|
1
|
Van Den Helm S, McCafferty C, Letunica N, Chau KY, Monagle P, Ignjatovic V. Platelet function in neonates and children. Thromb Res 2023; 231:236-246. [PMID: 36997443 DOI: 10.1016/j.thromres.2023.03.005] [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: 09/02/2022] [Revised: 11/22/2022] [Accepted: 03/17/2023] [Indexed: 03/29/2023]
Abstract
Platelets are major regulators of haemostasis and coagulation. The primary role of platelets in coagulation is to form a stable clot and stop bleeding. Studies of platelet phenotype and function in neonates and children have been restricted by the large volumes required for many common platelet function tests such as platelet aggregometry. Developmental changes in platelets have not been as well described as developmental changes in plasma coagulation proteins, and overall, platelet phenotype and function in neonates and children has been understudied when compared to adults. Recent developments in more sensitive platelet function testing methods requiring smaller blood volumes such as flow cytometry has enabled recent studies to further investigate platelet phenotype and function in neonates and children. In this review we will provide an overview of recent advances from the past five years in platelets in the context of developmental haemostasis, as well as the role of platelets in neonatal paediatric disease.
Collapse
Affiliation(s)
- Suelyn Van Den Helm
- Haematology Research, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Conor McCafferty
- Haematology Research, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Natasha Letunica
- Haematology Research, Murdoch Children's Research Institute, Melbourne, Australia
| | - Ka Ying Chau
- Haematology Research, Murdoch Children's Research Institute, Melbourne, Australia
| | - Paul Monagle
- Haematology Research, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Australia; Department of Clinical Haematology, The Royal Children's Hospital, Melbourne, Australia; Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | - Vera Ignjatovic
- Haematology Research, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Australia; Johns Hopkins All Children's Hospital, St Petersburg, USA.
| |
Collapse
|
|
2
|
Khizroeva J, Makatsariya A, Vorobev A, Bitsadze V, Elalamy I, Lazarchuk A, Salnikova P, Einullaeva S, Solopova A, Tretykova M, Antonova A, Mashkova T, Grigoreva K, Kvaratskheliia M, Yakubova F, Degtyareva N, Tsibizova V, Gashimova N, Blbulyan D. The Hemostatic System in Newborns and the Risk of Neonatal Thrombosis. Int J Mol Sci 2023; 24:13864. [PMID: 37762167 PMCID: PMC10530883 DOI: 10.3390/ijms241813864] [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: 07/28/2023] [Revised: 09/04/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
Newborns are the most vulnerable patients for thrombosis development among all children, with critically ill and premature infants being in the highest risk group. The upward trend in the rate of neonatal thrombosis could be attributed to progress in the treatment of severe neonatal conditions and the increased survival in premature babies. There are physiological differences in the hemostatic system between neonates and adults. Neonates differ in concentrations and rate of synthesis of most coagulation factors, turnover rates, the ability to regulate thrombin and plasmin, and in greater variability compared to adults. Natural inhibitors of coagulation (protein C, protein S, antithrombin, heparin cofactor II) and vitamin K-dependent coagulation factors (factors II, VII, IX, X) are low, but factor VIII and von Willebrand factor are elevated. Newborns have decreased fibrinolytic activity. In the healthy neonate, the balance is maintained but appears more easily converted into thrombosis. Neonatal hemostasis has less buffer capacity, and almost 95% of thrombosis is provoked. Different triggering risk factors are responsible for thrombosis in neonates, but the most important risk factors for thrombosis are central catheters, fluid fluctuations, liver dysfunction, and septic and inflammatory conditions. Low-molecular-weight heparins are the agents of choice for anticoagulation.
Collapse
Affiliation(s)
- Jamilya Khizroeva
- Department of Obstetrics, Gynecology and Perinatal Medicine, N.F. Filatov Clinical Institute of Children’s Health, I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str. 8-2, 119991 Moscow, Russia; (A.M.); (A.V.); (V.B.); (I.E.); (A.L.); (P.S.); (S.E.); (A.S.); (M.T.); (A.A.); (T.M.); (K.G.); (M.K.); (F.Y.); (N.D.); (N.G.); (D.B.)
| | - Alexander Makatsariya
- Department of Obstetrics, Gynecology and Perinatal Medicine, N.F. Filatov Clinical Institute of Children’s Health, I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str. 8-2, 119991 Moscow, Russia; (A.M.); (A.V.); (V.B.); (I.E.); (A.L.); (P.S.); (S.E.); (A.S.); (M.T.); (A.A.); (T.M.); (K.G.); (M.K.); (F.Y.); (N.D.); (N.G.); (D.B.)
| | - Alexander Vorobev
- Department of Obstetrics, Gynecology and Perinatal Medicine, N.F. Filatov Clinical Institute of Children’s Health, I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str. 8-2, 119991 Moscow, Russia; (A.M.); (A.V.); (V.B.); (I.E.); (A.L.); (P.S.); (S.E.); (A.S.); (M.T.); (A.A.); (T.M.); (K.G.); (M.K.); (F.Y.); (N.D.); (N.G.); (D.B.)
| | - Victoria Bitsadze
- Department of Obstetrics, Gynecology and Perinatal Medicine, N.F. Filatov Clinical Institute of Children’s Health, I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str. 8-2, 119991 Moscow, Russia; (A.M.); (A.V.); (V.B.); (I.E.); (A.L.); (P.S.); (S.E.); (A.S.); (M.T.); (A.A.); (T.M.); (K.G.); (M.K.); (F.Y.); (N.D.); (N.G.); (D.B.)
| | - Ismail Elalamy
- Department of Obstetrics, Gynecology and Perinatal Medicine, N.F. Filatov Clinical Institute of Children’s Health, I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str. 8-2, 119991 Moscow, Russia; (A.M.); (A.V.); (V.B.); (I.E.); (A.L.); (P.S.); (S.E.); (A.S.); (M.T.); (A.A.); (T.M.); (K.G.); (M.K.); (F.Y.); (N.D.); (N.G.); (D.B.)
- Hematology and Thrombosis Center, Tenon Hospital, Sorbonne University, 4 Rue de la Chine, 75020 Paris, France
| | - Arina Lazarchuk
- Department of Obstetrics, Gynecology and Perinatal Medicine, N.F. Filatov Clinical Institute of Children’s Health, I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str. 8-2, 119991 Moscow, Russia; (A.M.); (A.V.); (V.B.); (I.E.); (A.L.); (P.S.); (S.E.); (A.S.); (M.T.); (A.A.); (T.M.); (K.G.); (M.K.); (F.Y.); (N.D.); (N.G.); (D.B.)
| | - Polina Salnikova
- Department of Obstetrics, Gynecology and Perinatal Medicine, N.F. Filatov Clinical Institute of Children’s Health, I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str. 8-2, 119991 Moscow, Russia; (A.M.); (A.V.); (V.B.); (I.E.); (A.L.); (P.S.); (S.E.); (A.S.); (M.T.); (A.A.); (T.M.); (K.G.); (M.K.); (F.Y.); (N.D.); (N.G.); (D.B.)
| | - Sabina Einullaeva
- Department of Obstetrics, Gynecology and Perinatal Medicine, N.F. Filatov Clinical Institute of Children’s Health, I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str. 8-2, 119991 Moscow, Russia; (A.M.); (A.V.); (V.B.); (I.E.); (A.L.); (P.S.); (S.E.); (A.S.); (M.T.); (A.A.); (T.M.); (K.G.); (M.K.); (F.Y.); (N.D.); (N.G.); (D.B.)
| | - Antonina Solopova
- Department of Obstetrics, Gynecology and Perinatal Medicine, N.F. Filatov Clinical Institute of Children’s Health, I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str. 8-2, 119991 Moscow, Russia; (A.M.); (A.V.); (V.B.); (I.E.); (A.L.); (P.S.); (S.E.); (A.S.); (M.T.); (A.A.); (T.M.); (K.G.); (M.K.); (F.Y.); (N.D.); (N.G.); (D.B.)
| | - Maria Tretykova
- Department of Obstetrics, Gynecology and Perinatal Medicine, N.F. Filatov Clinical Institute of Children’s Health, I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str. 8-2, 119991 Moscow, Russia; (A.M.); (A.V.); (V.B.); (I.E.); (A.L.); (P.S.); (S.E.); (A.S.); (M.T.); (A.A.); (T.M.); (K.G.); (M.K.); (F.Y.); (N.D.); (N.G.); (D.B.)
| | - Alexandra Antonova
- Department of Obstetrics, Gynecology and Perinatal Medicine, N.F. Filatov Clinical Institute of Children’s Health, I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str. 8-2, 119991 Moscow, Russia; (A.M.); (A.V.); (V.B.); (I.E.); (A.L.); (P.S.); (S.E.); (A.S.); (M.T.); (A.A.); (T.M.); (K.G.); (M.K.); (F.Y.); (N.D.); (N.G.); (D.B.)
| | - Tamara Mashkova
- Department of Obstetrics, Gynecology and Perinatal Medicine, N.F. Filatov Clinical Institute of Children’s Health, I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str. 8-2, 119991 Moscow, Russia; (A.M.); (A.V.); (V.B.); (I.E.); (A.L.); (P.S.); (S.E.); (A.S.); (M.T.); (A.A.); (T.M.); (K.G.); (M.K.); (F.Y.); (N.D.); (N.G.); (D.B.)
| | - Kristina Grigoreva
- Department of Obstetrics, Gynecology and Perinatal Medicine, N.F. Filatov Clinical Institute of Children’s Health, I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str. 8-2, 119991 Moscow, Russia; (A.M.); (A.V.); (V.B.); (I.E.); (A.L.); (P.S.); (S.E.); (A.S.); (M.T.); (A.A.); (T.M.); (K.G.); (M.K.); (F.Y.); (N.D.); (N.G.); (D.B.)
| | - Margaret Kvaratskheliia
- Department of Obstetrics, Gynecology and Perinatal Medicine, N.F. Filatov Clinical Institute of Children’s Health, I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str. 8-2, 119991 Moscow, Russia; (A.M.); (A.V.); (V.B.); (I.E.); (A.L.); (P.S.); (S.E.); (A.S.); (M.T.); (A.A.); (T.M.); (K.G.); (M.K.); (F.Y.); (N.D.); (N.G.); (D.B.)
| | - Fidan Yakubova
- Department of Obstetrics, Gynecology and Perinatal Medicine, N.F. Filatov Clinical Institute of Children’s Health, I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str. 8-2, 119991 Moscow, Russia; (A.M.); (A.V.); (V.B.); (I.E.); (A.L.); (P.S.); (S.E.); (A.S.); (M.T.); (A.A.); (T.M.); (K.G.); (M.K.); (F.Y.); (N.D.); (N.G.); (D.B.)
| | - Natalia Degtyareva
- Department of Obstetrics, Gynecology and Perinatal Medicine, N.F. Filatov Clinical Institute of Children’s Health, I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str. 8-2, 119991 Moscow, Russia; (A.M.); (A.V.); (V.B.); (I.E.); (A.L.); (P.S.); (S.E.); (A.S.); (M.T.); (A.A.); (T.M.); (K.G.); (M.K.); (F.Y.); (N.D.); (N.G.); (D.B.)
| | - Valentina Tsibizova
- Almazov National Medical Research Centre, Health Ministry of Russian Federation, 2 Akkuratova Str., 197341 Saint Petersburg, Russia;
| | - Nilufar Gashimova
- Department of Obstetrics, Gynecology and Perinatal Medicine, N.F. Filatov Clinical Institute of Children’s Health, I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str. 8-2, 119991 Moscow, Russia; (A.M.); (A.V.); (V.B.); (I.E.); (A.L.); (P.S.); (S.E.); (A.S.); (M.T.); (A.A.); (T.M.); (K.G.); (M.K.); (F.Y.); (N.D.); (N.G.); (D.B.)
| | - David Blbulyan
- Department of Obstetrics, Gynecology and Perinatal Medicine, N.F. Filatov Clinical Institute of Children’s Health, I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str. 8-2, 119991 Moscow, Russia; (A.M.); (A.V.); (V.B.); (I.E.); (A.L.); (P.S.); (S.E.); (A.S.); (M.T.); (A.A.); (T.M.); (K.G.); (M.K.); (F.Y.); (N.D.); (N.G.); (D.B.)
| |
Collapse
|
|
3
|
Platelet parameters and the association with morbidity and mortality in Preterm Infants. Pediatr Neonatol 2023; 64:68-74. [PMID: 36207265 DOI: 10.1016/j.pedneo.2022.06.009] [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: 03/07/2022] [Revised: 05/14/2022] [Accepted: 06/14/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND There is growing recognition of the role of platelets in inflammation and immune responses, and platelets have been associated with various cardiovascular diseases. It is also known that neonatal morbidities are related to overall platelet activity, and platelet parameters may have the potential to predict morbidities and mortality in preterm infants. This study aimed to assess the initial platelet parameters and the association with major morbidities and mortality in preterm neonates. METHODS We retrospectively reviewed data from very preterm neonates with a gestational age (GA) <32 weeks who were admitted between June 2020 and May 2021 for platelet parameters (counts, mean platelet volume (MPV), platelet distribution width (PDW) and plateletcrit (platelet counts x MPV/10000(%)) at birth. Major morbidities included early- onset sepsis (EOS) ≤3 days after birth, severe intraventricular hemorrhage (IVH) grade ≥3, and early or overall mortality. RESULTS A total of 197 very preterm neonates were studied. Their mean (±SD) GA was 28.0 ± 2.4 weeks, birth weight was 990 ± 293 g, platelet counts were 245 ± 81 x1000/μL, MPV was 10.0 ± 0.7 fl, PDW was 11.0 ± 1.6 fl, and plateletcrit was 0.24 ± 0.08%. MPV had a weak negative correlation with both GA (r = -0.234, p = 0.001) and BW (r = -0.343, p <0.001). A lower plateletcrit was associated with EOS (0.14 (0.04-0.22) % vs. 0.23 (0.19-0.30) %, p = 0.027), severe IVH ≤7 days after birth (0.18 (0.14-0.27) % vs. 0.23 (0.20-0.30) %, p = 0.022), and early and overall mortality (0.15 (0.20-0.30) % vs. 0.23 (0.20-0.30) %, p = 0.049; 0.20 ± 0.09 % vs. 0.25 ± 0.07 %, p = 0.008). CONCLUSION A lower plateletcrit within 24 hours of birth was associated with EOS, severe IVH ≤7 days after birth, and first-week and overall mortality in very preterm neonates.
Collapse
|
|
4
|
Hovgesen NT, Hviid CVB, Grevsen AK, Hansen AK, Hvas AM. Reduced platelet function in preterm neonates compared with term neonates. Res Pract Thromb Haemost 2022; 6:e12751. [PMID: 35928524 PMCID: PMC9343599 DOI: 10.1002/rth2.12751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 04/25/2022] [Accepted: 05/13/2022] [Indexed: 11/11/2022] Open
Abstract
Background A reduced platelet function might contribute to the longer bleeding time seen in preterm neonates. However, the previously used platelet function testing in neonates is limited due to methodological limitations, mainly caused by difficulties in obtaining adequate blood volume. Therefore, the platelet function in preterm neonates is sparsely investigated. The aim of this study was to compare platelet function in preterm neonates at birth and at expected term age with platelet function in term neonates at birth. Methods We included 43 preterm neonates born at gestational age (GA) 28 + 0 to 34 + 0 and 21 term neonates born at GA 38 + 0 to 41 + 0. Within the first 24 hours of life, 1-1.5 mL peripheral blood was obtained and for preterm neonates, resampling was performed at expected term age (GA 38 + 0 to 41 + 0). Platelet function testing included impedance aggregometry and platelet activation measured by flow cytometry. In addition, platelet count was determined. Results Platelet count and platelet activation were reduced in preterm neonates compared with term neonates at birth, but we found no difference in impedance aggregometry at birth. At expected term age, platelet count and aggregation exceeded term levels, but platelet activation remained impaired in the preterm. Conclusion Preterm neonatal function is decreased at birth and does not seem to reach term levels during the first 4 to 13 weeks of life.
Collapse
Affiliation(s)
- Nadia Thrane Hovgesen
- Thrombosis and Hemostasis Research Unit, Department of Clinical Biochemistry Aarhus University Hospital Aarhus Denmark
| | - Claus V B Hviid
- Thrombosis and Hemostasis Research Unit, Department of Clinical Biochemistry Aarhus University Hospital Aarhus Denmark
| | - Alexander K Grevsen
- Thrombosis and Hemostasis Research Unit, Department of Clinical Biochemistry Aarhus University Hospital Aarhus Denmark
| | - Anne Kirkeby Hansen
- Neonatal Intensive Care Unit, Department of Pediatrics and Adolescent Medicine Aarhus University Hospital Aarhus Denmark
| | - Anne-Mette Hvas
- Thrombosis and Hemostasis Research Unit, Department of Clinical Biochemistry Aarhus University Hospital Aarhus Denmark.,Department of Clinical Medicine Aarhus University Aarhus Denmark
| |
Collapse
|
|
5
|
Neonatal Sepsis and Hemostasis. Diagnostics (Basel) 2022; 12:diagnostics12020261. [PMID: 35204352 PMCID: PMC8871162 DOI: 10.3390/diagnostics12020261] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 01/17/2022] [Accepted: 01/19/2022] [Indexed: 11/17/2022] Open
Abstract
Neonatal sepsis is considered critical for a significant increase in neonatal morbidity and mortality among hospitalized neonates. Neonatal sepsis, in most cases, coexists with coagulopathy, which can prove to be life-threatening. Complex molecular and cellular systems are involved in the cross-talk between inflammation and hemostasis during sepsis. Disturbances in the regulating systems of the vascular endothelium, and platelet–endothelial and platelet–neutrophil interactions play a pivotal role in both inflammation and coagulation. This complex process is poorly understood in neonates. In addition to the developmental maturation of hemostasis and the immune response in neonatal sepsis, a cellular model of hemostasis during sepsis should be taken into account. This review focused on the molecular and cellular mechanisms underlying inflammation and hemostasis during neonatal sepsis, taking the developmental immune response and developmental hemostasis into account in order to provide future diagnostic approaches to be applied in everyday clinical settings. Regarding the diagnostic modalities, we briefly provide the limitations of the currently used conventional coagulation assays, focusing on viscoelastic tests and platelet flow cytometry.
Collapse
|
|
6
|
Veninga A, Baaten CCFMJ, De Simone I, Tullemans BME, Kuijpers MJE, Heemskerk JWM, van der Meijden PEJ. Effects of Platelet Agonists and Priming on the Formation of Platelet Populations. Thromb Haemost 2021; 122:726-738. [PMID: 34689320 PMCID: PMC9197595 DOI: 10.1055/s-0041-1735972] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Platelets from healthy donors display heterogeneity in responsiveness to agonists. The response thresholds of platelets are controlled by multiple bioactive molecules, acting as negatively or positively priming substances. Higher circulating levels of priming substances adenosine and succinate, as well as the occurrence of hypercoagulability, have been described for patients with ischaemic heart disease. Here, we present an improved methodology of flow cytometric analyses of platelet activation and the characterisation of platelet populations following activation and priming by automated clustering analysis.Platelets were treated with adenosine, succinate, or coagulated plasma before stimulation with CRP-XL, 2-MeSADP, or TRAP6 and labelled for activated integrin αIIbβ3 (PAC1), CD62P, TLT1, CD63, and GPIX. The Super-Enhanced Dmax subtraction algorithm and 2% marker (quadrant) setting were applied to identify populations, which were further defined by state-of-the-art clustering techniques (tSNE, FlowSOM).Following activation, five platelet populations were identified: resting, aggregating (PAC1 + ), secreting (α- and dense-granules; CD62P + , TLT1 + , CD63 + ), aggregating plus α-granule secreting (PAC1 + , CD62P + , TLT1 + ), and fully active platelet populations. The type of agonist determined the distribution of platelet populations. Adenosine in a dose-dependent way suppressed the fraction of fully activated platelets (TRAP6 > 2-MeSADP > CRP-XL), whereas succinate and coagulated plasma increased this fraction (CRP-XL > TRAP6 > 2-MeSADP). Interestingly, a subset of platelets showed a constant response (aggregating, secreting, or aggregating plus α-granule secreting), which was hardly affected by the stimulus strength or priming substances.
Collapse
Affiliation(s)
- Alicia Veninga
- Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University, The Netherlands
| | - Constance C F M J Baaten
- Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University, The Netherlands.,Institute for Molecular Cardiovascular Research, University Hospital Aachen, RWTH Aachen University, Germany
| | - Ilaria De Simone
- Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University, The Netherlands.,Institute for Cardiovascular and Metabolic Research, University of Reading, Reading, United Kingdom
| | - Bibian M E Tullemans
- Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University, The Netherlands
| | - Marijke J E Kuijpers
- Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University, The Netherlands.,Thrombosis Expertise Center, Heart and Vascular Center, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Johan W M Heemskerk
- Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University, The Netherlands
| | - Paola E J van der Meijden
- Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University, The Netherlands.,Thrombosis Expertise Center, Heart and Vascular Center, Maastricht University Medical Center, Maastricht, The Netherlands
| |
Collapse
|
|
7
|
Abstract
Neonatal megakaryopoiesis and platelet turnover form a developmentally unique pattern by generating a pool of newly released reticulated platelets from the bone marrow into the circulation. Reticulated platelets are more reactive and hyperaggregable compared to mature platelets, due to their high residual mRNA content, large size, increased expression of platelet surface receptors, and degranulation. The proportion of reticulated platelets in neonates is higher compared to that in adults. Due to the emergence of an uninhibited platelet subpopulation, the newly formed reticulated platelet pool is inherently hyporesponsive to antiplatelets. An elevated population of reticulated platelets is often associated with increased platelet reactivity and is inversely related to high on-treatment platelet reactivity, which can contribute to ischemia. Measurements of the reticulated platelet subpopulation could be a useful indicator of increased tendency for platelet aggregation. Future research is anticipated to define the distinct functional properties of newly formed reticulated or immature platelets in neonates, as well as determine the impact of enhanced platelet turnover and high residual platelet reactivity on the response to antiplatelet agents.
Collapse
Affiliation(s)
- Belay Tesfamariam
- Division of Pharmacology and Toxicology, 372792Center for Drug Evaluation and Research, Silver Spring, MD, USA
| |
Collapse
|
|
8
|
Transfer to the clinic: refining forward programming of hPSCs to megakaryocytes for platelet production in bioreactors. Blood Adv 2021; 5:1977-1990. [PMID: 33843988 DOI: 10.1182/bloodadvances.2020003236] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 01/20/2021] [Indexed: 12/29/2022] Open
Abstract
The production of in vitro-derived platelets has great potential for transfusion medicine. Here, we build on our experience in the forward programming (FoP) of human pluripotent stem cells (hPSCs) to megakaryocytes (MKs) and address several aspects of the complex challenges to bring this technology to the bedside. We first identify clinical-grade hPSC lines that generate MKs efficiently. We design a bespoke media to maximize both production and maturity of MKs and improve platelet output. Crucially, we transition the lentiviral-based FoP of hPSCs to a nonviral inducible system. We also show how small molecules promote a definitive hematopoiesis phenotype during the differentiation process, thereby increasing the quality of the final product. Finally, we generate platelets using a bioreactor designed to reproduce the physical cues that promote platelet production in the bone marrow. We show that these platelets are able to contribute to both thrombus formation in vitro and have a hemostatic effect in thrombocytopenic mice in vivo.
Collapse
|
|
9
|
Abstract
The neonatal hemostatic system is strikingly different from that of adults. Among other differences, neonates exhibit hyporeactive platelets and decreased levels of coagulation factors, the latter translating into prolonged clotting times (PT and PTT). Since pre-term neonates have a high incidence of bleeding, particularly intraventricular hemorrhages, neonatologists frequently administer blood products (i.e., platelets and FFP) to non-bleeding neonates with low platelet counts or prolonged clotting times in an attempt to overcome these "deficiencies" and reduce bleeding risk. However, it has become increasingly clear that both the platelet hyporeactivity as well as the decreased coagulation factor levels are effectively counteracted by other factors in neonatal blood that promote hemostasis (i.e., high levels of vWF, high hematocrit and MCV, reduced levels of natural anticoagulants), resulting in a well-balanced neonatal hemostatic system, perhaps slightly tilted toward a prothrombotic phenotype. While life-saving in the presence of active major bleeding, the administration of platelets and/or FFP to non-bleeding neonates based on laboratory tests has not only failed to decrease bleeding, but has been associated with increased neonatal morbidity and mortality in the case of platelets. In this review, we will present a clinical overview of bleeding in neonates (incidence, sites, risk factors), followed by a description of the key developmental differences between neonates and adults in primary and secondary hemostasis. Next, we will review the clinical tests available for the evaluation of bleeding neonates and their limitations in the context of the developmentally unique neonatal hemostatic system, and will discuss current and emerging approaches to more accurately predict, evaluate and treat bleeding in neonates.
Collapse
Affiliation(s)
- Patricia Davenport
- Division of Newborn Medicine, Boston Children's Hospital, Boston, MA, United States
| | - Martha Sola-Visner
- Division of Newborn Medicine, Boston Children's Hospital, Boston, MA, United States
| |
Collapse
|
|
10
|
Fustolo-Gunnink SF, Roehr CC, Lieberman L, Christensen RD, Van Der Bom JG, Dame C, Del Vecchio A, Keir AK, Curley A, Stanworth SJ, Lopriore E. Platelet and red cell transfusions for neonates: lifesavers or Trojan horses? Expert Rev Hematol 2019; 12:797-800. [PMID: 31423859 DOI: 10.1080/17474086.2019.1657824] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Suzanne F Fustolo-Gunnink
- Sanquin Research, Center for Clinical Transfusion Research, Plesmanlaan 1A , Leiden , the Netherlands.,Department of Pediatric Hematology, Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Pediatric Hematology , Amsterdam , Netherlands
| | - Charles C Roehr
- Medical Sciences Division, Dept. Paediatrics, University of Oxford , Oxford , UK.,Newborn Services, John Radcliffe Hospital , Oxford , UK
| | - Lani Lieberman
- Department of Clinical Pathology, University Health Network, University of Toronto , Toronto , Canada
| | - Robert D Christensen
- Women and Newborn's Clinical Program, Intermountain Healthcare , Salt Lake City , UT , USA
| | - Johanna G Van Der Bom
- Sanquin Research, Center for Clinical Transfusion Research, Plesmanlaan 1A , Leiden , the Netherlands.,Department of Epidemiology, Leiden University Medical Center , Leiden , the Netherlands
| | - Christof Dame
- Department of Neonatology, Charité-Universitätsmedizin Berlin , Berlin , Germany
| | - Antonio Del Vecchio
- Neonatal Intensive Care Unit, Department of Women's and Children's Health, "Di Venere" Hospital of Bari , Bari , Italy
| | - Amy K Keir
- Robinson Research Institute, Adelaide Medical School, University of Adelaide , Adelaide , Australia.,Department of Neonatal Medicine, Women's and Children's Hospital , Adelaide , Australia.,Healthy Mothers, Babies and Children, South Australian Medical and Research Institute , Adelaide , Australia
| | - Anna Curley
- Department of Neonatology, National Maternity Hospital , Dublin , Ireland
| | - Simon J Stanworth
- Transfusion Medicine, National Health Service (NHS) Blood and Transplant , Oxford , UK.,Department of Haematology, Oxford University Hospitals, NHS Foundation Trust , Oxford , UK.,Radcliffe Department of Medicine, University of Oxford, and Oxford BRC Haematology Theme , Oxford , UK
| | - Enrico Lopriore
- Department of Pediatrics, Division of neonatology, Leiden University Medical Center , Leiden , the Netherlands
| |
Collapse
|