The nature of protein microarray platforms is favorable for multiplexing, leading to the development of tools for personalised medicine and highly precise diagnostics. However, to date, only a limited number of protein microarrays are available in the in vitro diagnostics (IVD) market. This review article will focus on the following operational challenges that are crucial for the use of microarrays in clinical settings: (1) probe printing and quality control; (2) procurement of bio-reagents and antibody cross-reactivity; (3) mass transport limitations and assay automation; (4) calibration and quantification. A selection of microarray assays applicable to IVD and a summary of the diagnostic products currently available on the market are provided.