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Pidcoke HF, Delacruz W, Herzig MC, Schaffer BS, Leazer ST, Fedyk CG, Montogomery RK, Prat NJ, Parida BK, Aden JK, Scherer MR, Reddick RL, Shade RE, Cap AP. Perfluorocarbons cause thrombocytopenia, changes in RBC morphology and death in a baboon model of systemic inflammation. PLoS One 2022; 17:e0279694. [PMID: 36584001 PMCID: PMC9803179 DOI: 10.1371/journal.pone.0279694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 12/13/2022] [Indexed: 12/31/2022] Open
Abstract
A perfluorocarbon (PFC) investigated for treatment of traumatic brain injury (TBI) delivers oxygen to support brain function, but causes transient thrombocytopenia. TBI can cause acute inflammation with resulting thrombocytopenia; an interaction between the PFC effects and TBI inflammation might exacerbate thrombocytopenia. Therefore, PFC effects on platelet (PLT) function and hemostasis in a lipopolysaccharide (LPS) model of inflammation in the baboon were studied. Animals were randomized to receive saline ±LPS, and ± one of two doses of PFC. PLT count, transmission electron microscopy, and microparticle populations were quantified at baseline (BL) and at 2, 24, 48, 72, and 96 hours; hemostatic parameters for aggregometry and for blood clotting were measured at baseline (BL) and days 3 and 4. Injection of vehicle and LPS caused thrombocytopenia within hours; PFCs caused delayed thrombocytopenia beginning 48 hours post-infusion. LPS+PFC produced a more prolonged PLT decline and decreased clot strength. LPS+PFC increased ADP-stimulated aggregation, but PFC alone did not. Microparticle abundance was greatest in the LPS+PFC groups. LPS+PFC caused diffuse microvascular hemorrhage and death in 2 of 5 baboons in the low dose LPS-PFC group and 2 of 2 in the high dose LPS-PFC group. Necropsy and histology suggested death was caused by shock associated with hemorrhage in multiple organs. Abnormal morphology of platelets and red blood cells were notable for PFC inclusions. In summary, PFC infusion caused clinically significant thrombocytopenia and exacerbated LPS-induced platelet activation. The interaction between these effects resulted in decreased hemostatic capacity, diffuse bleeding, shock and death.
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Affiliation(s)
- Heather F. Pidcoke
- Blood and Shock Resuscitation, U.S. Army Institute of Surgical Research, Fort Sam Houston, TX, United States of America
| | - Wilfred Delacruz
- Hematology-Oncology Service, San Antonio Military Medical Center, Fort Sam Houston, TX, United States of America
| | - Maryanne C. Herzig
- Blood and Shock Resuscitation, U.S. Army Institute of Surgical Research, Fort Sam Houston, TX, United States of America
| | - Beverly S. Schaffer
- Blood and Shock Resuscitation, U.S. Army Institute of Surgical Research, Fort Sam Houston, TX, United States of America
| | - Sahar T. Leazer
- Blood and Shock Resuscitation, U.S. Army Institute of Surgical Research, Fort Sam Houston, TX, United States of America
| | - Chriselda G. Fedyk
- Blood and Shock Resuscitation, U.S. Army Institute of Surgical Research, Fort Sam Houston, TX, United States of America
| | - Robbie K. Montogomery
- Blood and Shock Resuscitation, U.S. Army Institute of Surgical Research, Fort Sam Houston, TX, United States of America
| | - Nicolas J. Prat
- Blood and Shock Resuscitation, U.S. Army Institute of Surgical Research, Fort Sam Houston, TX, United States of America
| | - Bijaya K. Parida
- Blood and Shock Resuscitation, U.S. Army Institute of Surgical Research, Fort Sam Houston, TX, United States of America
| | - James K. Aden
- Blood and Shock Resuscitation, U.S. Army Institute of Surgical Research, Fort Sam Houston, TX, United States of America
| | - Michael R. Scherer
- Blood and Shock Resuscitation, U.S. Army Institute of Surgical Research, Fort Sam Houston, TX, United States of America
| | - Robert L. Reddick
- Department of Pathology and Laboratory Medicine, University of Texas, Health Science Center, San Antonio, TX, United States of America
| | - Robert E. Shade
- Southwest National Primate Research Center, Texas Biomedical Research Institute, San Antonio, TX, United States of America
| | - Andrew P. Cap
- Blood and Shock Resuscitation, U.S. Army Institute of Surgical Research, Fort Sam Houston, TX, United States of America
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