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Roncin KL, Reeves HM, Maitta RW. Immature platelet counts in transfused platelet units given to neonates. Clin Chim Acta 2024; 561:119760. [PMID: 38844020 DOI: 10.1016/j.cca.2024.119760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 05/22/2024] [Accepted: 06/03/2024] [Indexed: 06/10/2024]
Abstract
BACKGROUND Immature platelets, young and large platelets recently released from the bone marrow, have gained interest over the last decade as a clinically informative variable during thrombocytopenic presentations. These immature platelets are found in all donated platelet units, however, the role, if any, that these younger platelets play post transfusion is not known. It has also been reported that the immune response can affect responses to platelet transfusions. Thus, we looked at PLT increments in a cohort of neonates receiving platelet transfusions in our neonatal intensive care unit. METHODS During a twelve-month period, platelet transfusions received by neonates born and not discharged from our institution at time of transfusion were retrospectively analyzed. In the study period a total of 33 patients received either a single or multiple transfusions during their hospitalization, for a total of 100 transfusion events. RESULTS The cohort was mostly premature neonates with a mean gestational age of 29.6 weeks. The units transfused appeared to have a broad range of absolute immature platelet counts (A-IPC) but overall, it was similar between those receiving single or multiple transfusions. Considering that platelet count was similar among aliquots transfused, it appeared that count increments were influenced by higher A-IPC content of the aliquot especially among 2nd trimester and 3rd trimester premature neonates. Patients with higher baseline platelet count (PLT) tended to receive a single transfusion aliquot while those receiving multiple transfusions had lower baseline PLT (p = 0.0022). Looking at aliquot dose, regardless if receiving a single or multiple transfusions, younger patients received incrementally higher dose (ml/kg) with each transfusion. CONCLUSIONS A-IPC in platelet aliquots transfused to neonates may influence post-transfusion PLT. Full effect of A-IPC in platelet aliquots may not be seen since irradiation of units may hamper immature platelets viability and function. Further research is needed to determine if A-IPC plays an active role to limit the need for further transfusions of patients receiving transfusions.
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Affiliation(s)
- Kara L Roncin
- Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, OH, United States; Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Hollie M Reeves
- Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, OH, United States; Ohio State University College of Medicine, Columbus, OH, United States
| | - Robert W Maitta
- Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, OH, United States; Case Western Reserve University School of Medicine, Cleveland, OH, United States.
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lv M, Xu Q, Ye X, Yu Q, Wang B, Wang Y. Pretreatment Absolute Immature Platelet Count is a Promising Predictor of Response to Short-Term Dexamethasone Monotherapy or Combination Therapy in Newly Diagnosed Adult Primary Immune Thrombocytopenia. Indian J Hematol Blood Transfus 2024; 40:289-296. [PMID: 38708160 PMCID: PMC11065814 DOI: 10.1007/s12288-023-01702-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 10/04/2023] [Indexed: 05/07/2024] Open
Abstract
Reliable indicators that can predict drug responsiveness in primary immune thrombocytopenia (ITP) patients are urgent. We aimed to establish a reference interval of percentage of immature platelet fraction (IPF%) and absolute immature platelet count (A-IPC), and assess their efficacy in discriminating ITP patients from controls, especially their predictive value for responsiveness to drug treatment. We retrospectively studied 72 treatment-naive adult patients with ITP who received Dexamethasone monotherapy or combination therapy. Baseline (pretreatment) information was collected from medical records. Reference intervals for A-IPC and IPF% were established based on controls and their effectiveness in discriminating ITP patients from controls was assessed. Predictive value of pretreatment IPF% and A-IPC at four co-primary endpoints of treatment response in patients were investigated. The 95% reference intervals for A-IPC and IPF% were (2.7-15.6) × 109/L and 1.2%-7.3%, respectively. Both A-IPC and IPF% had excellent discrimination ability for ITP patients from controls. It showed highly statistically significant differences in pretreatment A-IPC for predicting treatment response at day 7 between responders and non-responders, but not at days 14, 21 and 28. Pretreatment A-IPC had the higher area under the ROC curve with a cut-off of 0.86 than that of IPF% with a cut-off of 14.5% in predicting the treatment response in ITP patients at day 7. Pretreatment A-IPC exhibited acceptable predictive power and could be a promising predictor of response to short-term Dexamethasone monotherapy or combination therapy at day 7 in ITP patients.
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Affiliation(s)
- Mengen lv
- Department of Laboratory Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
- Key Laboratory of Clinical In Vitro Diagnostic Techniques of Zhejiang Province, Hangzhou, People’s Republic of China
| | - Qing Xu
- Department of Laboratory Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
- Key Laboratory of Clinical In Vitro Diagnostic Techniques of Zhejiang Province, Hangzhou, People’s Republic of China
| | - Xianfei Ye
- Department of Laboratory Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
- Key Laboratory of Clinical In Vitro Diagnostic Techniques of Zhejiang Province, Hangzhou, People’s Republic of China
| | - Qian Yu
- Department of Laboratory Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
- Key Laboratory of Clinical In Vitro Diagnostic Techniques of Zhejiang Province, Hangzhou, People’s Republic of China
| | - Bibin Wang
- Department of Laboratory Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
- Key Laboratory of Clinical In Vitro Diagnostic Techniques of Zhejiang Province, Hangzhou, People’s Republic of China
| | - Ying Wang
- Department of Laboratory Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
- Key Laboratory of Clinical In Vitro Diagnostic Techniques of Zhejiang Province, Hangzhou, People’s Republic of China
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Noel MM, Feugray G, Kasonga F, Buchonnet G, Daliphard S, Barbay V, Bera E, Le Cam Duchez V, Billoir P. Stability over time of immature platelet fraction and comparison between EDTA and citrated whole blood samples. J Clin Lab Anal 2023; 37:e24946. [PMID: 37475131 PMCID: PMC10492457 DOI: 10.1002/jcla.24946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/22/2023] [Accepted: 07/10/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND Immature platelets (IP) are the youngest circulating platelets, released from megakaryocytes, and demonstrating increased dimensions, significant RNA content, and enhanced activity. Immature platelet research focuses on a differential diagnostic help in patients with thrombocytopenia. The objectives of this study were to compare the variability of IP in citrate and EDTA samples, and to determine stability over time. METHODS Fifty-six patients were included for comparison between EDTA and citrate whole blood sample collection. Among the patients, 28 had thrombocytopenia (platelet count < 150G/L). Platelet measurement impedancemetry and fluorimetry were performed with Sysmex XN-9000. The immature platelet fraction (IPF) and absolute immature platelet count (A-IPC) were determined with a fluorescent method. RESULTS The mean value of platelet count with fluorescence was, in EDTA sample, 215 ± 171 and, in citrate sample, 153 ± 118 G/L. No significant difference was observed between IPF between EDTA and citrate (7.74 ± 6.68% vs. 8.45 ± 7.37%, p = 0.69), respectively. With the Bland-Altman analysis, the mean difference in the EDTA sample, between 1 and 24 h, was 8.06 ± 6.96% and 8.73 ± 7.12% for IPF, whereas in the citrate sample, between 1 and 6 h, it was 8.60 ± 7.29% and 7.54 ± 6.97%, for IPF. Comparing 1 h EDTA sample with 6 h citrate sample, the variance ratio was 0.974 (95% CI: 0.864-1.084) in IPF. CONCLUSIONS We confirmed the potential to conduct IP measurements up to 24 h in the EDTA sample and IPF measurements in the citrate sample for up to 6 h. These results may be useful for the use of IPF, which is a promising parameter whose interest in clinical practice and standardization is not yet well defined.
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Affiliation(s)
| | - Guillaume Feugray
- Univ ROUENINSERM U1096RouenFrance
- General Biochemistry, CHU RouenRouenFrance
| | | | | | | | | | - Elsa Bera
- Rouen, France Hematology laboratoryCHU RouenRouenFrance
| | | | - Paul Billoir
- CHU RouenVascular Hemostasis UnitRouenFrance
- Univ ROUENINSERM U1096RouenFrance
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Salvador C, Meryk A, Hetzer B, Bargehr C, Kropshofer G, Meister B, Anliker M, Crazzolara R. Immature platelet fraction predicts early marrow recovery after severe chemotherapy associated neutropenia. Sci Rep 2023; 13:3371. [PMID: 36849723 PMCID: PMC9971198 DOI: 10.1038/s41598-023-30469-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 02/23/2023] [Indexed: 03/01/2023] Open
Abstract
Febrile neutropenia secondary to chemotherapy is one of the most critical complications in cancer treatment. The aim of this study was to determine if an increase in the percentage of immature platelet fraction (IPF%) might predict early neutrophil recovery following cytostatic-dependent aplasia. A retrospective cohort study compared serial complete blood counts and the level of C-reactive protein (CRP) following induction chemotherapy for Ewing sarcoma and Non-Ewing sarcoma patients. The measurements were taken on a Sysmex XE-2100 instrument. A total of 287 paired samples from 28 children after the first cycle of chemotherapy were analyzed to test if an increase in the IPF% anticipated the CRP peak and recovery of neutrophil count. The chemotherapy associated nadir of neutrophils, reticulocytes and platelets was reached at 9.7 ± 1.5, 11.0 ± 1.7 and 11.9 ± 0.9 days (mean ± SD) respectively, in Ewing sarcoma patients. Still in severe neutropenia, IPF% was the first parameter that significantly increased and anticipated the CRP peak (11.9 ± 1.6 days, mean ± SD). The IPF% continuously increased (maximum = 6.56% ± 2.8%, mean ± SD) and peaked at 12.2 ± 1.4 days (mean ± SD) after commencement of chemotherapy. Compared to neutrophil recovery (14.6 ± 1.4 days, mean ± SD), the IPF% peak was anticipated by 2.4 days (p = 0.0085). Although variably treated, in non-Ewing sarcoma patients the effect was similar and the IPF% peak anticipated neutrophil recovery by 6.8 ± 4.7 days (p < 0.01). IPF% increased significantly at > 48 h before neutrophil recovery in patients treated with chemotherapy. IPF% is an inexpensive parameter and may be valuable in the management of febrile neutropenia.
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Affiliation(s)
- Christina Salvador
- grid.5361.10000 0000 8853 2677Division of Hematology and Oncology, Department of Pediatrics I, Medical University of Innsbruck, Innsbruck, Austria
| | - Andreas Meryk
- grid.5361.10000 0000 8853 2677Division of Hematology and Oncology, Department of Pediatrics I, Medical University of Innsbruck, Innsbruck, Austria
| | - Benjamin Hetzer
- grid.5361.10000 0000 8853 2677Division of Hematology and Oncology, Department of Pediatrics I, Medical University of Innsbruck, Innsbruck, Austria
| | - Caroline Bargehr
- grid.5361.10000 0000 8853 2677Division of Hematology and Oncology, Department of Pediatrics I, Medical University of Innsbruck, Innsbruck, Austria
| | - Gabriele Kropshofer
- grid.5361.10000 0000 8853 2677Division of Hematology and Oncology, Department of Pediatrics I, Medical University of Innsbruck, Innsbruck, Austria
| | - Bernhard Meister
- grid.5361.10000 0000 8853 2677Division of Hematology and Oncology, Department of Pediatrics I, Medical University of Innsbruck, Innsbruck, Austria
| | - Markus Anliker
- grid.5361.10000 0000 8853 2677Central Institute for Medical and Chemical Laboratory Diagnosis, Medical University of Innsbruck, Innsbruck, Austria
| | - Roman Crazzolara
- Division of Hematology and Oncology, Department of Pediatrics I, Medical University of Innsbruck, Innsbruck, Austria.
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Reeves HM, Maitta RW. Comparison of absolute immature platelet count to the PLASMIC score at presentation in predicting ADAMTS13 deficiency in suspected thrombotic thrombocytopenic purpura. Thromb Res 2022; 215:30-36. [DOI: 10.1016/j.thromres.2022.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/25/2022] [Accepted: 05/16/2022] [Indexed: 11/29/2022]
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Delaney M, Andrews J, Virk M, Barber JR, Bost JE, Baech J, Feys HB. Multinational Analysis of Children Transfused With Pathogen Inactivated Platelets. Hosp Pediatr 2022; 12:311-316. [PMID: 35169851 DOI: 10.1542/hpeds.2021-006284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Pathogen inactivated (PI) platelets are a technological advancement in blood safety; however, the pediatric experience is not well characterized. We studied pediatric patients who received transfusions of PI platelets across several centers and countries to determine if transfusion reaction rates differed when compared with conventional platelets. METHODS This is a retrospective multisite study conducted during 2 time periods. The study period started at the time each site began using PI platelets on a widespread basis, and the control period was a similar timespan before PI introduction. Suspected acute transfusion reactions were compared. RESULTS The study included 3839 pediatric patients who were 0 to 18 years of age who received >7930 platelet transfusions, in total, across 4 centers in 3 countries between 2013 and 2019. The age distribution of patients in the study and control period was not significantly different (P = .190). There was not a difference in the percentage of patients who had any type of transfusion reaction between the time periods (1.0% and 1.1%, P = .803). There were fewer patients with mild allergic reactions in the study period compared with the control period (0.2% and 0.7% of patients with reactions, respectively, P = .018). CONCLUSIONS Pediatric patients have the same rate of acutely suspected transfusion reactions when receiving PI or conventional platelet transfusions. Subgroup analysis found fewer mild allergic reactions in the study period, which was contemporaneous to the addition of using platelet additive solution more broadly. Future studies of PI platelets should include children to better assess transfusion efficacy and hemostatic outcomes.
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Affiliation(s)
- Meghan Delaney
- Divisions of Pathology and Laboratory Medicine and.,Departments of Pathology and Pediatrics, The George Washington University Health Sciences, Washington, District of Columbia
| | - Jennifer Andrews
- Departments of Pathology, Immunology and Microbiology and Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Mrigender Virk
- Department of Pathology, Stanford University School of Medicine, Stanford, California
| | - John R Barber
- Biostatistics and Study Methodology, Children's National Hospital, Washington, District of Columbia
| | - James E Bost
- Biostatistics and Study Methodology, Children's National Hospital, Washington, District of Columbia
| | - John Baech
- Department of Clinical Immunology, Aalborg University Hospital, Aalborg, Denmark
| | - Hendrik B Feys
- Transfusion Research Center, Belgian Red Cross Flanders, Ghent, Belgium.,Department of Diagnostic Sciences, Ghent University, Ghent, Belgium
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Welder D, Jeon‐Slaughter H, Ashraf B, Choi S, Chen W, Ibrahim I, Bat T. Immature platelets as a biomarker for disease severity and mortality in COVID-19 patients. Br J Haematol 2021; 194:530-536. [PMID: 34132393 PMCID: PMC8444912 DOI: 10.1111/bjh.17656] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/28/2021] [Accepted: 05/30/2021] [Indexed: 12/19/2022]
Abstract
COVID-19, caused by SARS-CoV-2, is a contagious life-threatening viral disease that has killed more than three million people worldwide to date. Attempts have been made to identify biomarker(s) to stratify disease severity and improve treatment and resource allocation. Patients with SARS-COV-2 infection manifest with a higher inflammatory response and platelet hyperreactivity; this raises the question of the role of thrombopoiesis in COVID-19 infection. Immature platelet fraction (IPF, %) and immature platelet counts (IPC, ×109 /l) can be used to assess thrombopoiesis. This study investigates whether the level of thrombopoiesis correlates with COVID-19 severity. A large cohort of 678 well-characterized COVID-19 patients was analyzed, including 658 (97%) hospitalized and 139 (21%) admitted to the intensive care unit (ICU). Elevated percentage IPF at presentation was predictive of length of hospitalization (P < 0·01) and ICU admission (P < 0·05). Additionally, percentage IPF at the peak was significantly higher among ICU patients than non-ICU patients (6·9 ± 5·1 vs 5·3 ± 8·4, P < 0·01) and among deceased patients than recovered patients (7·9 ± 6·3 vs 5·4 ± 7·8, P < 0·01). Furthermore, IPC at the peak was significantly higher among ICU patients than non-ICU patients (18·5 ± 16·2 vs. 13·2 ± 8·3, P < 0·05) and among patients on a ventilator than those not (22·1 ± 20·1 vs.13·4 ± 8·4, P < 0·05). Our study demonstrated that elevated initial and peak values of percentage IPF and IPC might serve as prognostic biomarkers for COVID-19 progression to severe conditions.
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Affiliation(s)
- Daniel Welder
- Department of Pathology, Hematopathology SectionUniversity of Texas Southwestern Medical CenterDallasTXUSA
| | - Haekyung Jeon‐Slaughter
- Department of Internal MedicineVA North Texas Health Care SystemUniversity of Texas Southwestern Medical CenterDallasTXUSA
| | - Bilal Ashraf
- Department of Internal MedicineDivision of Hematology and OncologyUniversity of Texas Southwestern Medical CenterDallasTXUSA
| | - Sung‐Hee Choi
- Department of Internal MedicineVA North Texas Health Care System and Division of Hematology and OncologyUniversity of Texas Southwestern Medical CenterDallasTXUSA
| | - Weina Chen
- Department of Pathology, Hematopathology SectionUniversity of Texas Southwestern Medical CenterDallasTXUSA
| | - Ibrahim Ibrahim
- Department of Internal MedicineDivision of Hematology and OncologyUniversity of Texas Southwestern Medical CenterDallasTXUSA
| | - Taha Bat
- Department of Internal MedicineDivision of Hematology and OncologyUniversity of Texas Southwestern Medical CenterDallasTXUSA
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9
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Hamad MA, Schanze N, Schommer N, Nührenberg T, Duerschmied D. Reticulated Platelets-Which Functions Have Been Established by In Vivo and In Vitro Data? Cells 2021; 10:cells10051172. [PMID: 34065800 PMCID: PMC8150321 DOI: 10.3390/cells10051172] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 04/29/2021] [Accepted: 05/10/2021] [Indexed: 12/18/2022] Open
Abstract
Reticulated platelets (RP) are the youngest platelet fraction released into the circulation. These immature platelets have increased RNA content, a larger cell volume, more dense granules, higher levels of surface activation markers and are thought to be more reactive compared to their mature counterparts. RP have been associated with cardiovascular disease, diabetes and increased mortality. Yet only a few animal studies investigating RP have been conducted so far and further investigations are warranted. Established methods to count RP are flow cytometry (staining with thiazole orange or SYTO13) or fully automated hematology analyzers (immature platelet fraction, IPF). IPF has been established as a diagnostic parameter in thrombocytopenia, cardiovascular disease and, in particular, the response to antiplatelet therapy. This review seeks to provide an overview of the key features of RP as well as preanalytical and analytical aspects that need to be considered when working with this platelet population.
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Affiliation(s)
- Muataz Ali Hamad
- Department of Cardiology and Angiology I, Heart Center, Faculty of Medicine, University of Freiburg, 79106 Freiburg im Breisgau, Germany; (N.S.); (N.S.); (D.D.)
- Spemann Graduate School of Biology and Medicine (SGBM), University of Freiburg, 79104 Freiburg im Breisgau, Germany
- Faculty of Biology, University of Freiburg, 79104 Freiburg im Breisgau, Germany
- Correspondence: ; Tel.: +49-761-270-70470
| | - Nancy Schanze
- Department of Cardiology and Angiology I, Heart Center, Faculty of Medicine, University of Freiburg, 79106 Freiburg im Breisgau, Germany; (N.S.); (N.S.); (D.D.)
| | - Nicolas Schommer
- Department of Cardiology and Angiology I, Heart Center, Faculty of Medicine, University of Freiburg, 79106 Freiburg im Breisgau, Germany; (N.S.); (N.S.); (D.D.)
| | - Thomas Nührenberg
- Department of Cardiology and Angiology II, Heart Center, Faculty of Medicine, University of Freiburg, 79189 Bad Krozingen, Germany;
| | - Daniel Duerschmied
- Department of Cardiology and Angiology I, Heart Center, Faculty of Medicine, University of Freiburg, 79106 Freiburg im Breisgau, Germany; (N.S.); (N.S.); (D.D.)
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Reeves HM, Maitta RW. Immature Platelet Dynamics in Immune-Mediated Thrombocytopenic States. Front Med (Lausanne) 2020; 7:597734. [PMID: 33392220 PMCID: PMC7775312 DOI: 10.3389/fmed.2020.597734] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 11/24/2020] [Indexed: 01/19/2023] Open
Abstract
A major challenge encountered by clinicians is differentiating presentations characterized by significant thrombocytopenia due to overlapping clinical symptoms and signs in the setting of ambiguous laboratory results. Immature platelets represent the youngest platelets that can be measured in peripheral blood by current hematology analyzers. These young platelets are larger, with higher RNA content recently released from the bone marrow. Thrombocytopenic presentations caused directly or indirectly by immune responses can lead to compensatory bone marrow responses seeking to normalize the platelet count; thus obtaining absolute immature platelet counts may be informative while triaging patients. Over the last decade, their use has expanded beyond being an early biomarker of bone marrow reconstitution post-hematopoietic stem cell transplantation to being used to establish bone marrow responses to infection and thrombocytopenias due to immune etiologies. Its accessibility as part of more detailed platelet indices obtained with routine laboratories makes it a promising option to understand the bone marrow's real-time response to disease states characterized by thrombocytopenia. This review will look at the immature platelet count as a biomarker, while presenting current attempts trying to understand how it could be used in thrombocytopenias occurring secondary to a given immune etiology.
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Affiliation(s)
- Hollie M Reeves
- Department of Pathology, University Hospitals Cleveland Medical Center and Case Western Reserve University, Cleveland, OH, United States
| | - Robert W Maitta
- Department of Pathology, University Hospitals Cleveland Medical Center and Case Western Reserve University, Cleveland, OH, United States
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11
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Zhu ML, Reeves HM, Maitta RW. Immature platelet dynamics correlate with ADAMTS13 deficiency and predict therapy response in immune-mediated thrombotic thrombocytopenic purpura. Thromb Res 2020; 198:72-78. [PMID: 33290885 DOI: 10.1016/j.thromres.2020.11.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 10/23/2020] [Accepted: 11/20/2020] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Thrombotic thrombocytopenic purpura (TTP) requires prompt initiation of therapeutic plasma exchange (TPE) to avoid significant morbidity and mortality. ADAMTS13 activity testing defines TTP, however, at most institutions this is a send-out test and therapy is often initiated prior to measurement availability. We describe our experience looking at absolute immature platelet counts (A-IPC) in patients suspected with TTP at presentation and in response to therapy. MATERIALS AND METHODS Forty-eight patients treated for suspected TTP with A-IPC measure on admission and during hospitalization met inclusion criteria. Of these patients, sixteen had new-onset TTP (ADAMTS13 < 10%), ten were relapsing patients (first diagnosis prior to study period), and 22 were classified as non-TTP (ADAMTS13 ≥ 10%). RESULTS Patients with ADAMTS13 deficiency (TTP) had A-IPC different from those without deficiency. A-IPC of 1-2 × 109/L at presentation had high sensitivity and specificity with a negative predictive value of 95.5 to 100%. Two-to-three-fold increases in A-IPC from count prior to TPE initiation was limited to ADAMTS13 deficient patients who was the group responding to therapy. Increases were higher in patients with new disease onset compared to relapsing patients (p = 0.018). Likewise, relapsing patients' A-IPC appeared dependent upon platelet count at time of relapse. A-IPC predicted and correlated with ADAMTS13 deficiency in new-onset TTP (p = 0.0002). CONCLUSIONS Only patients with A-IPC-fold increases responded to TPE with platelet count normalization. Our results represent a proof of concept that A-IPC measurements can supplement ADAMTS13 testing and determine response to TPE. Future studies are needed to establish ways to apply these findings in the setting of suspected TTP.
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Affiliation(s)
- Meng-Lei Zhu
- University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, OH, United States of America
| | - Hollie M Reeves
- University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, OH, United States of America
| | - Robert W Maitta
- University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, OH, United States of America.
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Kundrapu S, Reeves HM, Maitta RW. Absolute Immature Platelet Counts Suggest Platelet Production Suppression during Complicated Relapsing Thrombotic Thrombocytopenic Purpura. Acta Haematol 2020; 144:465-469. [PMID: 33238282 DOI: 10.1159/000510913] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 08/14/2020] [Indexed: 11/19/2022]
Abstract
Absolute immature platelet counts (A-IPC) aid in diagnosis and treatment follow-up in thrombotic thrombocytopenic purpura (TTP). A-IPC was used to follow a patient on mycophenolate mofetil (MMF) maintenance therapy treated with a prolonged therapeutic plasma exchange (TPE) regimen for relapsing TTP. On admission, the platelet (PLT) count was 95 × 109/L declining to 14 × 109/L in 5 days. Daily TPE was initiated for suspected TTP, and MMF was discontinued. A-IPC and PLT count were 1 × 109/L and 14 × 109/L, respectively, prior to first TPE. A-IPC improved to 3.2 × 109/L with 1 TPE, and on day 5, A-IPC and PLT count were 7.5 × 109/L and 218 × 109/L, respectively. On day 6, A-IPC and PLT count decreased to 4.8 × 109/L and 132 × 109/L further worsening to 0.4 × 109/L and 13 × 109/L, respectively. ADAMTS13 activity remained <5% with an inhibitor; counts did not recover. Initial improvement followed by rapidly declining A-IPC despite therapy suggested production suppression. In TTP, A-IPC may aid in establishing early therapy effects over PLT production.
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Affiliation(s)
- Sirisha Kundrapu
- Department of Pathology, University Hospitals Cleveland Medical Center and Case Western Reserve University, Cleveland, Ohio, USA
| | - Hollie M Reeves
- Department of Pathology, University Hospitals Cleveland Medical Center and Case Western Reserve University, Cleveland, Ohio, USA
| | - Robert W Maitta
- Department of Pathology, University Hospitals Cleveland Medical Center and Case Western Reserve University, Cleveland, Ohio, USA,
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Benlachgar N, Doghmi K, Masrar A, Mahtat EM, Harmouche H, Tazi Mezalek Z. Immature platelets: a review of the available evidence. Thromb Res 2020; 195:43-50. [PMID: 32652352 DOI: 10.1016/j.thromres.2020.06.048] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 05/12/2020] [Accepted: 06/30/2020] [Indexed: 12/28/2022]
Abstract
Immature platelets or reticulated platelets are newly released thrombocytes. They can be identified by their large size and high RNA cytoplasm concentration. Immature platelet fraction (IPF) represents the percentage of immature circulative platelets to the total number of platelets. The development of analytical standardization of this hematological parameter by new automated devices allowed a better exploration of its contribution in a context of thrombocytopenia. In fact, several studies had confirmed its clinical utility to differentiate immune thrombocytopenia from other causes of thrombocytopenia. IPF can also predict platelets recovery after chemotherapy and successful engraftment. In addition, immature platelets have shown utility in other diseases such as coronary artery diseases, bacterial infections and liver diseases. Despite all these advantages, immature platelet fraction can be increased in some cases of thrombocytopenia characterized by platelets hypoproduction. The aim of this review is to present the immature platelet fraction contribution in clinical practice.
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Affiliation(s)
- Naoufal Benlachgar
- Department of Clinical Haematology, Military Hospital of Instruction Mohamed V, Rabat, Morocco.
| | - Kamal Doghmi
- Department of Clinical Haematology, Military Hospital of Instruction Mohamed V, Rabat, Morocco
| | - Azlarab Masrar
- Central laboratory of hematology, Ibn Sina Hospital, University Mohamed V of Medicine, Rue Lamfadel Cherkaoui, BP 6527 Rabat, Morocco
| | - El Mehdi Mahtat
- Department of Clinical Haematology, Military Hospital of Instruction Mohamed V, Rabat, Morocco
| | - Hicham Harmouche
- Internal Medicine Department, Ibn Sina Hospital, University Mohamed V of Medicine, Rue Lamfadel Cherkaoui, BP 6527 Rabat, Morocco
| | - Zoubida Tazi Mezalek
- Internal Medicine Department, Ibn Sina Hospital, University Mohamed V of Medicine, Rue Lamfadel Cherkaoui, BP 6527 Rabat, Morocco
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14
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Baccini V, Geneviève F, Jacqmin H, Chatelain B, Girard S, Wuilleme S, Vedrenne A, Guiheneuf E, Toussaint-Hacquard M, Everaere F, Soulard M, Lesesve JF, Bardet V. Platelet Counting: Ugly Traps and Good Advice. Proposals from the French-Speaking Cellular Hematology Group (GFHC). J Clin Med 2020; 9:jcm9030808. [PMID: 32188124 PMCID: PMC7141345 DOI: 10.3390/jcm9030808] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 03/12/2020] [Accepted: 03/12/2020] [Indexed: 12/25/2022] Open
Abstract
Despite the ongoing development of automated hematology analyzers to optimize complete blood count results, platelet count still suffers from pre-analytical or analytical pitfalls, including EDTA-induced pseudothrombocytopenia. Although most of these interferences are widely known, laboratory practices remain highly heterogeneous. In order to harmonize and standardize cellular hematology practices, the French-speaking Cellular Hematology Group (GFHC) wants to focus on interferences that could affect the platelet count and to detail the verification steps with minimal recommendations, taking into account the different technologies employed nowadays. The conclusions of the GFHC presented here met with a "strong professional agreement" and are explained with their rationale to define the course of actions, in case thrombocytopenia or thrombocytosis is detected. They are proposed as minimum recommendations to be used by each specialist in laboratory medicine who remains free to use more restrictive guidelines based on the patient’s condition.
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Affiliation(s)
- Véronique Baccini
- Laboratoire d’hématologie, CHU de la Guadeloupe, INSERM UMR S_1134, 97159 Pointe-à-Pitre, France
- Correspondence:
| | - Franck Geneviève
- Fédération Hospitalo-Universitaire ‘Grand Ouest Against Leukemia’ (FHU GOAL), 49033 Angers, France;
| | - Hugues Jacqmin
- Université Catholique de Louvain, CHU UCL Namur, Laboratoire d’hématologie, Namur Thrombosis and Hemostasis Center, 5530 Yvoir, Belgium; (H.J.); (B.C.)
| | - Bernard Chatelain
- Université Catholique de Louvain, CHU UCL Namur, Laboratoire d’hématologie, Namur Thrombosis and Hemostasis Center, 5530 Yvoir, Belgium; (H.J.); (B.C.)
| | - Sandrine Girard
- Hospices Civils de Lyon, Centre de biologie et pathologie Est, Service d’hématologie biologique, 69500 Bron, France;
| | - Soraya Wuilleme
- Laboratoire d’Hématologie, Institut de Biologie, CHU de Nantes; 44093 Nantes CEDEX, France;
| | - Aurélie Vedrenne
- Service de biologie clinique, Hôpital Foch, 92150 Suresnes, France;
| | - Eric Guiheneuf
- Service d’Hématologie Biologique, CHU Amiens-Picardie, 80054 Amiens CEDEX, France;
| | | | | | - Michel Soulard
- Plateau technique d’hématologie, Laboratoire Biogroup, 92300 Levallois-Perret, France;
| | | | - Valérie Bardet
- Service d’Hématologie-Immunologie-Transfusion, CHU Ambroise Paré, INSERM UMR 1184, AP-HP, Université Paris Saclay, 92100 Boulogne-Billancourt, France;
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15
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Bobée V, Daliphard S, Schrapp A, Lahary A. Screening of hereditary spherocytosis and pyruvate kinase deficiency by automated blood count using erythrocytic and reticulocytic parameters. Int J Lab Hematol 2018; 40:697-703. [DOI: 10.1111/ijlh.12906] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 05/17/2018] [Accepted: 06/18/2018] [Indexed: 01/19/2023]
Affiliation(s)
- Victor Bobée
- Department of Biological Hematology; Rouen University Hospital; Rouen France
| | - Sylvie Daliphard
- Department of Biological Hematology; Rouen University Hospital; Rouen France
| | - Aurélien Schrapp
- Department of Biological Hematology; Rouen University Hospital; Rouen France
| | - Agnès Lahary
- Department of Biological Hematology; Rouen University Hospital; Rouen France
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16
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Chen W, Ha JP, Hong H, Maitta RW. Absolute immature platelet counts in the setting of suspected heparin-induced thrombocytopenia may predict anti-PF4-heparin immunoassay testing results. Transfus Apher Sci 2018; 57:507-511. [DOI: 10.1016/j.transci.2018.04.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 03/30/2018] [Accepted: 04/01/2018] [Indexed: 12/15/2022]
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17
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Xu K, Chan NC, Hirsh J, Ginsberg JS, Bhagirath V, Kruger P, Dale B, Crowther M, Whitlock RP, Li C, Eikelboom JW. Quantifying immature platelets as markers of increased platelet production after coronary artery bypass grafting surgery. Eur J Haematol 2018; 101:362-367. [DOI: 10.1111/ejh.13109] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2018] [Indexed: 12/30/2022]
Affiliation(s)
- Ke Xu
- Department of Cardiology; The First Affiliated Hospital of Nanjing Medical University; Nanjing Jiangsu China
- Population Health Research Institute; McMaster University; Hamilton Ontario Canada
| | - Noel C. Chan
- Thrombosis and Atherosclerosis Research Institute; McMaster University; Hamilton Ontario Canada
- Department of Medicine; McMaster University; Hamilton Ontario Canada
| | - Jack Hirsh
- Department of Medicine; McMaster University; Hamilton Ontario Canada
| | | | - Vinai Bhagirath
- Population Health Research Institute; McMaster University; Hamilton Ontario Canada
- Department of Medicine; McMaster University; Hamilton Ontario Canada
| | - Paul Kruger
- Population Health Research Institute; McMaster University; Hamilton Ontario Canada
| | - Brian Dale
- Thrombosis and Atherosclerosis Research Institute; McMaster University; Hamilton Ontario Canada
- School of Pharmacy and Medical Sciences; University of South Australia; Adelaide South Australia Australia
| | - Mark Crowther
- Department of Medicine; McMaster University; Hamilton Ontario Canada
| | - Richard P. Whitlock
- Population Health Research Institute; McMaster University; Hamilton Ontario Canada
- Department of Surgery; Hamilton General Hospital; Hamilton Ontario Canada
| | - Chunjian Li
- Department of Cardiology; The First Affiliated Hospital of Nanjing Medical University; Nanjing Jiangsu China
| | - John W. Eikelboom
- Population Health Research Institute; McMaster University; Hamilton Ontario Canada
- Thrombosis and Atherosclerosis Research Institute; McMaster University; Hamilton Ontario Canada
- Department of Medicine; McMaster University; Hamilton Ontario Canada
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18
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Abstract
Platelets play a key role in the pathophysiology of coronary artery disease and acute coronary syndromes. Our understanding of platelet function in thrombus formation has increased considerably, resulting in the development of clinically effective treatment strategies and identification of new targets. An underappreciated platelet function is their contribution toward acute and chronic inflammatory processes including atherogenesis. In this review, we discuss the role of platelets in atherosclerosis and thrombosis, platelet function testing, and the pharmacology of currently available antiplatelet drugs.
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19
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Delaney M, Matthews DC, Gernsheimer TB. The use of antifibrinolytics in pediatric patients with hypoproliferative thrombocytopenia. Pediatr Blood Cancer 2017; 64. [PMID: 28544698 DOI: 10.1002/pbc.26641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 03/25/2017] [Accepted: 04/18/2017] [Indexed: 01/19/2023]
Abstract
Despite the use of evidence-based platelet transfusion therapy during periods of hypoproliferative thrombocytopenia, a large proportion of pediatric hematology/oncology patients continue to suffer from clinically significant bleeding. Antifibrinolytic (AF) drugs have been shown in certain surgical and trauma settings to decrease bleeding, blood transfusion, and improve survival. We conducted a retrospective assessment of the safety of using AF drugs in pediatric patients with hypoproliferative thrombocytopenia at our center as well as the impact on bleeding occurrence and severity.
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Affiliation(s)
- Meghan Delaney
- Department of Pathology & Laboratory Medicine, Seattle Children's Hospital, Seattle, Washington.,Department of Laboratory Medicine, University of Washington, Seattle, Washington.,Bloodworks Northwest, Seattle, Washington
| | - Dana C Matthews
- Division of Hematology & Oncology, Department of Pediatrics, University of Washington, Seattle, WA.,Cancer and Blood Disorders Center, Seattle Children's Hospital, Seattle, Washington
| | - Terry B Gernsheimer
- Division of Hematology, Department of Medicine, University of Washington, Seattle, Washington.,Seattle Cancer Care Alliance, Seattle, WA
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20
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Kurahashi H, Takami A, Murotani K, Numoto S, Okumura A. Decreased platelet count in children with epilepsy treated with valproate and its relationship to the immature platelet fraction. Int J Hematol 2017; 107:105-111. [DOI: 10.1007/s12185-017-2323-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Revised: 08/14/2017] [Accepted: 08/22/2017] [Indexed: 11/30/2022]
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21
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Tang YT, He P, Li YZ, Chen HZ, Chang XL, Xie QD, Jiao XY. Diagnostic value of platelet indices and bone marrow megakaryocytic parameters in immune thrombocytopenic purpura. Blood Coagul Fibrinolysis 2017; 28:83-90. [PMID: 27926581 DOI: 10.1097/mbc.0000000000000612] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Platelet indices could mirror megakaryopoietic activity in immune thrombocytopenic purpura (ITP), but its specificity and sensitivity need to be studied. The diagnostic performance of platelet indices was analyzed by receiver-operating characteristic curves, and the probability of true positive (sensitivity) and true negative (specificity) in predicting ITP, myelodysplasia, or controls was determined. Mean platelet volume (MPV) was higher, whereas plateletcrit (PCT) was significantly lower in ITP than in myelodysplasia and controls. The platelet distribution width in ITP patients was lower than in myelodysplasia, but higher than in controls. Increased megakaryocytes were only observed in ITP. A strong positive correlation was found between MPV and quantities of granular megakaryocytes, whereas a negative relationship existed between MPV and platelet-form megakaryocytes. In receiver-operating characteristic analysis, MPV and PCT gave a sensitivity of 70.3% (89.8%) and specificity of 74.8% (84.7%) at a cutoff of 9.35 (0.085) in diagnosis of ITP. Combined parallel test of MPV and PCT increased the sensitivity to 97.5 with 64.1% specificity, whereas series test increased the specificity to 94.7 with 62.7% sensitivity. Our results suggest that MPV, PCT, and platelet distribution width represent megakaryopoietic activity in bone marrow and may be reliable markers in ITP diagnosis.
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Affiliation(s)
- Yue-Ting Tang
- aLaboratory Medicine Center, Nangfang Hospital, Southern Medical University, Guangzhou bDepartment of Cell Biology and Genetics, Shantou University Medical College cShantou University Medical College, Shantou, Guangdong, China
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22
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Grotto HZW. Platelet and reticulocyte new parameters: why and how to use them? Rev Bras Hematol Hemoter 2016; 38:283-284. [PMID: 27863753 PMCID: PMC5119670 DOI: 10.1016/j.bjhh.2016.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 08/02/2016] [Indexed: 11/25/2022] Open
Affiliation(s)
- Helena Zerlotti Wolf Grotto
- Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil; Sysmex Latin America & The Caribbean, São Paulo, SP, Brazil.
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23
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Jaing TH, Chen SH, Wen YC, Chang TY, Huang JL, Tsay PK. Assessment of Platelet Activation and Immature Platelet Fraction as Predictors of Platelet Engraftment After Hematopoietic Stem Cell Transplantation. Cell Transplant 2016; 25:1259-64. [PMID: 26765743 DOI: 10.3727/096368916x690412] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Delayed platelet engraftment is a well-known complication of umbilical cord blood transplantation (CBT). Megakaryocytes derived from cord blood (CB) in vitro are smaller than megakaryocytes derived from bone marrow (BM) in adults. A small megakaryocyte size might contribute to delayed megakaryocytic maturation. This study included 37 patients undergoing hematopoietic stem cell transplantation (HSCT) at Chang Gung Children's Hospital between July 2011 and June 2013. Blood samples were obtained at different times: preconditioning and post-HSCT days 56 and 97. To test whether platelet activation persists posttransplantation, two commonly used platelet activation marker antibodies, CD62P (P-selectin) and CD42b, were evaluated using whole blood flow cytometry, combining thiazole orange and anti-CD41a staining, to assess reticulated platelets. Serial peripheral blood (PB) samples were obtained posttransplantation from patients undergoing CBT (CBT group; n = 15) and mobilized peripheral blood transplantation (PBT group; n = 22). Platelet activation in the postengraftment samples was considerably higher in the PBT group than the CBT group. Moreover, immature platelet fractions (IPF) were higher in the CBT group. Our results emphasize the role of IPF for dynamic prediction of platelet engraftment in CBT.
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Affiliation(s)
- Tang-Her Jaing
- Division of Hematology/Oncology, Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung University, Linkou, Taoyuan, Taiwan
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24
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25
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Adly AAM, Ragab IA, Ismail EAR, Farahat MM. Evaluation of the immature platelet fraction in the diagnosis and prognosis of childhood immune thrombocytopenia. Platelets 2014; 26:645-50. [DOI: 10.3109/09537104.2014.969220] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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26
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Zhen XE, Zong M, Gao SN, Cao YG, Jiang L, Chen SX, Wang K, Sun SQ, Peng HS, Bai YH, Li S. Preparation and characterization of a novel aspirin derivative with anti-thrombotic and gastric mucosal protection properties. PLoS One 2014; 9:e98513. [PMID: 24892779 PMCID: PMC4043976 DOI: 10.1371/journal.pone.0098513] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 05/01/2014] [Indexed: 12/20/2022] Open
Abstract
The use of acetylsalicylic acid (ASP) is limited by its adverse effects, especially the effect on the gastric mucosa. To address this problem, we synthesized a derivative form of ASP, prepared by modification of ASP with nano-hydroxyapatite (a kind of inorganic particle containing Ca(2+)). The derivative was named Ca-ASP. Structural study showed that Ca-ASP was a kind of carboxylate containing intramolecular hydrogen bonds. Rats given a high dose of Ca-ASP (5 mmol per kg body weight) showed similar anti-thrombotic activity as those given the same dose of ASP, but had much lower gastric mucosal damage than ASP (UI: 2 versus UI: 12.5). These rats also showed reduced expression of COX-2, but their COX-1 expression was similar to that of control rats, but significantly higher than that of ASP-administered rats. Furthermore, the level of prostaglandin E2 (PGE2) was up-regulated in Ca-ASP-administered rats compared to ASP-administered rats. Taken together, the results showed that Ca-ASP possessed similar antithrombotic activity as ASP but without the side effect associated with ASP, and the underlying mechanism may center on inhibiting COX-2 without inhibiting COX-1, and thus favouring the production of PGE2, the prostaglandin that plays a vital role in the suppression of platelet aggregation and thrombosis, as well as in the repair of gastric damage.
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Affiliation(s)
- Xi-E Zhen
- Department of Pharmaceutics, Daqing Branch, Harbin Medical University, Daqing, China
| | - Ming Zong
- Department of Pharmaceutics, Daqing Branch, Harbin Medical University, Daqing, China
| | - Sai-Nan Gao
- Department of Pharmaceutics, Daqing Branch, Harbin Medical University, Daqing, China
| | - Yong-Gang Cao
- Department of Pharmaceutics, Daqing Branch, Harbin Medical University, Daqing, China
| | - Lei Jiang
- Department of Pharmaceutics, Daqing Branch, Harbin Medical University, Daqing, China
| | - Shu-Xin Chen
- Department of Pharmaceutics, Daqing Branch, Harbin Medical University, Daqing, China
| | - Kuan Wang
- Department of Pharmaceutics, Daqing Branch, Harbin Medical University, Daqing, China
| | - Shi-Qin Sun
- Department of Pharmaceutics, Daqing Branch, Harbin Medical University, Daqing, China
| | - Hai-Sheng Peng
- Department of Pharmaceutics, Daqing Branch, Harbin Medical University, Daqing, China
| | - Yu-Hua Bai
- Department of Pharmaceutics, Daqing Branch, Harbin Medical University, Daqing, China
| | - Sen Li
- Department of Pharmaceutics, Daqing Branch, Harbin Medical University, Daqing, China
- * E-mail:
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27
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Estcourt LJ, Stanworth SJ, Harrison P, Powter G, McClure M, Murphy MF, Mumford AD. Prospective observational cohort study of the association between thromboelastometry, coagulation and platelet parameters and bleeding in patients with haematological malignancies- The ATHENA study. Br J Haematol 2014; 166:581-91. [DOI: 10.1111/bjh.12928] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 03/24/2014] [Indexed: 11/25/2022]
Affiliation(s)
- Lise J. Estcourt
- NHS Blood and Transplant; Oxford UK
- Radcliffe Department of Medicine; University of Oxford; Oxford UK
| | - Simon J. Stanworth
- NHS Blood and Transplant; Oxford UK
- Radcliffe Department of Medicine; University of Oxford; Oxford UK
| | - Paul Harrison
- School of Immunity and Infection; College of Medical and Dental Sciences; University of Birmingham; Birmingham UK
| | | | - Marianne McClure
- Haematology Department; University of Oxford Hospitals NHS Trust; Oxford UK
| | - Michael F. Murphy
- NHS Blood and Transplant; Oxford UK
- Radcliffe Department of Medicine; University of Oxford; Oxford UK
| | - Andrew D. Mumford
- School of Cellular and Molecular Medicine; University of Bristol; Bristol UK
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