Platelet Function Analyser Approaching 50 Years: Strengths, Limits, and Clinical Role
The PFA-100/200 system remains highly sensitive for detecting von Willebrand disease and aspirin effect but has only moderate sensitivity for broader platelet function defects. As the PFA-200 gradually replaces the original model, recommendations for clinical use still vary by institution. This review summarises the instrument's history, performance characteristics, and evolving applications including pre-operative bleeding risk and thrombosis risk assessment.
The original study
Towards 50 years of platelet function analyser (PFA) testing.
- Authors
- Favaloro EJ, Pasalic L, Lippi G
- Journal
- Clinical chemistry and laboratory medicine
- Type
- Review, Journal Article
- PMID
- 35859143
Original abstract
The platelet function analyser (PFA) is a prevalent platelet function screening instrument, and comes in two models-the original PFA-100 and the contemporary PFA-200. The instruments have 'identical' output, being a 'closure time' (CT). Moreover, normal reference ranges provided by the manufacturer, for the specific test cartridges, are the same for both models. There are three different types of test cartridge: collagen/epinephrine (C/Epi), collagen/adenosine diphosphate (C/ADP), and "Innovance PFA P2Y" (only available in certain geographical locations). The PFA-100 was released in the mid 1990s, and so is approaching 50 years of age. The PFA-200, released in some locations in the mid 2010s, is destined to eventually replace the PFA-100, but is not yet available in the USA. The test system is highly sensitive to von Willebrand disease (VWD; C/Epi and C/ADP) and to aspirin therapy (C/Epi only), but only has moderate sensitivity to defects in platelet function and/or deficiencies in platelet number. Accordingly, recommendations for use for screening platelet function vary according to user experience. Some workers have alternatively used the PFA to assess thrombosis risk or pre-operative bleeding risk. In this review, we provide an overview of the history of PFA, and summarise its current clinical utility.