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Wu YF, Shen CL, Huang WH, Chu SC, Li CC, Liu CZ, Wang TF. Improving platelet function following prophylactic platelet transfusion in patients with hematological malignancies. Int J Lab Hematol 2024. [PMID: 38682289 DOI: 10.1111/ijlh.14283] [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: 11/18/2023] [Accepted: 04/01/2024] [Indexed: 05/01/2024]
Abstract
INTRODUCTION Platelet transfusion is a standard treatment to prevent bleeding in patients with hematological malignancies. Although transfusions can improve platelet count, their impact on platelet function remains controversial. METHODS We conducted flow cytometry to assess platelet function before and after transfusion and performed subgroup analyses to examine differences based on blood type, corrected count increment (CCI), and platelet microparticles. RESULTS Overall, 50 patients who received prophylactic platelet transfusion were enrolled. CD42b expression increased, whereas CD41 expression decreased after transfusion. Apheresis platelets exhibited the lowest expression of PAC-1 and P-selectin when exposed to agonist stimulations. PAC-1 expression increased under high adenosine diphosphate (ADP) stimulation, while P-selectin expression increased under both high ADP and thrombin receptor-activating peptide stimulation. In the subgroup analysis, patients with a CCI >4500 and those with the same blood types exhibited a more significant increase in PAC-1 and P-selectin expression under agonist stimulation. When comparing apheresis platelets collected on different days, only the percentage of platelet-derived microparticles showed a significant increase. CONCLUSION Prophylactic transfusion improved platelet function. Platelet function significantly improved in patients with a CCI >4500, those with the same blood types as that of apheresis platelets, or those with platelet-derived microparticle levels <4.7%. No significant improvement in platelet function was noted after the transfusion of different blood types with acceptable compatibility or the transfusion of incompatible blood types. Our results suggest that transfusing platelets with the same blood type remains the optimal choice.
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Affiliation(s)
- Yi-Feng Wu
- Department of Hematology and Oncology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
- College of Medicine, Tzu-Chi University, Hualien, Taiwan
- Ph.D. Program in Pharmacology and Toxicology, Tzu Chi University, Hualien, Taiwan
| | - Chih-Lung Shen
- Department of Hematology and Oncology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Wei-Han Huang
- Department of Hematology and Oncology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
- Department of Clinical Pathology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Sung-Chao Chu
- Department of Hematology and Oncology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
- College of Medicine, Tzu-Chi University, Hualien, Taiwan
| | - Chi-Cheng Li
- Department of Hematology and Oncology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
- Center of Stem Cell & Precision Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Chao-Zong Liu
- Department of Pharmacology, School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Tso-Fu Wang
- Department of Hematology and Oncology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
- College of Medicine, Tzu-Chi University, Hualien, Taiwan
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Wang YS, Wang W, Zhang S, Zhang SY, Shen AZ, Wang W, Song HC, Yao HZ, Song RP, Meng FZ, Li L, Nashan B, Wang JZ, Liu LX. Clinical efficacy of avatrombopag and recombinant human thrombopoietin in the treatment of chronic liver disease-associated severe thrombocytopenia: A real-world study. Front Pharmacol 2022; 13:1009612. [PMID: 36267268 PMCID: PMC9577549 DOI: 10.3389/fphar.2022.1009612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 09/13/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose: To investigate the clinical efficacy of avatrombopag, an oral thrombopoietin receptor agonist, versus subcutaneous recombinant human thrombopoietin (rh-TPO) in the treatment of severe thrombocytopenia (TCP) associated with chronic liver disease (CLD).Methods: Clinical data of 250 patients with severe TCP associated with CLD were collected in a single hospital from January 2019 to January 2022. The main parameters measured were the therapeutic response rate, changes in platelets (PLTs), and adverse events. Propensity score matching (PSM) was used to avoid possible selection bias.Results: After PSM, a total of 154 patients were enrolled in the study: 77 in the avatrombopag group and 77 in the rh-TPO group. There was no statistically significant difference between the two groups in the effect of increasing the PLT count (Waldχ2 = 1.659, p = 0.198; Waldχ2 = 0.220, p = 0.639). In addition, no interaction between time and different medications was found (Waldχ2 = 0.540, p = 0.910; Waldχ2 = 1.273, p = 0.736). Interestingly, in the subgroup analysis, both before and after PSM, avatrombopag showed better clinical efficacy than rh-TPO in the treatment of TCP associated with CLD in Child‒Pugh Class A (88.89% vs. 63.41%, p =0.003; 81.33% vs. 61.76%, p = 0.043). Fewer patients reported dizziness in the avatrombopag group than in the rh-TPO group both before and after PSM (7.8% vs. 25.0%; 7.8% vs. 24.7%, p < 0.05).Conclusion: Both before and after PSM, avatrombopag showed better clinical efficacy than rh-TPO in the treatment of TCP associated with CLD in Child‒Pugh Class A and showed a lower incidence of dizziness in all patients.
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Affiliation(s)
- Yong-Shuai Wang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Wei Wang
- Department of Pharmacy, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Sai Zhang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Shen-Yu Zhang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Ai-Zong Shen
- Department of Pharmacy, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Wei Wang
- Department of Pathology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Hua-Chuan Song
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Huan-Zhang Yao
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Rui-Peng Song
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Fan-Zheng Meng
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Lei Li
- Department of Infectious Disease, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Bjoern Nashan
- Department of Organ transplant center, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Ji-Zhou Wang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
- Anhui Province Key Laboratory of Hepatopancreatobiliary Surgery, Hefei, Anhui, China
- *Correspondence: Ji-Zhou Wang, ; Lian-Xin Liu,
| | - Lian-Xin Liu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
- Anhui Province Key Laboratory of Hepatopancreatobiliary Surgery, Hefei, Anhui, China
- *Correspondence: Ji-Zhou Wang, ; Lian-Xin Liu,
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Sun LH, Bai KH, Wu GY, Tian XP, Zou ZQ, Wang DW, Dai YJ, Chen SL. Mechanism of Abnormal Coagulation Induced by Tigecycline in Cancer Patients. Front Pharmacol 2022; 13:891952. [PMID: 35865948 PMCID: PMC9294380 DOI: 10.3389/fphar.2022.891952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 05/04/2022] [Indexed: 11/23/2022] Open
Abstract
Tigecycline is a broad-spectrum active intravenous antibiotic that is active against methicillin-resistant staphylococcus aureus. In Phase 3 and 4 clinical trials, increased all-cause mortality was observed in patients treated with tigecycline compared to patients in the control group. The reason for the increase is unclear. In this study, we found that tigecycline cause abnormal coagulation in tumor patients, especially in patients with hematological malignancies. The main manifestations were decreased fibrinogen and prolonged activated prothrombin time (APTT), thrombin time (TT), and D-dimer. In addition, through functional studies, we found that tigecycline inhibit platelet adhesion and aggregation, and the coagulation function of patients gradually recover after discontinuation. Gene sequencing results suggested that tigecycline significantly regulate the expression of genes related to platelet function pathways and increase the incidence of single nucleotide polymorphisms and the number of alternative splices in the Chinese hamster ovary (CHO) cells treated with tigecycline. An abnormal function and low numbers of platelets are common in patients with hematological malignancies. Our study can explain the mechanism of abnormal coagulation caused by tigecycline. Additionally, doctors who apply tigecycline to cure infections in tumor patients should be warned.
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Affiliation(s)
- Li-Hua Sun
- Department of Hematology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Kun-Hao Bai
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
- Department of Endoscopy, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Guo-Yan Wu
- Department of Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiao-Peng Tian
- Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Zhi-Qing Zou
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Da-Wei Wang
- State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, National Research Center for Translational Medicine at Shanghai, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yu-Jun Dai
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
- Department of Hematologic Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China
- *Correspondence: Yu-Jun Dai , ; Si-Liang Chen ,
| | - Si-Liang Chen
- Department of Hematology, Peking University Shenzhen Hospital, Shenzhen, China
- *Correspondence: Yu-Jun Dai , ; Si-Liang Chen ,
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Sabljic N, Pantic N, Virijevic M, Bukumiric Z, Novakovic T, Pravdic Z, Rajic J, Vidovic A, Suvajdzic N, Jaradeh M, Fareed J, Antic D, Mitrovic M. Application of Rotational Thromboelastometry in Patients with Acute Promyelocytic Leukemia. Clin Appl Thromb Hemost 2022; 28:10760296221119809. [PMID: 35942712 PMCID: PMC9373117 DOI: 10.1177/10760296221119809] [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] [Indexed: 11/17/2022] Open
Abstract
Introduction Hemorrhagic early death (HED) remains a major cause of treatment failure
among patients with acute promyelocytic leukemia (APL). We aimed to
investigate the prognostic potential of rotational thromboelastometry
(ROTEM) for bleeding in patients with APL. Materials and Methods 31 newly-diagnosed APL patients (median age of 40 years; 14 female/17 male)
that underwent treatment at the Clinic of Hematology UCCS from 2016-2020
with all-trans retinoic acid and anthracyclines were recruited. CBCs
(complete blood count), conventional coagulation tests (CCTs), and ROTEM
parameters obtained before treatment initiation were evaluated. Results All patients demonstrated at least one ROTEM parameter out of the reference
range. ROTEM parameters associated with significant hemorrhage were EXTEM
clotting time (CT) (P = 0.041) and INTEM amplitude 10 (A10) (P = 0.039),
however, only EXTEM CT (P = 0.036) was associated with HED. Among CBCs and
CCTs, only platelets were associated with significant bleeding (P = 0.015),
while D-dimer was associated with both bleeding and HED (P = 0.001 and
P = 0.002, respectively). Conclusion Our results indicate that ROTEM parameters may reveal hypocoagulability in
APL patients and have the potential to improve current hemorrhage prognostic
methods. Additionally, these results suggest the combination of ROTEM and
CCTs might be useful in identifying patients at risk for HED.
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Affiliation(s)
- Nikica Sabljic
- Clinic of Hematology, 63740University Clinical Center of Serbia, Belgrade, Serbia
| | - Nikola Pantic
- Clinic of Hematology, 63740University Clinical Center of Serbia, Belgrade, Serbia
| | - Marijana Virijevic
- Clinic of Hematology, 63740University Clinical Center of Serbia, Belgrade, Serbia.,Faculty of Medicine, 54801University of Belgrade, Belgrade, Serbia
| | - Zoran Bukumiric
- Faculty of Medicine, 54801University of Belgrade, Belgrade, Serbia.,Faculty of Medicine, Institute for medical statistics and informatics, 54801University of Belgrade, Beograd, Serbia
| | - Tina Novakovic
- Clinic of Vascular Surgery, 63740University Clinical Center of Serbia, Belgrade, Serbia
| | - Zlatko Pravdic
- Clinic of Hematology, 63740University Clinical Center of Serbia, Belgrade, Serbia
| | - Jovan Rajic
- Clinic of Hematology, 63740University Clinical Center of Serbia, Belgrade, Serbia
| | - Ana Vidovic
- Clinic of Hematology, 63740University Clinical Center of Serbia, Belgrade, Serbia.,Faculty of Medicine, 54801University of Belgrade, Belgrade, Serbia
| | - Nada Suvajdzic
- Clinic of Hematology, 63740University Clinical Center of Serbia, Belgrade, Serbia.,Faculty of Medicine, 54801University of Belgrade, Belgrade, Serbia
| | - Mark Jaradeh
- Department of Molecular Pharmacology & Neuroscience, 25815Loyola University Medical Center, Maywood, USA
| | - Jawed Fareed
- Department of Molecular Pharmacology & Neuroscience, 25815Loyola University Medical Center, Maywood, USA
| | - Darko Antic
- Clinic of Hematology, 63740University Clinical Center of Serbia, Belgrade, Serbia.,Faculty of Medicine, 54801University of Belgrade, Belgrade, Serbia
| | - Mirjana Mitrovic
- Clinic of Hematology, 63740University Clinical Center of Serbia, Belgrade, Serbia.,Faculty of Medicine, 54801University of Belgrade, Belgrade, Serbia
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