Diagnostic assessment of platelet disorders: what are the challenges to standardization?

The platelet disorders are a group of heterogeneous, congenital and acquired bleeding disorders associated with impaired platelet function. There is a growing interest in standardizing the assessment of these disorders, but this is challenged by their heterogeneity, the absence of widely accepted diagnostic criteria, and inconsistency in laboratory testing practices for platelet disorders. Symptoms commonly associated with platelet disorders include rapid-onset bleeding with hemostatic challenges, peripartum bleeding, menorrhagia, epistaxis, gingival bleeding, and increased bruising. Attempts have been made to standardize the assessment of these symptoms, using clinical tools and bleeding scores. However, there are currently no standardized tools available with proven utility for the assessment of platelet disorders, apart from a tool specifically designed to assess Quebec platelet disorder. There have been several efforts to improve and standardize the laboratory assessment of platelet disorders. These efforts include guidelines from the International Society on Thrombosis and Haemostasis and the Clinical and Laboratory Standards Institute. Recent research indicates that the application of standardized laboratory tests for the assessment of platelet disorders in individuals referred for bleeding problems has valuable diagnostic utility. This has provided further incentive to standardize clinical and laboratory approaches to improve the diagnostic evaluation of platelet disorders worldwide.