r2= 0.14). Closure time on PFA-100 testing was inversely correlated with hematocrit for both cartridges. Regression analysis revealed different 95% reference intervals in comparison with originally established intervals for both MEA and PFA-100 in low platelet or hematocrit conditions. Multiple regression analysis of ASPI and both tests on the PFA-100 for combined low platelet and hematocrit conditions revealed that only PFA-100 testing should be adjusted for both thrombocytopenia and anemia. 95% reference intervals were calculated using multiple regression analysis. However, coefficients of determination of PFA-100 were poor, and some variance remained unexplained. Thus, in this pilot study using (multiple) regression analysis, we could establish reference intervals of platelet function in anemia and thrombocytopenia conditions on PFA-100 and in thrombocytopenia conditions on MEA.
authors.affiliation: a Department of Anaesthesiology and Pain Treatment , Maastricht University Medical Center (MUMC+) , Maastricht , The Netherlands.|b Laboratory for Clinical Thrombosis and Haemostasis, Department of Internal Medicine , Cardiovascular Research Institute Maastricht, Maastricht University Medical Center (MUMC+) , Maastricht , The Netherlands.
authors.forename: Gerhardus J A J M
authors.identifier: http://orcid.org/0000-0002-1729-4063
authors.initials: GJAJM
authors.lastname: Kuiper
authors.affiliation: b Laboratory for Clinical Thrombosis and Haemostasis, Department of Internal Medicine , Cardiovascular Research Institute Maastricht, Maastricht University Medical Center (MUMC+) , Maastricht , The Netherlands.|c Department of Neurology , Maastricht University Medical Center (MUMC+) , Maastricht , The Netherlands.
authors.forename: Rik
authors.initials: R
authors.lastname: Houben
authors.affiliation: d Central Diagnostic Laboratory, Cluster for Hemostasis and transfusion, Maastricht University Medical Center (MUMC+) , Maastricht , The Netherlands.
authors.forename: Rick J H
authors.initials: RJH
authors.lastname: Wetzels
authors.affiliation: d Central Diagnostic Laboratory, Cluster for Hemostasis and transfusion, Maastricht University Medical Center (MUMC+) , Maastricht , The Netherlands.
authors.forename: Paul W M
authors.identifier: http://orcid.org/0000-0002-5926-9384
authors.initials: PWM
authors.lastname: Verhezen
authors.affiliation: b Laboratory for Clinical Thrombosis and Haemostasis, Department of Internal Medicine , Cardiovascular Research Institute Maastricht, Maastricht University Medical Center (MUMC+) , Maastricht , The Netherlands.|d Central Diagnostic Laboratory, Cluster for Hemostasis and transfusion, Maastricht University Medical Center (MUMC+) , Maastricht , The Netherlands.
authors.forename: Rene van
authors.initials: RV
authors.lastname: Oerle
authors.affiliation: b Laboratory for Clinical Thrombosis and Haemostasis, Department of Internal Medicine , Cardiovascular Research Institute Maastricht, Maastricht University Medical Center (MUMC+) , Maastricht , The Netherlands.
authors.forename: Hugo
authors.identifier: http://orcid.org/0000-0001-7796-4463
authors.initials: H
authors.lastname: Ten Cate
authors.affiliation: d Central Diagnostic Laboratory, Cluster for Hemostasis and transfusion, Maastricht University Medical Center (MUMC+) , Maastricht , The Netherlands.
authors.forename: Yvonne M C
authors.initials: YMC
authors.lastname: Henskens
authors.affiliation: a Department of Anaesthesiology and Pain Treatment , Maastricht University Medical Center (MUMC+) , Maastricht , The Netherlands.
authors.forename: Marcus D
authors.identifier: http://orcid.org/0000-0001-8558-0531
authors.initials: MD
authors.lastname: Lancé
mesh_terms: D000244:Adenosine Diphosphate / Q000494:pharmacology; D000293:Adolescent; D000328:Adult; D000740:Anemia / Q000097:blood / Q000175:diagnosis* / Q000473:pathology; D016718:Arachidonic Acid / Q000494:pharmacology; D057205:Automation, Laboratory / Q000295:instrumentation / Q000592:standards*; D001792:Blood Platelets / Q000187:drug effects / Q000378:metabolism / Q000473:pathology*; D016022:Case-Control Studies; D003094:Collagen / Q000494:pharmacology; D005260:Female; D006400:Hematocrit; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D010974:Platelet Aggregation / Q000187:drug effects; D010979:Platelet Function Tests / Q000592:standards; D000067716:Point-of-Care Testing / Q000592:standards*; D018179:Receptors, Thrombin / Q000737:chemistry; D012016:Reference Values; D012044:Regression Analysis; D013921:Thrombocytopenia / Q000097:blood / Q000175:diagnosis* / Q000473:pathology
chemical_list: D018179:Receptors, Thrombin; D016718:Arachidonic Acid; D000244:Adenosine Diphosphate; D003094:Collagen
keywords: Platelet function; anemia; multiple electrode aggregometry; platelet function analyzer 100; thrombocytopenia