You are on page 1of 17

11/8/2016

PlateletWikipedia

Platelet
FromWikipedia,thefreeencyclopedia

Platelets,alsocalledthrombocytes(thromb+cyte,"bloodclotcell"),areacomponentofbloodwhose
function(alongwiththecoagulationfactors)istostopbleedingbyclumpingandclottingbloodvessel
injuries.[1]Plateletshavenocellnucleus:theyarefragmentsofcytoplasmthatarederivedfromthe
megakaryocytes[2]ofthebonemarrow,andthenenterthecirculation.Theseunactivatedplateletsarebiconvex
discoid(lensshaped)structures,[3][4]23mingreatestdiameter.[5]Plateletsarefoundonlyinmammals,
whereasinotheranimals(e.g.birds,amphibians)thrombocytescirculateasintactmononuclearcells.[6]

Platelets

Onastainedbloodsmear,plateletsappearasdarkpurplespots,about20%thediameterofredbloodcells.The
smearisusedtoexamineplateletsforsize,shape,qualitativenumber,andclumping.Theratioofplateletstored
bloodcellsinahealthyadultis1:10to1:20.
Themainfunctionofplateletsistocontributetohemostasis:theprocessofstoppingbleedingatthesiteof
interruptedendothelium.Theygatheratthesiteandunlesstheinterruptionisphysicallytoolarge,theyplugthe
hole.First,plateletsattachtosubstancesoutsidetheinterruptedendothelium:adhesion.Second,theychange
shape,turnonreceptorsandsecretechemicalmessengers:activation.Third,theyconnecttoeachotherthrough
receptorbridges:aggregation.[7]Formationofthisplateletplug(primaryhemostasis)isassociatedwith
activationofthecoagulationcascadewithresultantfibrindepositionandlinking(secondaryhemostasis).These
processesmayoverlap:thespectrumisfromapredominantlyplateletplug,or"whiteclot"toapredominantly
fibrinclot,or"redclot"orthemoretypicalmixture.Thefinalresultistheclot.Somewouldaddthesubsequent
clotretractionandplateletinhibitionasfourthandfifthstepstothecompletionoftheprocess[8]andstillothers
asixthstepwoundrepair.

Imagefromalightmicroscope(500)froma
Giemsastainedperipheralbloodsmearshowing
platelets(bluedots)surroundedbyredbloodcells
(pinkandcircular)
Anatomicalterminology
[editonWikidata]

Lowplateletconcentrationisthrombocytopeniaandisduetoeitherdecreasedproductionorincreaseddestruction.Elevatedplateletconcentrationis
thrombocytosisandiseithercongenital,reactive(tocytokines),orduetounregulatedproduction:oneofthemyeloproliferativeneoplasmsorcertainother
myeloidneoplasms.Adisorderofplateletfunctionisathrombocytopathy.
Normalplateletscanrespondtoanabnormalityonthevesselwallratherthantohemorrhage,resultingininappropriateplateletadhesion/activationand
thrombosis:theformationofaclotwithinanintactvessel.Thesearisebydifferentmechanismsthananormalclot.Examplesare:extendingthefibrinclotof
venousthrombosisextendinganunstableorrupturedarterialplaque,causingarterialthrombosisandmicrocirculatorythrombosis.Anarterialthrombusmay
partiallyobstructbloodflow,causingdownstreamischemiaorcompletelyobstructit,causingdownstreamtissuedeath.

Contents

https://en.wikipedia.org/wiki/Platelet

1/17

11/8/2016

PlateletWikipedia

Contents
1
2
3
4
5
6
7
8

Discovery,earlyobservations,andnaming
Measurement
Structure
Symptomsofplateletdisorders
Kinetics
Dynamics
Adhesion
Activation
8.1 Inhibition
8.2 Trigger(Induction)
8.3 Components(Consequences)
8.3.1 GPIIb/IIIaactivation
8.3.2 Granulesecretion
8.3.3 Morphologychange
8.3.4 Coagulationfacilitation
9 Aggregation
10 Woundrepair
11 Plateletcoagulationfactorinteractions
12 Roleinnonhematologicdiseases
12.1 Inflammation
13 Clotformationinnonmammalianvertebrates
14 Testsofplateletfunction
14.1 Bleedingtime
14.2 Multiplatemultipleelectrodeaggregometry
14.3 PFA100
15 Plateletdisorders
15.1 Thrombocytopenia
15.2 Alteredplateletfunction
15.3 Thrombocytosisandthrombocythemia
16 Drugsaffectingplatelets
16.1 Antiinflammatorydrugs
16.2 Drugsthatsuppressplateletfunction
16.2.1 Oralagents
16.3 Drugsthatstimulateplateletproduction
16.3.1 Intravenousagents
17 Therapywithplatelets
17.1 Transfusion
17.1.1 Indications
https://en.wikipedia.org/wiki/Platelet

Theligands,denotedbyletterL,
signalforplatelets(P)tomigrate
towardsthewound(SiteA).Asmore
plateletsgatheraroundtheopening,
theyproducemoreligandstoamplify
theresponse.Theplateletscongregate
aroundthewoundinordertocreatea
captostopbloodflowoutofthe
tissue.

2/17

11/8/2016

PlateletWikipedia

17.1.1 Indications
17.1.2 Collection
17.1.3 Storage
17.1.4 Deliverytorecipients
17.2 Woundtherapy
18 References
19 Furtherreading
20 Externallinks

Discovery,earlyobservations,andnaming
GeorgeGulliverin1841drewpicturesofplatelets[9]usingthetwinlens(compound)microscopeinventedin1830byJosephJacksonLister.[10]Thismicroscope
improvedresolutionsufficientlytomakeitpossibletoseeplateletsforthefirsttime.WilliamAddisonin1842drewpicturesofaplateletfibrinclot.[11]Lionel
Bealein1864wasthefirsttopublishadrawingshowingplatelets.[12]MaxSchultzein1865describedwhathecalled"spherules",whichhenotedweremuch
smallerthanredbloodcells,occasionallyclumped,andweresometimesfoundincollectionsoffibrinmaterial.[13]Queen'sCollege,Birmingham(apredecessor
collegeofBirminghamUniversity)physicianDrRichardHillNorriswasthefirsttodescribetheactionofplateletsin1880.[14]GiulioBizzozeroin1882studied
thebloodofamphibiansmicroscopicallyinvivo.HenamedSchultz'sspherules(It.)piastrine:littleplates.[15][16]WilliamOslerobservedthemand,inpublished
lecturesin1886,calledthemathirdcorpuscleandabloodplaqueanddescribedthemasacolorlessprotoplasmicdisc.[17]JamesWrightexaminedbloodsmears
usingthestainnamedforhim,andusedthetermplatesinhis1906publication[18]butchangedtoplateletsinhis1910publication[19]whichhasbecomethe
universallyacceptedterm.
Thetermthrombocyte(clotcell)cameintouseintheearly1900sandissometimesusedasasynonymforplateletbutnotgenerallyinthescientificliterature,
exceptasarootwordforothertermsrelatedtoplatelets(e.g.thrombocytopeniameaninglowplatelets).[6]Thrombocytesarecellsfoundinthebloodofnon
mammalianvertebrates.Theyarethefunctionalequivalentsofplatelets,butcirculateasintactmononuclearcells,andarenotsimplycytoplasmicfragmentsof
bonemarrowmegakaryocytes.[6]
Insomecontexts,thewordthrombusisusedinterchangeablywiththewordclot,regardlessofitscomposition(white,red,ormixed).Inothercontextsitisusedto
contrastanormalfromanabnormalclot:thrombusarisesfromphysiologichemostasis,thrombosisarisesfromapathologicandexcessivequantityofclot.[20]Ina
thirdcontextitisusedtocontrasttheresultfromtheprocess:thrombusistheresult,thrombosisistheprocess.

Measurement

https://en.wikipedia.org/wiki/Platelet

3/17

11/8/2016

PlateletWikipedia

Plateletconcentrationismeasuredeithermanuallyusingahemocytometer,orbyplacingbloodinanautomatedplateletanalyzerusingelectricalimpedance,such
asaCoultercounter.[21]Thenormalrange(99%ofpopulationanalyzed)forplateletsinhealthyCaucasiansis150,000to450,000percubicmillimeter[22](amm3
equalsamicroliter).or150400109perlitre.Thenormalrangehasbeenconfirmedtobethesameintheelderly[23]andSpanishpopulations.[24]

Structure
Structurallytheplateletcanbedividedintofourzones,fromperipheraltoinnermost:
Peripheralzoneisrichinglycoproteinsrequiredforplateletadhesion,activation,andaggregation.Forexample,GPIb/IX/XGPVIGPIIb/IIIa.
Solgelzoneisrichinmicrotubulesandmicrofilaments,allowingtheplateletstomaintaintheirdiscoidshape.
Organellezoneisrichinplateletgranules.AlphagranulescontainclottingmediatorssuchasfactorV,factorVIII,fibrinogen,fibronectin,plateletderived
growthfactor,andchemotacticagents.Deltagranules,ordensebodies,containADP,calcium,serotonin,whichareplateletactivatingmediators.
Membranouszonecontainsmembranesderivedfrommegakaryocyticsmoothendoplasmicreticulumorganizedintoadensetubularsystemwhichis
responsibleforthromboxaneA2synthesis.ThisdensetubularsystemisconnectedtothesurfaceplateletmembranetoaidthromboxaneA2release.

Symptomsofplateletdisorders
Spontaneousandexcessivebleedingcanoccurbecauseofplateletdisorders.Thisbleedingcanbecausedbydeficientnumbersofplatelets,dysfunctionalplatelets,
orveryexcessivenumbersofplatelets:over1.0million/microliter.(TheexcessivenumberscreatearelativevonWillibrandfactordeficiencydueto
sequestration.)[25][26]
Onecangetaclueastowhetherbleedingisduetoaplateletdisorderoracoagulationfactordisorderbythecharacteristicsandlocationofthebleeding.[27]Allof
thefollowingsuggestplateletbleeding,notcoagulationbleeding:thebleedingfromaskincutsuchasarazornickispromptandexcessive,butcanbecontrolled
bypressurespontaneousbleedingintotheskinwhichcausesapurplishstainnamedbyitssize:petechiae,purpura,ecchymosesbleedingintomucousmembranes
causingbleedinggums,nosebleed,andgastrointestinalbleedingmenorrhagiaandintraretinalandintracranialbleeding.
Excessivenumbersofplatelets,and/ornormalplateletsrespondingtoabnormalvesselwalls,canresultinvenousthrombosisandarterialthrombosis.The
symptomsdependonthesiteofthrombosis.

Kinetics
Megakaryocyteandplateletproductionisregulatedbythrombopoietin,ahormoneproducedinthekidneysandliver.
Eachmegakaryocyteproducesbetween1,000and3,000plateletsduringitslifetime.
Anaverageof1011plateletsareproduceddailyinahealthyadult.
Reserveplateletsarestoredinthespleen,andarereleasedwhenneededbyspleniccontractioninducedbythesympatheticnervoussystem.
https://en.wikipedia.org/wiki/Platelet

4/17

11/8/2016

PlateletWikipedia

Theaveragelifespanofcirculatingplateletsis8to9days.[28]Lifespanofindividualplateletsiscontrolledbythe
internalapoptoticregulatingpathway,whichhasaBclxLtimer.[29]
Oldplateletsaredestroyedbyphagocytosisinthespleenandliver.

Dynamics
Anoverviewsummarizingplateletdynamics,thecomplexprocessofconvertinginactiveplateletsintoaplateletplug,is
essentialEL2.Complicatinganyverbaldescriptionisthefactthatatleast193proteinsand301interactionsareinvolvedin
plateletdynamics.Theseparationofplateletdynamicsintothreestagesisusefulinthisregard,butitisartificial:infact,
eachstageisinitiatedinrapidsuccession,andeachcontinuesuntilthetriggerforthatstageisnolongerpresent,sothereis
overlap.[7]

Plateletsderivefromtotipotent
marrowstemcells

Adhesion
Thrombusformationonanintactendotheliumispreventedbynitricoxide,[30]prostacyclin,[31]andCD39.[32]
EndothelialcellsareattachedtothesubendothelialcollagenbyvonWillebrandfactor(VWF)whichthesecellsproduce.
VWFisalsostoredintheWeibelPaladebodiesoftheendothelialcellsandsecretedconstitutivelyintotheblood.Platelets
storevWFintheiralphagranules.
Whentheendotheliallayerisdisrupted,collagenandVWFanchorplateletstothesubendothelium.PlateletGP1bIXV
receptorbindswithVWFandGPVIreceptorandintegrinalpha2beta1bindwithcollagen.[33]

Activation
Anoverviewofplateletactivationisausefulintroductiontothismultifacetedprocess.[EL3]

Inhibition
Theintactendotheliallininginhibitsplateletactivationbyproducingnitricoxide,endothelialADPase,andPGI2.

Plateletsextrudedfrom
megakaryocytes

EndothelialADPasedegradestheplateletactivatorADP.

https://en.wikipedia.org/wiki/Platelet

5/17

11/8/2016

PlateletWikipedia

RestingplateletsmaintainactivecalciumeffluxviaacyclicAMPactivatedcalciumpump.Intracellularcalcium
concentrationdeterminesplateletactivationstatus,asitisthesecondmessengerthatdrivesplateletconformationalchange
anddegranulation(seebelow).Endothelialprostacyclinbindstoprostanoidreceptorsonthesurfaceofrestingplatelets.
ThiseventstimulatesthecoupledGsproteintoincreaseadenylatecyclaseactivityandincreasestheproductionofcAMP,
furtherpromotingtheeffluxofcalciumandreducingintracellularcalciumavailabilityforplateletactivation.
ADPontheotherhandbindstopurinergicreceptorsonplateletsurface.SincethethrombocyticpurinergicreceptorP2Y12
iscoupledtoGiproteins,ADPreducesplateletadenylatecyclaseactivityandcAMPproduction,leadingtoaccumulation
ofcalciuminsidetheplateletbyinactivatingthecAMPcalciumeffluxpump.TheotherADPreceptorP2Y1couplestoGq
thatactivatesphospholipaseCbeta2PLCB2,resultingininositol1,4,5trisphosphate(IP3)generationandintracellular
releaseofmorecalcium.Thistogetherinducesplateletactivation.EndothelialADPasedegradesADPandpreventsthis
fromhappening.ClopidogrelandrelatedantiplateletmedicationsalsoworkaspurinergicreceptorP2Y12antagonists.

Trigger(Induction)

3DRenderingofPlatelets

Plateletactivationbeginssecondsafteradhesionoccurs.Itistriggeredwhencollagenfromthesubendotheliumbindswith
itsreceptorsontheplatelet.GPVIisassociatedwiththeFcReceptorgammachainandleadsviatheactivationofatyrosine
kinasecascadefinallytotheactivationofPLCgamma2PLCG2andmorecalciumrelease.
TissuefactoralsobindstofactorVIIintheblood,whichinitiatestheextrinsiccoagulationcascadetoincreasethrombin
production.Thrombinisapotentplateletactivator,actingthroughGqandG12.TheseareGproteincoupledreceptorsand
theyturnoncalciummediatedsignalingpathwayswithintheplatelet,overcomingthebaselinecalciumefflux.Familiesof
threeGproteins(Gq,Gi,G12)operatetogetherforfullactivation.Thrombinalsopromotessecondaryfibrinreinforcement
oftheplateletplug.PlateletactivationinturndegranulatesandreleasesfactorVandfibrinogen,potentiatingthe
coagulationcascade.Soinrealitytheprocessofplateletpluggingandcoagulationareoccurringsimultaneouslyratherthan
sequentially,witheachinducingtheothertoformthefinalclot.

Components(Consequences)

Scanningelectronmicrographof
bloodcells.Fromlefttoright:human
erythrocyte,activatedplatelet,
leukocyte.

GPIIb/IIIaactivation
CollagenmediatedGPVIsignallingincreasestheplateletproductionofthromboxaneA2(TXA2)anddecreasestheproductionofprostacyclin.Thisoccursby
alteringthemetabolicfluxofplatelet'seicosanoidsynthesispathway,whichinvolvesenzymesphospholipaseA2,cyclooxygenase1,andthromboxaneA
synthase.PlateletssecretethromboxaneA2,whichactsontheplatelet'sownthromboxanereceptorsontheplateletsurface(hencethesocalled"outin"
mechanism),andthoseofotherplatelets.Thesereceptorstriggerintraplateletsignaling,whichconvertsGPIIb/IIIareceptorstotheiractiveformtoinitiate
aggregation.[7]
https://en.wikipedia.org/wiki/Platelet

6/17

11/8/2016

PlateletWikipedia

Granulesecretion
Plateletscontaindensegranules,lambdagranulesandalphagranules.Activatedplateletssecretethecontentsofthese
granulesthroughtheircanalicularsystemstotheexterior.Simplistically,boundandactivatedplateletsdegranulateto
releaseplateletchemotacticagentstoattractmoreplateletstothesiteofendothelialinjury.Granulecharacteristics:
granules(alphagranules)containingPselectin,plateletfactor4,transforminggrowthfactor1,plateletderived
growthfactor,fibronectin,Bthromboglobulin,vWF,fibrinogen,andcoagulationfactorsVandXIII).
granules(deltaordensegranules)containingADPorATP,calcium,andserotonin).
granules(gammagranules)similartolysosomesandcontainseveralhydrolyticenzymes.
granules(lambdagranules)contentsinvolvedinclotresorptionduringlaterstagesofvesselrepair.
Morphologychange

Diagramofthestructureofaplatelet
showingthegranules

Mitochondriahyperpolarizationisakeyeventininitiatingchangesinmorphology.[34]Intraplateletcalciumconcentration
increases,stimulatingtheinterplaybetweenmicrotubule/actinfilamentcomplex.Thecontinuouschangesinshapefromtheunactivatedtothefullyactivated
plateletisbestseenonscanningelectronmicroscopy.[EL4]Threestepsalongthispatharenamedearlydendritic,earlyspreadandspread.Thesurfaceofthe
unactivatedplateletlooksverysimilartothesurfaceofthebrain,withawrinkledappearancefromnumerousshallowfoldstoincreasethesurfaceareaearly
dendritic,anoctopuswithmultiplearmsandlegsearlyspread,anuncookedfryingegginapan,the"yolk"beingthecentralbodyandthespread,acookedfried
eggwithadensercentralbody.Thesechangesareallbroughtaboutbytheinteractionofthemicrotubule/actincomplexwiththeplateletcellmembraneandopen
canalicularsystem(OCS),whichisanextensionandinvaginationofthatmembrane.Thiscomplexrunsjustbeneaththesemembranes,andisthechemicalmotor
whichliterallypullstheinvaginatedOCSoutoftheinterioroftheplateletliketurningpantspocketsinsideout,creatingthedendrites.[EL7]andthenspreadseach
dendriteuntiltheentireOCSbecomesindistinguishablefromtheinitialplateletmembraneasitformsthe"friedegg".Thisdramaticincreaseinsurfaceareacomes
aboutwithneitherstretchingnoraddingphospholipidstotheplateletmembrane.[35]
Coagulationfacilitation
Plateletactivationcausesitsmembranesurfacetobecomenegativelycharged.Oneofthesignalingpathwaysturnsonscramblase,whichmovesnegatively
chargedphospholipidsfromtheinnertotheouterplateletmembranesurface.Thesephospholipidsthenbindthetenaseandprothrombinasecomplexes,twoofthe
sitesofinterplaybetweenplateletsandthecoagulationcascade.Calciumionsareessentialforthebindingofthesecoagulationfactors.

Aggregation

https://en.wikipedia.org/wiki/Platelet

7/17

11/8/2016

PlateletWikipedia

Aggregationbeginsminutesafteractivation,andoccursasaresultofturningontheGPIIb/IIIareceptor,whichallowsthese
receptorstobindwithvWForfibrinogen.[7]Thereare50100ofthesereceptorsperplatelet.[36]Whenanyoneormoreof
atleastninedifferentplateletsurfacereceptorsareturnedonduringactivation,intraplateletsignalingpathwayscause
existingGpIIb/IIIareceptorstochangeshapecurledtostraightandthusbecomecapableofbinding.[7]
SincefibrinogenisarodlikeproteinwithnodulesoneitherendcapableofbindingGPIIb/IIIa,activatedplateletswith
exposedGPIIb/IIIacanbindfibrinogentoaggregatetogether.GPIIb/IIIacanalsofurtheranchortheplateletsto
subendothelialvWFforadditionalclotstructuralstabilisation.
Classicallyitwasthoughtthatthiswastheonlymechanisminvolvedinaggregation,butthreenewmechanismshavebeen
identifiedwhichcaninitiateaggregation,dependingonthevelocityofbloodflow(i.e.shearrange).[37]

Plateletclumpsinabloodsmear

Woundrepair
Thebloodclotisonlyatemporarysolutiontostopbleedingtissuerepairisneeded.Smallinterruptionsintheendotheliumarehandledbyphysiological
mechanismslargeinterruptionsbythetraumasurgeon.[38]Thefibrinisslowlydissolvedbythefibrinolyticenzyme,plasmin,andtheplateletsareclearedby
phagocytosis.[39]

Plateletcoagulationfactorinteractions
InadditiontointeractingwithvWFandfibrin,plateletsinteractwiththrombin,FactorsX,Va,VIIa,XI,IX,andprothrombintocompleteclotformationviathe
coagulationcascade.[40][41]Sixstudiessuggestedplateletsexpresstissuefactor:thedefinitivestudyshowstheydonot.[40]

Roleinnonhematologicdiseases
Inflammation
Inadditiontobeingthecellulareffectorofhemostasis,plateletsarerapidlydeployedtositesofinjuryorinfection,andpotentiallymodulateinflammatory
processesbyinteractingwithleukocytesandbysecretingcytokines,chemokines,andotherinflammatorymediators.[42][43][44][45]Plateletsalsosecreteplatelet
derivedgrowthfactor(PDGF).

Clotformationinnonmammalianvertebrates
https://en.wikipedia.org/wiki/Platelet

8/17

11/8/2016

PlateletWikipedia

Insteadofhavingplatelets,nonmammalianvertebrateshavethrombocytes,whichhaveanucleusandresembleBlymphocytesinmorphology.Theyaggregatein
responsetothrombin,butnottoADP,serotonin,noradrenaline,asplateletsdo.[46][47]

Testsofplateletfunction
Bleedingtime
DevelopedbyDukein1910andbearinghisname,itmeasuredthetimeforbleedingtostopfromastandardizedwoundintheearlobewhichisblottedeach30
seconds.Normalwaslessthan3minutes.[48]Moremoderntechniquesarenowused.Anormalbleedingtimereflectssufficientplateletnumbersandfunctionplus
normalmicrovasculature.

Multiplatemultipleelectrodeaggregometry
IntheMultiplateanalyzer,anticoagulatedwholebloodismixedwithsalineandaplateletagonistinasingleusecuvettewithtwopairsofelectrodes.Theincrease
inimpedancebetweentheelectrodesasplateletsaggregateontothem,ismeasuredandvisualizedasacurve.

PFA100
ThePFA100isasystemforanalysingplateletfunctioninwhichcitratedwholebloodisaspiratedthroughadisposablecartridgecontaininganaperturewithina
membranecoatedwitheithercollagenandepinephrineorcollagenandADP.Theseagonistsinduceplateletadhesion,activationandaggregationleadingtorapid
occlusionoftheapertureandcessationofbloodflowtermedtheclosuretime(CT).AnelevatedCTwithEPIandcollagencanindicateintrinsicdefectssuchas
vonWillebranddisease,uremia,orcirculatingplateletinhibitors.ThefollowuptestinvolvingcollagenandADPisusedtoindicateiftheabnormalCTwith
collagenandEPIwascausedbytheeffectsofacetylsulfosalicylicacid(aspirin)ormedicationscontaininginhibitors.

Plateletdisorders
Adaptedfrom[49]
Thethreebroadcategoriesofplateletdisordersare"notenough""dysfunctional"and"toomany".[49]

Thrombocytopenia
Immunethrombocytopenias(ITP)formerlyknownasimmunethrombocytopeniapurpuraandidiopathicthrombocytopenicpurpura
Splenomegaly
Gaucher'sdisease
https://en.wikipedia.org/wiki/Platelet

9/17

11/8/2016

PlateletWikipedia

Familialthrombocytopenia[50]
Chemotherapy
Babesiosis
Dengue
Onyalai
Thromboticthrombocytopenicpurpura
HELLPsyndrome
Hemolyticuremicsyndrome
Druginducedthrombocytopenicpurpura(fiveknowndrugsmostproblematicisheparininducedthrombocytopenia(HIT)
Pregnancyassociated
Neonatalalloimmuneassociated
Aplasticanemia
Transfusionassociated
Pseudothrombocytopenia
idiopathicthrombocytopenicpurpura
Gilbert'sSyndrome[51]

Alteredplateletfunction
Congenital
Disordersofadhesion
BernardSouliersyndrome
Disordersofactivation
Disordersofgranuleamountorrelease
HermanskyPudlakSyndrome
Grayplateletsyndrome
ADPReceptordefect
Decreasedcyclooxygenaseactivity
Storagepooldefects,acquiredorcongenital
Disordersofaggregation
Glanzmann'sthrombasthenia
WiskottAldrichsyndrome
Acquired
Disordersofadhesion
Paroxysmalnocturnalhemoglobinuria
Asthma[52]
Samter'striad(aspirinexacerbatedrespiratorydisease/AERD)[53]
Cancer[54]
https://en.wikipedia.org/wiki/Platelet

10/17

11/8/2016

PlateletWikipedia

Malaria[55]
Decreasedcyclooxygenaseactivity

Thrombocytosisandthrombocythemia
Reactive
Chronicinfection
Chronicinflammation
Malignancy
Hyposplenism(postsplenectomy)
Irondeficiency
Acutebloodloss
Myeloproliferativeneoplasmsplateletsarebothelevatedandactivated
Essentialthrombocytosis
Polycythemiavera
Associatedwithothermyeloidneoplasms
Congenital

Drugsaffectingplatelets
Antiinflammatorydrugs
Somedrugsusedtotreatinflammationhavetheunwantedsideeffectofsuppressingnormalplateletfunction.Thesearethenonsteroidalantiinflammatorydrugs
(NSAIDS).Aspirinirreversiblydisruptsplateletfunctionbyinhibitingcyclooxygenase1(COX1),andhencenormalhemostasis.Theresultingplateletsareunable
toproducenewcyclooxygenasebecausetheyhavenoDNA.Normalplateletfunctionwillnotreturnuntiltheuseofaspirinhasceasedandenoughoftheaffected
plateletshavebeenreplacedbynewones,whichcantakeoveraweek.Ibuprofen,anotherNSAID,doesnothavesuchalongdurationeffect,withplateletfunction
usuallyreturningwithin24hours,[56]andtakingibuprofenbeforeaspirinpreventstheirreversibleeffectsofaspirin.[57]

Drugsthatsuppressplateletfunction
Thesedrugsareusedtopreventthrombusformation.
Oralagents
aspirin
clopidogrel
cilostazol
https://en.wikipedia.org/wiki/Platelet

11/17

11/8/2016

PlateletWikipedia

ticlopidine
ticagrelor
prasugrel

Drugsthatstimulateplateletproduction
thrombopoietinmimetics
desmopressin
factorVIIa
Intravenousagents
abciximab,
eptifibatide
tirofiban
Othersoprelvekin,romiplostim,eltrombopag,argatroban

Therapywithplatelets
Transfusion
Indications
Platelettransfusionismostfrequentlyusedtocorrectunusuallylowplateletcounts,eithertopreventspontaneousbleeding(typicallyatcountsbelow(10109/L)
orinanticipationofmedicalproceduresthatwillnecessarilyinvolvesomebleeding.Forexample,inpatientsundergoingsurgery,alevelbelow50109/Lis
associatedwithabnormalsurgicalbleeding,andregionalanaestheticproceduressuchasepiduralsareavoidedforlevelsbelow80109/L.[58]Plateletsmayalsobe
transfusedwhentheplateletcountisnormalbuttheplateletsaredysfunctional,suchaswhenanindividualistakingaspirinorclopidogrel.[59]Finally,platelets
maybetransfusedaspartofamassivetransfusionprotocol,inwhichthethreemajorbloodcomponents(redbloodcells,plasma,andplatelets)aretransfusedto
addressseverehemorrhage.Platelettransfusioniscontraindicatedinthromboticthrombocytopenicpurpura(TTP),asitfuelsthecoagulopathy.
Collection
Plateletsareeitherisolatedfromcollectedunitsofwholebloodandpooledtomakeatherapeuticdose,orcollectedbyplateletapheresis:bloodistakenfromthe
donor,passedthroughadevicewhichremovestheplatelets,andtheremainderisreturnedtothedonorinaclosedloop.Theindustrystandardisforplateletstobe
testedforbacteriabeforetransfusiontoavoidsepticreactions,whichcanbefatal.RecentlytheAABBIndustryStandardsforBloodBanksandTransfusion
https://en.wikipedia.org/wiki/Platelet

12/17

11/8/2016

PlateletWikipedia

Services(5.1.5.1)hasallowedforuseofpathogenreductiontechnologyasanalternativetobacterialscreeningsin
platelets.[60]
Pooledwholebloodplatelets,sometimescalledrandomplatelets,areseparatedbyoneoftwomethods.[61]IntheUS,a
unitofwholebloodisplacedintoalargecentrifugeinwhatisreferredtoasasoftspin.Atthesesettings,theplatelets
remainsuspendedintheplasma.Theplateletrichplasma(PRP)isremovedfromtheredcells,thencentrifugedatafaster
settingtoharvesttheplateletsfromtheplasma.Inotherregionsoftheworld,theunitofwholebloodiscentrifugedusing
settingsthatcausetheplateletstobecomesuspendedinthebuffycoatlayer,whichincludestheplateletsandthewhite
bloodcells.Thebuffycoatisisolatedinasterilebag,suspendedinasmallamountofredbloodcellsandplasma,then
centrifugedagaintoseparatetheplateletsandplasmafromtheredandwhitebloodcells.Regardlessoftheinitialmethod
ofpreparation,multipledonationsmaybecombinedintoonecontainerusingasterileconnectiondevicetomanufacturea
singleproductwiththedesiredtherapeuticdose.
Apheresisplateletsarecollectedusingamechanicaldevicethatdrawsbloodfromthedonorandcentrifugesthecollected
bloodtoseparateouttheplateletsandothercomponentstobecollected.Theremainingbloodisreturnedtothedonor.The
Plateletconcentrate.
advantagetothismethodisthatasingledonationprovidesatleastonetherapeuticdose,asopposedtothemultiple
donationsforwholebloodplatelets.Thismeansthatarecipientisnotexposedtoasmanydifferentdonorsandhaslessrisk
oftransfusiontransmitteddiseaseandothercomplications.Sometimesapersonsuchasacancerpatientwhorequiresroutinetransfusionsofplateletswillreceive
repeateddonationsfromaspecificdonortofurtherminimizetherisk.Pathogenreductionofplateletsusingforexample,riboflavinandUVlighttreatmentscan
alsobecarriedouttoreducetheinfectiousloadofpathogenscontainedindonatedbloodproducts,therebyreducingtheriskoftransmissionoftransfusion
transmitteddiseases.[62][63]AnotherphotochemicaltreatmentprocessutilizingamotosalenandUVAlighthasbeendevelopedfortheinactivationofviruses,
bacteria,parasites,andleukocytesthatcancontaminatebloodcomponentsintendedfortransfusion.[64]Inaddition,apheresisplateletstendtocontainfewer
contaminatingredbloodcellsbecausethecollectionmethodismoreefficientthansoftspincentrifugationatisolatingthedesiredbloodcomponent.
Storage
Plateletscollectedbyeithermethodhaveaveryshortshelflife,typicallyfivedays.Thisresultsinfrequentproblemswithshortsupply,astestingthedonations
oftenrequiresuptoafullday.Sincetherearenoeffectivepreservativesolutionsforplatelets,theylosepotencyquicklyandarebestwhenfresh.
Plateletsarestoredunderconstantagitationat2024C(6875.2F).Unitscannotberefrigeratedasthiscausesplateletstochangeshapeandlosefunction.
Storageatroomtemperatureprovidesanenvironmentwhereanybacteriathatareintroducedtothebloodcomponentduringthecollectionprocessmayproliferate
andsubsequentlycausebacteremiainthepatient.RegulationsareinplaceintheUnitedStatesthatrequireproductstobetestedforthepresenceofbacterial
contaminationbeforetransfusion.[65]
Deliverytorecipients

https://en.wikipedia.org/wiki/Platelet

13/17

11/8/2016

PlateletWikipedia

PlateletsdonotneedtobelongtothesameABObloodgroupastherecipientorbecrossmatchedtoensureimmunecompatibilitybetweendonorandrecipient
unlesstheycontainasignificantamountofredbloodcells(RBCs).ThepresenceofRBCsimpartsareddishorangecolortotheproduct,andisusuallyassociated
withwholebloodplatelets.Aneffortissometimesmadetoissuetypespecificplatelets,butthisisnotcriticalasitiswithRBCs.
Priortoissuingplateletstotherecipient,theymaybeirradiatedtopreventtransfusionassociatedgraftversushostdiseaseortheymaybewashedtoremovethe
plasmaifindicated.
Thechangeintherecipient'splateletcountaftertransfusionistermedthe"increment"andiscalculatedbysubtractingthepretransfusionplateletcountfromthe
posttransfusionplateletcount.Manyfactorsaffecttheincrementincludingtherecipient'sbodysize,thenumberofplateletstransfused,andclinicalfeaturesthat
maycauseprematuredestructionofthetransfusedplatelets.Whenrecipientsfailtodemonstrateanadequateposttransfusionincrement,thisistermedplatelet
transfusionrefractoriness.
Platelets,eitherapheresisderivedorrandomdonor,canbeprocessedthroughavolumereductionprocess.Inthisprocess,theplateletsarespuninacentrifugeand
theexcessplasmaisremoved,leaving10to100mLofplateletconcentrate.Suchvolumereducedplateletsarenormallytransfusedonlytoneonatalandpediatric
patients,whenalargevolumeofplasmacouldoverloadthechild'ssmallcirculatorysystem.Thelowervolumeofplasmaalsoreducesthechancesofanadverse
transfusionreactiontoplasmaproteins.[66]Volumereducedplateletshaveashelflifeofonlyfourhours.[67]

Woundtherapy
Plateletsreleaseplateletderivedgrowthfactor(PDGF),apotentchemotacticagentandTGFbeta,whichstimulatesthedepositionofextracellularmatrix
fibroblastgrowthfactor,insulinlikegrowthfactor1,plateletderivedepidermalgrowthfactor,andvascularendothelialgrowthfactor.Localapplicationofthese
factorsinincreasedconcentrationsthroughPlateletrichplasma(PRP)isusedasanadjunctinwoundhealing.[68]

References
1.LakiK(Dec8,1972)."Ourancientheritageinbloodclottingandsomeofits
consequences".AnnalsoftheNewYorkAcademyofSciences.202:297307.
doi:10.1111/j.17496632.1972.tb16342.x.PMID4508929.
2.MachlusKRThonJNItalianoJE(2014)."Interpretingthedevelopmentaldance
ofthemegakaryocyte:Areviewofthecellularandmolecularprocessesmediating
plateletformation".BritishJournalofHaematology.165(2):22736.
doi:10.1111/bjh.12758.PMID24499183.
3.JainNC(1975)."Ascanningelectronmicroscopicstudyofplateletsofcertain
animalspecies".Thrombosisetdiathesishaemorrhagica.33(3):5017.
PMID1154309.
4.Michelson,Platelets,2013,p.117118
5.PaulusJM(1975)."Plateletsizeinman".Blood.46(3):32136.PMID1097000.
6.Michelson,Platelets,2013,p.3
https://en.wikipedia.org/wiki/Platelet

7.YipJShenYBerndtMCAndrewsRK(2005)."Primaryplateletadhesion
receptors".IUBMBLife(InternationalUnionofBiochemistryandMolecular
Biology:Life).57(2):1038.doi:10.1080/15216540500078962.PMID16036569.
8.Berridge,M.J.(2012)CellSignallingBiologydoi:10.1042/csb0001011(https://d
x.doi.org/10.1042%2Fcsb0001011)
9.Lancet,1882,ii.916NotesofGulliver'sResearchesinAnatomy,Physiology,
Pathology,andBotany,1880Carpenter'sPhysiology,ed.Power,9thed.,see
Indexunder'Gulliver.'
10.Godlee,SirRickman(1917).LordLister.London:Macmillan&Co.
11."WhythePlateletswereDiscovered",BritishJournalofHaematology,12Mar
2008,Volume13Issues1,Pages618637

14/17

11/8/2016

PlateletWikipedia

12.BealeLS(1864)."OntheGerminalMatteroftheBlood,withRemarksuponthe
FormationofFibrin".TransactionsoftheMicroscopicalSociety&Journal.12:
4763.doi:10.1111/j.13652818.1864.tb01625.x.
13.SchultzeM(1865)."EinheizbarerObjecttischundseineVerwendungbei
UntersuchungendesBlutes".ArchMikroskAnat.1(1):142.
doi:10.1007/BF02961404.
14.http://www.birmingham.ac.uk/Documents/university/ourimpact.pdf
15.Bizzozero,J.(1882)."bereinenneuenForrnbestandteildesBlutesunddessen
RollebeiderThromboseundBlutgerinnung".ArchPatholAnatPhysKlinMed.
90(2):261332.doi:10.1007/BF01931360.
16.BrewerDB(2006)."MaxSchultze(1865),G.Bizzozero(1882)andthediscovery
oftheplatelet".Br.J.Haematol.133(3):2518.doi:10.1111/j.1365
2141.2006.06036.x.PMID16643426.
17.OslerW(1886)."Oncertainproblemsinthephysiologyofthebloodcorpuscles".
TheMedicalNews.48:4215.
18.WrightJH(1906)."TheOriginandNatureoftheBloodPlates".TheBoston
MedicalandSurgicalJournal.154(23):643645.
doi:10.1056/NEJM190606071542301.
19.WrightJH(1910)."Thehistogenesisofbloodplatelets".JMorphology.21:263
278.doi:10.1002/jmor.1050210204.
20.FurieBFurieBC(2008)."Mechanismsofthrombusformation".NewEngland
JournalofMedicine.359(9):93849.doi:10.1056/NEJMra0801082.
PMID18753650.
21.GirlingJ.H.(1962)."Anautomaticplateletcountingtechnique".TheJournalof
medicallaboratorytechnology.19:16873.PMID13898919.
22.RossD.W.AyscueL.H.WatsonJ.BentleyS.A.(1988)."Stabilityof
hematologicparametersinhealthysubjects.Intraindividualversusinterindividual
variation".Americanjournalofclinicalpathology.90(3):2627.PMID3414599.
23.RuoccoL.DelCorsoL.RomanelliA.M.DeriD.etal.(2001)."New
hematologicalindicesinthehealthyelderly".Minervamedica.92(2):6973.
PMID11323567.
24.LozanoM.NarvezJ.FandezA.MazzaraR.etal.(1998)."Plateletcountand
meanplateletvolumeintheSpanishpopulation".Medicinaclinica.110(20):774
7.PMID9666418.
25.MurakawaMOkamuraTTsutsumiKTanoguchiSetal.(1992)."Acquiredvon
Willebrand'sdiseaseinassociationwithessentialthrombocythemia:Regression
followingtreatment".Actahaematologica.87(12):837.
doi:10.1159/000204725.PMID1585777.
26.vanGenderenPJLeenknegtHMichielsJJBuddeU(1996)."Acquiredvon
Willebranddiseaseinmyeloproliferativedisorders".LeukemiaandLymphoma.22
Suppl1:7982.doi:10.3109/10428199609074364.PMID8951776.
27.Michelson,Platelets,2013,p.815,Table394
https://en.wikipedia.org/wiki/Platelet

28.HarkerLARoskosLKMarzecUMCarterRAetal.(April2000)."Effectsof
megakaryocytegrowthanddevelopmentfactoronplateletproduction,plateletlife
span,andplateletfunctioninhealthyhumanvolunteers".Blood.95(8):251422.
PMID10753829.
29.MasonKDCarpinelliMRFletcherJICollingeJEetal.(2007)."Programmed
anuclearcelldeathdelimitsplateletlifespan".Cell.128(6):117386.
doi:10.1016/j.cell.2007.01.037.PMID17382885.
30.PalmerRMFerrigeAGMoncadaS(1987)."Nitricoxidereleaseaccountsforthe
biologicalactivityofendotheliumderivedrelaxingfactor".Nature.327(6122):
5246.doi:10.1038/327524a0.PMID3495737.
31.JonesCIBarrettNEMoraesLAGibbinsJMetal.(2012)."Endogenous
inhibitorymechanismsandtheregulationofplateletfunction".MethodsMol.Biol.
788:34166.doi:10.1007/9781617793073_23.PMID22130718.
32.MarcusAJBroekmanMJDrosopoulosJHOlsonKEetal.(2005)."Roleof
CD39(NTPDase1)inthromboregulation,cerebroprotection,and
cardioprotection".SeminarsinThrombosisandHemostasis.31(2):23446.
doi:10.1055/s2005869528.PMID15852226.
33.DuboisCPanicotDuboisLMerrillSkoloffGFurieBetal.(May2006).
"GlycoproteinVIdependentandindependentpathwaysofthrombusformationin
vivo".Blood.107(10):39026.doi:10.1182/blood2005093687.PMC1895285
.PMID16455953.
34.MatarresePStrafaceEPalumboGAnselmiMetal.(2009)."Mitochondria
regulateplateletmetamorphosisinducedbyopsonizedzymosanAactivationand
longtermcommitmenttocelldeath".FEBSJournal.276(3):84556.
doi:10.1111/j.17424658.2008.06829.x.PMID19143843.
35.BehnkeO(1970)."Themorphologyofbloodplateletmembranesystems".Series
haematologica.3(4):316.PMID4107203.
36.PhillipsDRCharoIFScarboroughRM(May1991)."GPIIbIIIa:theresponsive
integrin".Cell.65(3):35962.doi:10.1016/00928674(91)904514.
PMID2018971.
37.CollerBSChereshDAAschESeligsohnU(1991)."Plateletvitronectin
receptorexpressiondifferentiatesIraqiJewishfromArabpatientswithGlanzmann
thrombastheniainIsrael".Blood.77(1):7583.PMID1702031.
38.Nguyen,D.T.,OrgillD.P.,MurphyG.F.(2009).Chapter4:ThePathophysiologic
BasisforWoundHealingandCutaneousRegeneration.BiomaterialsForTreating
SkinLoss.WoodheadPublishing(UK/Europe)&CRCPress(US),
Cambridge/BocaRaton,p.2557.(ISBN9781420099898/ISBN978184569
3633)
39.MovatHZWeiserWJGlynnMFMustardJF(1965)."Plateletphagocytosisand
aggregation".J.CellBiol.27(3):53143.doi:10.1083/jcb.27.3.531.
PMC2106759 .PMID4957257.
15/17

11/8/2016

PlateletWikipedia

40.BouchardBAMannKGButenasS(August2010)."Noevidencefortissuefactor
onplatelets".Blood.116(5):8545.doi:10.1182/blood201005285627.
PMC2918337 .PMID20688968.
41.AhmadSSRawalaSheikhRWalshPN(1992)."Componentsandassemblyof
thefactorXactivatingcomplex".Semin.Thromb.Hemost.18(3):31123.
doi:10.1055/s20071002570.PMID1455249.
42.WeyrichASZimmermanGA(2004)."Platelets:signalingcellsintheimmune
continuum".TrendsImmunol.25(9):48995.doi:10.1016/j.it.2004.07.003.
PMID15324742.
43.WagnerDDBurgerPC(2003)."Plateletsininflammationandthrombosis".
Arterioscler.Thromb.Vasc.Biol.23(12):21317.
doi:10.1161/01.ATV.0000095974.95122.EC.PMID14500287.
44.DiacovoTGPuriKDWarnockRASpringerTAetal.(1996)."Platelet
mediatedlymphocytedeliverytohighendothelialvenules".Science.273(5272):
2525.doi:10.1126/science.273.5272.252.PMID8662511.
45.IannaconeMSitiaGIsogawaMMarchesePetal.(2005)."Plateletsmediate
cytotoxicTlymphocyteinducedliverdamage".Nat.Med.11(11):11679.
doi:10.1038/nm1317.PMC2908083 .PMID16258538.
46.SchmaierAAStalkerTJRungeJJLeeDetal.(September2011)."Occlusive
thrombiariseinmammalsbutnotbirdsinresponsetoarterialinjury:evolutionary
insightintohumancardiovasculardisease".Blood.118(13):36619.
doi:10.1182/blood201102338244.PMC3186337 .PMID21816834.
47.BelamarichFASheproDKienM(November1968)."ADPisnotinvolvedin
thrombininducedaggregationofthrombocytesofanonmammalianvertebrate".
Nature.220(5166):50910.doi:10.1038/220509a0.PMID5686175.
48.DukeWW(1910)."Therelationofbloodplateletstohemorrhagicdisease".
JAMA.55:118592.doi:10.1001/jama.1910.04330140029009.
49.Michelson,Platelets,2013,p.vii
50.Geddis,AE(Feb2013)."Inheritedthrombocytopenias:anapproachtodiagnosis
andmanagement".Internationaljournaloflaboratoryhematology.35(1):1425.
doi:10.1111/j.1751553x.2012.01454.x.PMID22846067.
51."TheeffectsofGilbert'ssyndromeonthemeanplateletvolumeandother
hematologicalparameters".BloodCoagul.Fibrinolysis.24:4848.2013.
doi:10.1097/MBC.0b013e32835e4230.PMID23348429.
52.KornerupKNPageCP(2007)."Theroleofplateletsinthepathophysiologyof
asthma".Platelets.18(5):31928.doi:10.1080/09537100701230436.
PMID17654302.
53.LaidlawTMKidderMSBhattacharyyaNXingWetal.(2012)."Cysteinyl
leukotrieneoverproductioninaspirinexacerbatedrespiratorydiseaseisdrivenby
plateletadherentleukocytes".Blood.119(16):37908.doi:10.1182/blood2011
10384826.PMC3335383 .PMID22262771.
https://en.wikipedia.org/wiki/Platelet

54.ErpenbeckLSchnMP(2010)."Deadlyallies:thefatalinterplaybetween
plateletsandmetastasizingcancercells".Blood.115(17):342736.
doi:10.1182/blood200910247296.PMC2867258 .PMID20194899.
55.PleassRJ(2009)."Plateletpower:stickyproblemsforstickyparasites?".Trends
Parasitol.25(7):2969.doi:10.1016/j.pt.2009.04.002.PMC3116138 .
PMID19539528.
56."PlateletFunctionafterTakingIbuprofenfor1Week".AnnalsofInternal
Medicine.142(7):I54.2005.doi:10.7326/00034819142720050405000004.
PMID15809457.
57.RaoGHJohnsonGGReddyKRWhiteJG(1983)."Ibuprofenprotectsplatelet
cyclooxygenasefromirreversibleinhibitionbyaspirin".Arteriosclerosis.3(4):
3838.doi:10.1161/01.ATV.3.4.383.PMID6411052.
58.vanVeenJJNokesTJMakrisM(2010)."Theriskofspinalhaematoma
followingneuraxialanaesthesiaorlumbarpunctureinthrombocytopenic
individuals".Br.J.Haematol.148(1):1525.doi:10.1111/j.1365
2141.2009.07899.x.PMID19775301.
59.Roback,J.Grossman,B.Harris,T.Hillyer,C.,eds.(2011).TechnicalManual
(17thed.).BethesdaMD:AABB.p.580.ISBN9781563953156.
60.AmericanAssociationofBloodBanks(2003)."5.1.5.1".StandardsforBlood
BanksandTransfusionServices(22nded.).BethesdaMD:AABB.
61.HgmanCF(1992)."Newtrendsinthepreparationandstorageofplatelets".
Transfusion.32(1):36.doi:10.1046/j.15372995.1992.32192116428.x.
PMID1731433.
62.RuanePHEdrichRGamppDKeilSDetal.(2004)."Photochemical
inactivationofselectedvirusesandbacteriainplateletconcentratesusing
riboflavinandlight".Transfusion.44(6):87785.doi:10.1111/j.1537
2995.2004.03355.x.PMID15157255.
63.PerezPujolSTondaRLozanoMFusteBetal.(2005)."Effectsofanew
pathogenreductiontechnology(MirasolPRT)onfunctionalaspectsofplatelet
concentrates".Transfusion.45(6):9119.doi:10.1111/j.15372995.2005.04350.x.
PMID15934989.
64.ProwseCV(2013)."Componentpathogeninactivation:Acriticalreview".Vox
Sanguinis.104(3):183199.doi:10.1111/j.14230410.2012.01662.x.
65.AABB(2009).StandardsforBloodBanksandTransfusionServices(26thed.).
BethesdaMD:AABB.
66.SchoenfeldHSpiesCJakobC(2006)."Volumereducedplateletconcentrates".
Curr.Hematol.Rep.5(1):828.PMID16537051.
67.CBBS:WashedandvolumereducedPlateletpheresisunits(http://www.cbbsweb.or
g/enf/2001/pltwashvol.html).Cbbsweb.org(20011025).Retrievedon201111
14.

16/17

11/8/2016

PlateletWikipedia

68.GawazMVogelS(October2013)."Plateletsintissuerepair:controlofapoptosis
andinteractionswithregenerativecells".Blood.122(15):25504.
doi:10.1182/blood201305468694.PMID23963043.

Furtherreading
Michelson,AlanD.(2013).Platelets(3rded.).Academic.ISBN0123878373.1351pages60,000references.Excerptsfreeonline.

Externallinks
MediarelatedtoplateletsatWikimediaCommons
Retrievedfrom"https://en.wikipedia.org/w/index.php?title=Platelet&oldid=746952621"
Categories: Bloodproducts Coagulationsystem Cellbiology Humancells Transfusionmedicine
Thispagewaslastmodifiedon30October2016,at15:26.
TextisavailableundertheCreativeCommonsAttributionShareAlikeLicenseadditionaltermsmayapply.Byusingthissite,youagreetotheTermsofUse
andPrivacyPolicy.WikipediaisaregisteredtrademarkoftheWikimediaFoundation,Inc.,anonprofitorganization.

https://en.wikipedia.org/wiki/Platelet

17/17