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Ali U, Knight G, Chopra M, Tsitsikas DA. Reproducibility and stability of the immature platelet fraction using Sysmex XN-10. Scand J Clin Lab Invest 2024; 84:91-96. [PMID: 38420711 DOI: 10.1080/00365513.2024.2321590] [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: 10/25/2023] [Accepted: 02/18/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND The Immature Platelet Fraction (IPF) is an indicator of thrombopoiesis which is a useful parameter in thrombocytopenia. It demonstrates compensatory mechanisms in production of platelets, but currently not implemented in routine clinical practice. The aim of this study was to establish the reproducibility and stability of IPF, for both percentage (%-IPF) and absolute (A-IPF) measurements.Material/methods: A total of 71 samples, of which 45 for reproducibility and 26 for stability analysis, were assayed for full blood count using the Sysmex XN-10 analyser at room temperature (RT:19-25 °C). For reproducibility analysis, IPF measurements were analysed 11 times by different appraisers using the same sample, while for stability analysis, IPF was measured over fourteen hourly-intervals up to 24 h (n = 21) and then separately extended beyond the point of stability to 72 h (n = 5). RESULTS Reproducibility analysis of %-IPF and A-IPF (n = 45) showed very reliable results, with the range of mean CV% values between 1.25-8.90% and 1.70-9.96%, respectively. On the other hand, overall, stability analysis of %-IPF and A-IPF (n = 21) at RT over 24 h showed reliable results, with pooled mean CV% values of 1.32% and 1.43%, respectively, with no significant difference between %-IPF and A-IPF (p = 0.767 and p = 0.821). All %-IPF and A-IPF values had exceeded the set acceptance criterion of stability (CV% ≥ 10.0%) before 72 h. CONCLUSIONS Overall, %-IPF and A-IPF reproducibility and storage at RT for 24 h predominantly demonstrates the suitability of their usage for testing on the Sysmex XN-series analysers.
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Affiliation(s)
- Usman Ali
- Department of Haematology, The Royal London Hospital, London, UK
| | - Gavin Knight
- School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, UK
| | - Mridula Chopra
- School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, UK
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2
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Bongiovanni D, Novelli L, Condello F, Kirmes K, Han J, Wein B, Elvinger S, Viggiani G, von Scheidt M, Laugwitz KL, Raake PWJ, Kastrati A, Chiarito M, Bernlochner I. Reticulated Platelets Predict Cardiovascular Death and Adverse Events in Coronary Artery Disease: A Systematic Review and Meta-analysis. Thromb Haemost 2024; 124:310-319. [PMID: 37696301 DOI: 10.1055/s-0043-1773763] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
BACKGROUND The pro-thrombotic immature or reticulated platelets (RPs) are known to be elevated in high-risk patients and in different pathological settings. It has been shown that RPs correlate with an insufficient antiplatelet response to antiplatelet agents. RPs are emerging novel predictors of adverse cardiovascular events in cardiovascular disease. This study, using the totality of existing evidence, evaluated the prognostic role of RPs in patients with coronary artery disease. METHODS We performed a systematic review and meta-analysis including trials of acute and chronic coronary syndrome reporting clinical outcomes according to RPs levels in the peripheral blood. We compared patients with elevated RPs (RPshigh) to patients without elevated RPs (RPslow). Odds ratios (ORs) and 95% CIs were used as metric of choice for treatment effects with random-effects models. The primary endpoint was major adverse cardiovascular and cerebrovascular events (MACCE). Secondary endpoints were cardiovascular death, myocardial infarction, ischemic stroke, urgent coronary revascularization and bleedings. RESULTS A total of 7 studies, including 2213 patients, were included. The risk for MACCE was significantly higher in RPshigh compared to RPslow patients (OR 2.67 [1.87; 3.81], I2 = 43.8%). RPshigh were associated with cardiovascular death (OR 2.09 [1.36; 3.22], I2 = 40.4%). No associations for RPshigh were detected with the other singular components of MACCE: myocardial infarction (OR 1.73 [0.89; 3.38] I2 = 60.5%) and stroke (OR 1.72 [0.59; 4.96] I2 = 21%). The risk of bleeding did not differ between groups(OR 0.58 [0.15; 2.22] I2 = 86.1%). CONCLUSION Elevated RPs are significantly associated with increased risk of cardiovascular events and cardiovascular death.
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Affiliation(s)
- Dario Bongiovanni
- Department of Internal Medicine I, Cardiology, University Hospital Augsburg, University of Augsburg, Germany
- Department of Cardiovascular Medicine, Humanitas Clinical and Research Center IRCCS and Humanitas University, Rozzano, Milan, Italy
- Department of Internal Medicine I, School of Medicine, University hospital rechts der Isar, Technical University of Munich, Munich, Germany
| | - Laura Novelli
- Department of Cardiovascular Medicine, Humanitas Clinical and Research Center IRCCS and Humanitas University, Rozzano, Milan, Italy
| | - Francesco Condello
- Department of Cardiovascular Medicine, Humanitas Clinical and Research Center IRCCS and Humanitas University, Rozzano, Milan, Italy
| | - Kilian Kirmes
- Department of Internal Medicine I, School of Medicine, University hospital rechts der Isar, Technical University of Munich, Munich, Germany
| | - Jiaying Han
- Department of Internal Medicine I, School of Medicine, University hospital rechts der Isar, Technical University of Munich, Munich, Germany
| | - Bastian Wein
- Department of Internal Medicine I, Cardiology, University Hospital Augsburg, University of Augsburg, Germany
| | - Sébastien Elvinger
- Department of Internal Medicine I, Cardiology, University Hospital Augsburg, University of Augsburg, Germany
| | - Giacomo Viggiani
- Department of Internal Medicine I, School of Medicine, University hospital rechts der Isar, Technical University of Munich, Munich, Germany
| | - Moritz von Scheidt
- Department of Cardiology, Deutsches Herzzentrum München, Technical University of Munich, Munich, Germany
| | - Karl-Ludwig Laugwitz
- Department of Internal Medicine I, School of Medicine, University hospital rechts der Isar, Technical University of Munich, Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Germany
| | - Philip W J Raake
- Department of Internal Medicine I, Cardiology, University Hospital Augsburg, University of Augsburg, Germany
| | - Adnan Kastrati
- Department of Cardiology, Deutsches Herzzentrum München, Technical University of Munich, Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Germany
| | - Mauro Chiarito
- Department of Cardiovascular Medicine, Humanitas Clinical and Research Center IRCCS and Humanitas University, Rozzano, Milan, Italy
| | - Isabell Bernlochner
- Department of Internal Medicine I, School of Medicine, University hospital rechts der Isar, Technical University of Munich, Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Germany
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3
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Hoffmann JJML, Urrechaga E. Recent advances in laboratory hematology reflected by a decade of CCLM publications. Clin Chem Lab Med 2022; 61:829-840. [PMID: 36285728 DOI: 10.1515/cclm-2022-0962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 09/27/2022] [Indexed: 11/15/2022]
Abstract
Abstract
On the occasion of the 60th anniversary of Clinical Chemistry and Laboratory Medicine (CCLM) we present a review of recent developments in the discipline of laboratory hematology as these are reflected by papers published in CCLM in the period 2012–2022. Since data on CCLM publications from 1963 to 2012 are also available, we were able to make a comparison between the two periods. This interestingly revealed that the share of laboratory hematology papers has steadily increased and reached now 16% of all papers published in CCLM. It also became evident that blood coagulation and fibrinolysis, erythrocytes, platelets and instrument and method evaluation constituted the ‘hottest’ topics with regard to number of publications. Some traditional, characteristic CCLM categories like reference intervals, standardization and harmonization, were more stable and probably will remain so in the future. With the advent of important newer topics, like new coagulation assays and drugs and cell population data generated by hematology analyzers, laboratory hematology is anticipated to remain a significant discipline in CCLM publications.
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Affiliation(s)
| | - Eloísa Urrechaga
- Biocruces Bizkaia Health Research Institute , Baracaldo , Spain
- Core Laboratory, Hospital Galdakao Usansolo , Vizcaya , Spain
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4
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Bongiovanni D, Han J, Klug M, Kirmes K, Viggiani G, von Scheidt M, Schreiner N, Condorelli G, Laugwitz KL, Bernlochner I. Role of Reticulated Platelets in Cardiovascular Disease. Arterioscler Thromb Vasc Biol 2022; 42:527-539. [PMID: 35321562 DOI: 10.1161/atvbaha.121.316244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Human platelets differ considerably with regard to their size, RNA content and thrombogenicity. Reticulated platelets (RPs) are young, hyper-reactive platelets that are newly released from the bone marrow. They are larger and contain more RNA compared to older platelets. In comparison to more mature platelets, they exhibit a significantly higher thrombogenicity and are known to be elevated in patients with an increased platelet turnover such as, diabetics and after acute myocardial infarction. Several studies have shown that RPs correlate with an insufficient antiplatelet response to aspirin and specific P2Y12 receptor inhibitors. In addition, RPs are promising novel biomarkers for the prediction of adverse cardiovascular events in cardiovascular disease. However, the reason for RPs intrinsic hyper-reactivity and their association with ischemic events is not completely understood and the biology of RPs is still under investigation. We here present a structured review of preclinical and clinical findings concerning the role of RPs in cardiovascular disease.
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Affiliation(s)
- Dario Bongiovanni
- Department of Internal Medicine I, School of Medicine, University hospital rechts der Isar, Technical University of Munich, Germany (D.B., J.H., M.K., K.K., G.V., N.S., K.-L.L., I.B.).,Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland (D.B.).,German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Germany (D.B., M.K., M.v.S., K.-L.L., I.B.).,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy (D.B., G.C.).,IRCCS Humanitas Research Hospital, Department of Cardiovascular Medicine, Rozzano, Milan, Italy (D.B., G.C.)
| | - Jiaying Han
- Department of Internal Medicine I, School of Medicine, University hospital rechts der Isar, Technical University of Munich, Germany (D.B., J.H., M.K., K.K., G.V., N.S., K.-L.L., I.B.)
| | - Melissa Klug
- Department of Internal Medicine I, School of Medicine, University hospital rechts der Isar, Technical University of Munich, Germany (D.B., J.H., M.K., K.K., G.V., N.S., K.-L.L., I.B.).,Experimental Bioinformatics, TUM School of Life Sciences Weihenstephan, Technical University of Munich, Germany (M.K.)
| | - Kilian Kirmes
- Department of Internal Medicine I, School of Medicine, University hospital rechts der Isar, Technical University of Munich, Germany (D.B., J.H., M.K., K.K., G.V., N.S., K.-L.L., I.B.).,German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Germany (D.B., M.K., M.v.S., K.-L.L., I.B.)
| | - Giacomo Viggiani
- Department of Internal Medicine I, School of Medicine, University hospital rechts der Isar, Technical University of Munich, Germany (D.B., J.H., M.K., K.K., G.V., N.S., K.-L.L., I.B.)
| | - Moritz von Scheidt
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Germany (D.B., M.K., M.v.S., K.-L.L., I.B.).,Department of Cardiology, Deutsches Herzzentrum München, Technical University of Munich, Germany (M.v.S.)
| | - Nina Schreiner
- Department of Internal Medicine I, School of Medicine, University hospital rechts der Isar, Technical University of Munich, Germany (D.B., J.H., M.K., K.K., G.V., N.S., K.-L.L., I.B.)
| | - Gianluigi Condorelli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy (D.B., G.C.).,IRCCS Humanitas Research Hospital, Department of Cardiovascular Medicine, Rozzano, Milan, Italy (D.B., G.C.)
| | - Karl-Ludwig Laugwitz
- Department of Internal Medicine I, School of Medicine, University hospital rechts der Isar, Technical University of Munich, Germany (D.B., J.H., M.K., K.K., G.V., N.S., K.-L.L., I.B.).,German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Germany (D.B., M.K., M.v.S., K.-L.L., I.B.)
| | - Isabell Bernlochner
- Department of Internal Medicine I, School of Medicine, University hospital rechts der Isar, Technical University of Munich, Germany (D.B., J.H., M.K., K.K., G.V., N.S., K.-L.L., I.B.).,German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Germany (D.B., M.K., M.v.S., K.-L.L., I.B.)
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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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6
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Jeon MJ, Yu ES, Kang KW, Lee BH, Park Y, Lee SR, Sung HJ, Yoon SY, Choi CW, Kim BS, Kim DS. Immature platelet fraction based diagnostic predictive scoring model for immune thrombocytopenia. Korean J Intern Med 2020; 35:970-978. [PMID: 32264655 PMCID: PMC7373978 DOI: 10.3904/kjim.2019.093] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 03/24/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND/AIMS The diagnosis of immune thrombocytopenia (ITP) is based on clinical manifestations and there is no gold standard. Thus, even hematologic malignancy is sometimes misdiagnosed as ITP and adequate treatment is delayed. Therefore, novel diagnostic parameters are needed to distinguish ITP from other causes of thrombocytopenia. Immature platelet fraction (IPF) has been proposed as one of new parameters. In this study, we assessed the usefulness of IPF and developed a diagnostic predictive scoring model for ITP. METHODS We retrospectively studied 568 patients with thrombocytopenia. Blood samples were collected and IPF quantified using a fully-automated hematology analyzer. We also estimated other variables that could affect thrombocytopenia by logistic regression analysis. RESULTS The median IPF was significantly higher in the ITP group than in the non-ITP group (8.7% vs. 5.1%). The optimal cut-off value of IPF for differentiating ITP was 7.0%. We evaluated other laboratory variables via logistic regression analysis. IPF, hemoglobin, lactate dehydrogenase (LDH), and ferritin were statistically significant and comprised a diagnostic predictive scoring model. Our model gave points to each of variables: 1 to high hemoglobin (> 12 g/dL), low ferritin (≤ 177 ng/ mL), normal LDH (≤ upper limit of normal) and IPF ≥ 7 and < 10, 2 to IPF ≥ 10. The final score was obtained by summing the points. We defined that ITP could be predicted in patients with more than 3 points. CONCLUSION IPF could be a useful parameter to distinguish ITP from other causes of thrombocytopenia. We developed the predictive scoring model. This model could predict ITP with high probability.
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Affiliation(s)
- Min Ji Jeon
- Division of Hematology-Oncology, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Eun Sang Yu
- Division of Hematology-Oncology, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Ka-Won Kang
- Division of Hematology-Oncology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Byung-Hyun Lee
- Division of Hematology-Oncology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Yong Park
- Division of Hematology-Oncology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Se Ryeon Lee
- Division of Hematology-Oncology, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Korea
| | - Hwa Jung Sung
- Division of Hematology-Oncology, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Korea
| | - Soo Yong Yoon
- Department of Laboratory Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Chul Won Choi
- Division of Hematology-Oncology, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Byung Soo Kim
- Division of Hematology-Oncology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Dae Sik Kim
- Division of Hematology-Oncology, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea
- Correspondence to Dae Sik Kim, M.D. Division of Hematology-Oncology, Department of Internal Medicine, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul 08308, Korea Tel: +82-2-2626-3062 Fax: +82-2-2626-2208 E-mail:
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7
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Abstract
Abstract
Reticulated platelets are immature platelets freshly released from the bone marrow into the circulation and contain vestigial amounts of ribonucleic acid. Thus, they can serve as an indicator for the activity of thrombopoiesis. Despite the current lack of a standardized reference method, two types of hematology analyzers have incorporated a fully automated measurement of reticulated platelets. The “immature platelet fraction” (IPF; Sysmex XE-/XN-series) has some clinical utility in the differential diagnosis of thrombocytopenia. This is less clear for “reticulated platelets” (retPLT; Abbott CELL-DYN Sapphire/Alinity HQ). The usefulness of these parameters in the prediction of platelet recovery after chemotherapy or stem cell transplantation and as a decision aid for platelet transfusions has not been unequivocally confirmed. Recent findings have shown an association of reticulated platelets with an adverse risk in patients with coronary artery disease and stroke as well as resistance to anti-platelet therapy. Furthermore, a role of reticulated platelets for the prediction of sepsis was indicated. However, validation in larger prospective trials is necessary to establish the clinical benefit of reticulated platelets in these conditions. This review gives an overview of the available analytical methods and summarizes the current knowledge regarding the clinical application of reticulated platelets.
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Affiliation(s)
- Lisa Meintker
- Department of Medicine 5 for Hematology and Oncology , University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg , Erlangen , Germany
| | - Stefan W. Krause
- Department of Medicine 5 for Hematology and Oncology , University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg , Erlangen , Germany
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8
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Wysokinski WE, Tafur A, Wu Y, Ammash N, Asirvatham SJ, Gosk-Bierska I, Grill DE, Slusser JP, Mruk J, McBane RD. Platelet-predominate gene expression and reticulated platelets in nonvalvular atrial fibrillation: Effect of pulmonary veins isolation. J Cardiovasc Electrophysiol 2018; 29:412-420. [PMID: 29377394 DOI: 10.1111/jce.13438] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 11/30/2017] [Accepted: 12/06/2017] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Reticulated platelet (RP) content is increased in nonvalvular atrial fibrillation (NVAF). The purpose of this study was to determine if platelet content, morphology, and RP proportion are modulated by platelet genes. METHODS AND RESULTS Expression of six platelet-predominate genes impacting platelet formation and release, platelet count, and RP content was assessed in NVAF patients before and 3-4 months after pulmonary veins isolation (PVI) and compared to normal sinus rhythm (NSR) controls. RNA from isolated platelets was reverse-transcribed assayed against selected genes utilizing real-time qPCR, and expressed as mean cycle threshold (ΔCt) using beta-2-microglobulin as endogenous control. RP content was assessed by flow cytometry. A fourfold lower expression of CFL1 gene coding for nonmuscle cofilin (7.8 ± 0.9 vs. 5.7 ± 1.6, P < 0.001) and twofold lower expression of four other genes were associated with similar platelet counts but fourfold higher (28.7+7.0 vs. 6.7+5.4, P < 0.001) RP content (%) in 97 NVAF cases compared to 51 NSR controls. Three to 4 months after PVI, RP decreased by 28%, while CFL1 gene expression increased over twofold but TUBA4A gene expression decreased almost twofold; NFE2 and MYL6 gene expression remained unchanged. CONCLUSIONS NVAF is associated with notable downregulation of genes directing platelet production and size but increased RP content. PVI impacts the expression of many of these genes, implying a direct relationship between atrial fibrillation and platelet biogenesis.
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Affiliation(s)
- Waldemar E Wysokinski
- Department of Cardiovascular Medicine, Mayo Clinic Foundation for Education and Research, Rochester, MN, USA
| | - Alfonso Tafur
- Department of Cardiovascular Medicine, Mayo Clinic Foundation for Education and Research, Rochester, MN, USA
| | - Yanhong Wu
- Department of Cardiovascular Medicine, Mayo Clinic Foundation for Education and Research, Rochester, MN, USA
| | - Naser Ammash
- Department of Cardiovascular Medicine, Mayo Clinic Foundation for Education and Research, Rochester, MN, USA
| | - Samuel J Asirvatham
- Department of Cardiovascular Medicine, Mayo Clinic Foundation for Education and Research, Rochester, MN, USA
| | - Izabela Gosk-Bierska
- Department of Angiology, Hypertension and Diabetology, Wroclaw Medical University, Wroclaw, Poland
| | - Diane E Grill
- Department of Cardiovascular Medicine, Mayo Clinic Foundation for Education and Research, Rochester, MN, USA
| | - Joshua P Slusser
- Department of Cardiovascular Medicine, Mayo Clinic Foundation for Education and Research, Rochester, MN, USA
| | - Jozef Mruk
- Department of Internal Medicine, University of Kansas School of Medicine-Wichita, Witchita, KS, USA.,Wichita Clinic, Wichita, KS, USA
| | - Robert D McBane
- Department of Cardiovascular Medicine, Mayo Clinic Foundation for Education and Research, Rochester, MN, USA
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9
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Ali U, Knight G, Gibbs R, Tsitsikas DA. Reference intervals for absolute and percentage immature platelet fraction using the Sysmex XN-10 automated haematology analyser in a UK population. Scandinavian Journal of Clinical and Laboratory Investigation 2017; 77:658-664. [PMID: 29117724 DOI: 10.1080/00365513.2017.1394488] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Immature platelet fraction (IPF) estimation is a non-invasive and sensitive test that is available on recently introduced Sysmex XN-series of automated haematology analysers. It is a direct cellular indicator of thrombopoiesis. The aim of this study was to establish reference intervals for IPF, for both absolute (A-IPF) and percentage (%-IPF) measurements. MATERIAL AND METHODS A total of 2366 samples that met the inclusion criteria were assayed for full blood count on the Sysmex XN-10 and a non-parametric percentile method was used for calculating the reference intervals. RESULTS After the outliers were excluded, the reference interval for %-IPF and A-IPF on Sysmex XN-10 were 1.6-10.1% and 4.37-23.21 × 109/L in total individuals, respectively. There was a statistical significance noted between the sexes (p = .004) for %-IPF, therefore a sex-specific reference interval was established, which was 1.8-10.0% for the males and 1.5-10.1% for females. No significant difference in sex status for A-IPF and age status for both %-IPF and A-IPF was observed. A very poor correlation was estimated between age versus %-IPF, ρ = 0.0156, and age versus A-IPF, ρ = -0.0023, indicating that there is no overall biological relationship between age and these parameters. As expected, a strong correlation between %-IPF and A-IPF was noted which could be attributed to their inter-relatedness. CONCLUSIONS This large-scale study showed comparable reference intervals with the previous studies for %-IPF and A-IPF in a UK population. It found the need to establish sex-specific reference intervals for %-IPF, but not for A-IPF, whereas reference intervals were found to be stable across the age range.
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Affiliation(s)
- Usman Ali
- a Department of Haematology , Homerton University Hospital NHS Foundation Trust , London , UK
| | - Gavin Knight
- b School of Pharmacy and Biomedical Sciences , University of Portsmouth , Portsmouth , UK
| | - Roz Gibbs
- b School of Pharmacy and Biomedical Sciences , University of Portsmouth , Portsmouth , UK
| | - Dimitris A Tsitsikas
- a Department of Haematology , Homerton University Hospital NHS Foundation Trust , London , UK
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10
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Abstract
Abstract
Persistently enhanced platelet activation has been characterized in polycythemia vera (PV) and essential thrombocythemia (ET) and shown to contribute to a higher risk of both arterial and venous thrombotic complications. The incidence of major bleeding complications is also somewhat higher in PV and ET than in the general population. Although its efficacy and safety was assessed in just 1 relatively small trial in PV, low-dose aspirin is currently recommended in practically all PV and ET patients. Although for most patients with a thrombosis history the benefit/risk profile of antiplatelet therapy is likely to be favorable, in those with no such history this balance will depend critically on the level of thrombotic and hemorrhagic risks of the individual patient. Recent evidence for a chemopreventive effect of low-dose aspirin may tilt the balance of benefits and harm in favor of using aspirin more broadly, but the potential for additional benefits needs regulatory scrutiny and novel treatment guidelines. A clear pharmacodynamic rationale and analytical tools are available for a personalized approach to antiplatelet therapy in ET, and an improved regimen of low-dose aspirin therapy should be tested in a properly sized randomized trial.
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11
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Strauss G, Vollert C, von Stackelberg A, Weimann A, Gaedicke G, Schulze H. Immature platelet count: a simple parameter for distinguishing thrombocytopenia in pediatric acute lymphocytic leukemia from immune thrombocytopenia. Pediatr Blood Cancer 2011; 57:641-7. [PMID: 21826780 DOI: 10.1002/pbc.22907] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2010] [Accepted: 10/08/2010] [Indexed: 11/08/2022]
Abstract
BACKGROUND Platelet counts below normal values define thrombocytopenia. However, platelet counts alone do not reveal the underlying pathomechanism. New blood cell counters provide additional information on platelet size and volume, and enable the distinction of sub-populations. In this preliminary study, we evaluate whether one of these markers can be used for diagnosis of isolated thrombocytopenia in children. PROCEDURE We provide normal values for mean platelet volume (MPV), platelet distribution width (PDW), plateletcrit (PCT), platelet large cell ratio (P-LCR), platelet mean-frequent volume (P-MFV), relative immature platelet fraction (IPF%), and absolute IPF (IPF#) for 100 healthy children and analyzed 87 children with thrombocytopenia. RESULTS In children with platelet production defects, IPF% was low, while in acute immune thrombocytopenia (ITP), IPF% was markedly increased (median 25.2%, P < 0.01), representing accelerated platelet turnover. Interestingly, children diagnosed with acute lymphocytic leukemia (ALL) also had elevated IPF% (median 10%, P < 0.01), suggesting that thrombopoiesis is stimulated despite virtual absence of bone marrow progenitors. Low IPF# was only found in patients with acute ITP. CONCLUSIONS IPF% is a marker for thrombocytopenia due to defective platelet production while IPF#, representing the immature platelet count, might become a practical parameter to distinguish acute ITP from thrombocytopenia in children with newly diagnosed ALL (P < 0.01).
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Affiliation(s)
- Gabriele Strauss
- Department of Pediatrics, Charité - Universitätsmedizin Berlin, Berlin, Germany
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12
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Ruisi MM, Psaila B, Ward MJ, Villarica G, Bussel JB. Stability of measurement of the immature platelet fraction. Am J Hematol 2010; 85:622-4. [PMID: 20658593 DOI: 10.1002/ajh.21748] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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13
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Wasiluk A, Mantur M, Kemona H, Szczepański M, Jasińska E, Milewski R. Thrombopoiesis in small for gestational age newborns. Platelets 2009; 20:520-4. [DOI: 10.3109/09537100903207505] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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14
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Michur H, Maślanka K, Szczepiński A, Mariańska B. Reticulated platelets as a marker of platelet recovery after allogeneic stem cell transplantation. Int J Lab Hematol 2009; 30:519-25. [PMID: 18983304 DOI: 10.1111/j.1751-553x.2007.00993.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Reticulated platelets (RP) are the youngest forms of platelets in blood and reflect the rate of bone marrow platelet production. In the present study, we used flow cytometric analysis to determine the percentage of RPs in patients undergoing allogeneic stem cell transplantation. We investigated 10 patients after transplantation from HLA identical siblings: five with acute myeloid leukemia (AML), four with chronic myeloid leukemia (CML), and one patient with myelodysplastic syndrome (MDS). Of the patients examined, four patients underwent allogeneic bone marrow transplantation and six patients underwent peripheral blood stem cell transplantation. It was observed that the initially reduced percentage of RPs (2.9 +/- 1.7%; mean +/- SD) was significantly higher (P = 0.0109) in all patients (13.6 +/- 6.4%) in the following 10-26 days. The RP percentage peak preceded the recovery of peripheral platelet count up to 45.6 x 10(9)/l on average by 3 days. We found no difference in RP% between the AML and CML patients but we did observe that in CML patients the RP percentage increased on average 7 days earlier than in AML patients. The elevated RP percentage reflects increased bone marrow regeneration and can be considered an additional marker of thrombopoietic recovery in the patients undergoing allogeneic stem cell transplantation.
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Affiliation(s)
- H Michur
- Institute of Haematology and Blood Transfusion, Warsaw, Poland.
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15
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Abstract
Although mammalian platelets are anucleated cells, a number of studies have shown that they retain a pool of messenger RNA (mRNA) carried over from the megakaryocyte during thrombopoiesis. Platelet mRNA was originally thought to be relatively unstable and short-lived within the youngest cells and has been used as a potential marker of platelet turnover. In this article we will discuss both theoretical and methodological issues related to the measurement of these younger, "reticulated platelets". A key question relating to platelet mRNA is also whether it has any functional relevance other than a marker of platelet immaturity. Evidence going back more than 30 years suggests that platelets can biosynthesize proteins. However, it is only very recently that the nature and specificity of platelet mRNA has been examined in any detail. Difficulties in obtaining pure platelet mRNA, free of contamination from other cells has added to the complexity of unravelling this story. However, there is now clear evidence that platelets contain small but significant levels of message for a variety of proteins. The platelet mRNA pool is much richer and more diverse than previously thought and recent data suggests that regulated synthesis of a selected number of proteins can be induced on platelet activation. The full complexity of the platelet genome is now just being revealed and may open the possibility for improved diagnosis and therapy of many haemostatic and thrombotic disorders.
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Affiliation(s)
- Paul Harrison
- Oxford Haemophilia and Thrombosis Centre, Churchill Hospital, Oxford, UK.
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16
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Chavda N, Mackie IJ, Porter JB, Harrison P, Patterson K, Machin SJ. Rapid flow cytometric quantitation of reticulated platelets in whole blood. Platelets 2009; 7:189-94. [DOI: 10.3109/09537109609023578] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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17
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Wasiluk A, Mantur M, Kemona-Chetnik I, Szczepański M, Warda J, Bochenko-Łuczyńska J. Does prematurity affect thrombocytopoiesis? Platelets 2009; 18:424-7. [PMID: 17763151 DOI: 10.1080/09537100701206816] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Data concerning thrombocytopoiesis in newborns are poorly recognized. Platelets have a crucial role in hemostatic physiology, which is deficient in newborns, especially in preterm newborns. A total of 51 preterm newborns (PTN), 25 girls and 26 boys, were recruited for the study. The control group consisted of 25 female and 30 male healthy term newborns (HTN). Plasma thrombopoietin (TPO) was measured using Quantikine human TPO system. Reticulated platelets (PLRET) was estimated by means of Retic-Count Kit. Platelet count (PLT) was determined using Advia(TU) 120 Hematology System. TPO was evidently higher in PTN (110.9 pg/ml) than in HTN (71.5 pg/ml), (p < 0.001). The percentage of reticulated platelets (PLRET) was also twice as high in PTN (3.49%) in comparison to HTN (1.7%), (p < 0.001). The PLT count was lower in PTN (246.7 x 10(3) microL) than in HTN (287.2 x 10(3) microL), (p < 0.01). Increased TPO levels and the percentage of PLRET indicate that thrombocytopoiesis is more active in prematurity. Our finding may be useful in therapeutic strategies.
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Affiliation(s)
- Alicja Wasiluk
- Department of Neonatology, Medical University, Bialystok, Poland.
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18
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Matic GB, Rothe G, Schmitz G. Flow cytometric analysis of reticulated platelets. ACTA ACUST UNITED AC 2008; Chapter 7:Unit 7.10. [PMID: 18770722 DOI: 10.1002/0471142956.cy0710s17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Flow Cytometric Analysis of Reticulated Platelets (G. Matic, G. Rothe, and G. Schmitz, University of Regensburg, Regensburg, Germany). In the last several years, flow cytometry has emerged as one of the tools of choice in evaluation of platelets. In particular, the distinction between reticulated platelets and mature platelets based on RNA fluorescence has proved to be a vital tool in the clinical hematology laboratory. Further, as is now well understood, it is important to evaluate platelets in whole blood rather than in isolated populations. Platelet quantification in a dual-color whole-blood method is of interest for the characterization of thrombocytopoiesis in (immune)-thrombocytopenia or in the regenerating bone marrow.
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Affiliation(s)
- G B Matic
- University of Regensburg, Regensburg, Germany
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19
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Sugimori N, Kondo Y, Shibayama M, Omote M, Takami A, Sugimori C, Ishiyama K, Yamazaki H, Nakao S. Aberrant increase in the immature platelet fraction in patients with myelodysplastic syndrome: a marker of karyotypic abnormalities associated with poor prognosis. Eur J Haematol 2008; 82:54-60. [PMID: 18801060 DOI: 10.1111/j.1600-0609.2008.01156.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Some patients with myelodysplastic syndrome (MDS) show a marked increase in the percentage of immature platelet fraction (IPF%) despite the absence of severe thrombocytopenia. To determine the significance of such an unbalanced increase in the IPF%, we investigated the IPF% and other laboratory findings of 51 patients recently diagnosed with MDS. METHOD Subjects consisted of 80 healthy males, 90 healthy females, and 51 patients with MDS and 20 patients with idiopathic thrombocytopenic purpura (ITP). The IPF and IPF% were determined using a Sysmex XE-2100 system loaded with IPF Master software (XE IPF Master, Sysmex). Platelet counts were measured simultaneously. RESULTS IPF% and platelet counts of these patients ranged from 1.1% to 25.1% (median, 5.3%) and from 6 to 260 x 10(9)/L (median, 71 x 10(9)/L), respectively. Twelve patients showed platelet counts more than 50 x 10(9)/L with 10% or more IPF%. All of the 12 patients had chromosome abnormalities including monosomy 7 and complex abnormalities involving 7 or 5q. In the other 39 patients who did not show the aberrant IPF% increase, chromosomal abnormalities were seen only in seven patients and none of them had chromosome 7 abnormalities. The IPF% of two patients increased to more than 10% in association with the appearance of monosomy 7. CONCLUSIONS These findings suggest that a high IPF% in MDS patient may be a marker for karyotypic abnormalities with a poor prognosis, including chromosome 7 abnormalities.
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Affiliation(s)
- Naomi Sugimori
- Cellular Transplantation Biology, Division of Cancer Medicine, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
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20
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Monteagudo M, Amengual MJ, Muñoz L, Soler JA, Roig I, Tolosa C. Reticulated platelets as a screening test to identify thrombocytopenia aetiology. QJM 2008; 101:549-55. [PMID: 18400777 DOI: 10.1093/qjmed/hcn047] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Thrombocytopenia is a common haematological abnormality and no simple diagnostic test is available to diagnose thrombocytopenia pathogenesis. AIM To evaluate sensitivity and specificity of reticulated platelets (RP) as a diagnostic test for thrombocytopenia with increased thrombopoietic activity. DESIGN Prospective observational study in thrombocytopenic patients. METHODS A direct, whole-blood, dual-labelling flow cytometric method was used. Direct, whole-blood double coverage was achieved using a monoclonal anti-glycoprotein (GP)-III antibody (CD61 PerCP) for platelet identification and thiazole orange (Retic-count) as platelet mARN stain. RESULTS RP were measured in 101 thrombocytopenic patients and 104 non-thrombocytopenic controls. The mean RP percentage in 60 thrombocytopenic patients with no increased thrombopoietic activity was 7.5% (CI for 95%: 5.2-9.7) and RP absolute number was 3.2 x 10(9)/l (CI for 95%: 2.1-4.3). The mean RP percentage in 41 thrombocytopenic patients with increased thrombopoietic activity was 30.3% (CI for 95%: 25.1-35.5) and RP absolute number was 6.2 (CI for 95%: 4.8-7.7). The RP percentage cut-off for a diagnosis of thrombocytopenia with increased thrombopoietic activity was 11% [sensitivity 93%, specificity 85%, positive predictive value (PPV) 83%, negative predictive value (NPV) 95%]. CONCLUSION RP measurement by flow cytometry, directly from whole-blood, is a useful screening test to differentiate between thrombocytopenia with high or low thrombopoietic activity. A RP percentage in excess of 11%, has a high sensitivity and good specificity for a diagnosis of thrombocytopenia with increased thrombopoietic activity.
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Affiliation(s)
- M Monteagudo
- Internal Medicine Department, Hospital de Sabadell, Parc Taulí S/N, 08208 Sabadell, Barcelona, Spain.
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21
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Thomas-Kaskel AK, Mattern D, Köhler G, Finke J, Behringer D. Reticulated platelet counts correlate with treatment response in patients with idiopathic thrombocytopenic purpura and help identify the complex causes of thrombocytopenia in patients after allogeneic hematopoietic stem cell transplantation. CYTOMETRY PART B-CLINICAL CYTOMETRY 2007; 72:241-8. [PMID: 17266149 DOI: 10.1002/cyto.b.20163] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND In thrombocytopenic conditions of unknown origin, quantification of reticulated platelets (RP) in the peripheral blood by flow cytometry has been shown to differentiate increased platelet (Plt) turnover from insufficient Plt production. METHODS We used a whole blood flow cytometry method combining thiazole orange and anti-CD41a-staining to assess RP in 71 healthy subjects, six with thrombocytopenic myelodysplastic syndrome (MDS), nine with liver cirrhosis, 14 patients with idiopathic thrombocytopenic purpura (ITP), and 12 patients who had undergone hematopoietic stem cell transplantation (HSCT). RESULTS Patients with MDS had normal, patients with liver cirrhosis had slightly elevated RP counts compared to healthy subjects. ITP patients had elevated RP counts, and RP >15% were associated with treatment response (P = 0.015). In 7/10 patients after HSCT, an increase of RP preceded Plt recovery, whereas in patients with secondary thrombocytopenia after normal regeneration, the assessment of RP allowed the differentiation between conditions with high Plt turnover, such as GvHD and microangiopathy, indicated by high RP counts, and graft failure, indicated by low RP counts. CONCLUSIONS Our data provide the rationale for prospective studies on the diagnostic and prognostic value of RP counts in larger patient populations with ITP and after HSCT.
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22
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Cho YG, Lee JH, Kim DS, Lee HS, Choi SI. Clinical Usefulness of the Simple Technique to Diagnose Thrombocytopenia Using Immature Platelet Fraction. Ann Lab Med 2007; 27:1-6. [DOI: 10.3343/kjlm.2007.27.1.1] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Yong Gon Cho
- Department of Laboratory Medicine, Chonbuk National University Medical School, Jeonju, Korea
- Research Institute of Clinical Medicine, Chonbuk National University, Jeonju, Korea
| | - Jae Hyun Lee
- Department of Laboratory Medicine, Chonbuk National University Medical School, Jeonju, Korea
| | - Dal Sik Kim
- Department of Laboratory Medicine, Chonbuk National University Medical School, Jeonju, Korea
- Research Institute of Clinical Medicine, Chonbuk National University, Jeonju, Korea
| | - Hye Soo Lee
- Department of Laboratory Medicine, Chonbuk National University Medical School, Jeonju, Korea
- Research Institute of Clinical Medicine, Chonbuk National University, Jeonju, Korea
| | - Sam Im Choi
- Department of Laboratory Medicine, Chonbuk National University Medical School, Jeonju, Korea
- Research Institute of Clinical Medicine, Chonbuk National University, Jeonju, Korea
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23
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Butkiewicz AM, Kemona H, Dymicka-Piekarska V, Matowicka-Karna J, Radziwon P, Lipska A. Platelet count, mean platelet volume and thrombocytopoietic indices in healthy women and men. Thromb Res 2006; 118:199-204. [PMID: 16139337 DOI: 10.1016/j.thromres.2005.06.021] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2005] [Revised: 05/19/2005] [Accepted: 06/13/2005] [Indexed: 12/01/2022]
Abstract
UNLABELLED Gender-dependent differences in platelet count have been demonstrated in few studies. In women platelet count is higher than in men, which seems to reflect different hormonal profiles or a compensatory mechanism associated with menstrual blood loss. The aim of the study was to assess platelet count, mean platelet volume and thrombocytopoietic indices in women and men. The study was conducted on healthy blood donors divided into groups: F - 60 women and M - 65 men. Platelet count and mean platelet volume were determined on a haematological analyser Advia 120, Bayer. The following thrombocytopoietic indices were measured: thrombopoietin concentration (ELISA), percentage of reticulated platelets (flow cytometry, COULTER EPICS XL) and absolute reticulated platelet count. RESULTS Higher platelet count was noted in the group of women 252.35 +/- 41.25 x 10(9)/l as compared to men 221.87 +/- 37.63 x 10(9)/l (p = 0.0002). At the same time women had lower thrombopoietin concentration 156.50 +/- 57.18 pg/ml compared to men 180.46 +/- 60.98 pg/ml, (p = 0.03). No statistically significant differences were found in the mean platelet volume, percentage of reticulated platelets or absolute reticulated platelet count between group F and M. CONCLUSIONS Platelet count is gender-dependent, being higher in women than in men. Thrombopoietin concentration is gender-dependent and is lower in women than in men. In physiological conditions, there is no correlation between platelet count and thrombopoietin concentration in women (r = -0.155) and men (r = -0.2586).
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Affiliation(s)
- Anna M Butkiewicz
- Department of Clinical Laboratory Diagnostics, Medical University of Bialystok, Poland.
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24
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Abstract
AIMS Thrombocytopoiesis was investigated in term newborns determining thrombopoietin (TPO), reticulated platelets (PLRET) and blood platelets (PLT) in relation to gender. PATIENTS AND METHODS The study was undertaken on 72 healthy term newborns, 33 girls and 39 boys. They fitted all criteria for healthy term newborns. Blood was collected from the umbilical vein immediately after cutting the umbilical cord. The evaluation of thrombocytopoiesis was performed by the following methods: TPO-Quantikine human TPO kit, PLRET- Retic-Count kit, PLT- Advia 120 hematology System. RESULTS Concentrations of TPO and percentages of reticulated platelets were greater in the female group than in the male group. The changes were not statistically significant, perhaps as a result of the very wide range of parameters tested. The blood platelet count was higher in female newborns than in male newborns, P<0.001. CONCLUSION The data may indicate that thrombocytopoiesis is more active in female than in male newborns.
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Affiliation(s)
- Alicja Wasiluk
- Department of Neonatology and Department of Clinical Laboratory Diagnostics, Medical Academy, Bialystok, Poland.
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25
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Chaoui D, Chakroun T, Robert F, Rio B, Belhocine R, Legrand O, Salanoubat C, Lecrubier C, Casadevall N, Marie JP, Elalamy I. Reticulated platelets: a reliable measure to reduce prophylactic platelet transfusions after intensive chemotherapy. Transfusion 2005; 45:766-72. [PMID: 15847667 DOI: 10.1111/j.1537-2995.2005.04286.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Reticulated platelets (RPs) are the youngest circulating platelets (PLTs). The aim of our study was to predict PLT recovery with RP percentage (RP%) and therefore to identify PLT transfusions that could be avoided after autologous peripheral blood progenitor cell (PBPC) transplantation. STUDY DESIGN AND METHODS With a whole-blood dual-labeling flow cytometric method, RP% was prospectively assessed in 47 patients who received myeloablative chemotherapy followed by autologous PBPC transplantation. Retrospective analysis of RP evolution identified three time points: nadir of the RP% (NRP), imminent PLT recovery (IPR) corresponding to an RP% of greater than 7 percent, and PLT transfusion autonomy (PTA). RESULTS Median occurrences of NRP, IPR, and PTA were on Days +5, +8, and +12 after transplantation, respectively. The RP% value at NRP (4%) was significantly lower compared to the IPR (15%) and PTA (14%). Thirty patients (64%) achieved PTA within 4 days after IPR. On Day +8, if RP% was greater than 7 percent, positive and negative predictive values for PTA within 4 days, specificity, and sensitivity were 79, 63, 66, and 76 percent, respectively. Fever between IPR and PTA was the only factor found to negatively influence PLT recovery (p = 0.02). All patients required at least one PLT transfusion. Among patients with rapid PLT recovery (IPR-PTA interval < 4 days; n = 30), half of them received one PLT transfusion after RP increase, which could be avoided. CONCLUSION These encouraging results may allow us to reduce the prophylactic PLT transfusion according to patients RP% increase.
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Affiliation(s)
- Driss Chaoui
- Department of Hematology and Medical Oncology, Biological Hematology Service, Hôtel-Dieu, AP-HP, Paris, France
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Gyongyossy-Issa MIC, Bussel JB, Carter CJ, Devine DV. Comparison of thrombopoiesis during ITP and HIV-ITP and response to intravenous gammaglobulin treatment. Platelets 2003; 14:267-76. [PMID: 12944242 DOI: 10.1080/0953710031000137037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Immune thrombocytopenic purpura's diagnosis (ITP) is based on low platelet count and exclusion of clinical conditions rather than a specific diagnostic test. We used the reticulated platelet (RP) assay to study ITP and thrombocytopenia associated with HIV infection (HIV-ITP). Data from 96 ITP and 23 HIV-ITP patients showed low platelet counts (PC) with both high or low %RP suggesting that individuals have different degrees of thrombopoiesis. About 20% of ITP and 46% of HIV-ITP patients had %RP in the 'low' or 'normal' ranges. Grouped by platelet count <30x10(9)/L, 24% ITP and 36% HIV-ITP patients had 'low' to 'normal' %RP. The patient population did not show correlation between PC and %RP, but individuals showed an inverse relationship. Within a week of receiving IVIG, 18 ITP and 9 HIV-ITP patients' PC increased, %RP decreased. Patients with %RP measured within 24 h of IVIG treatment had lower %RP than expected, suggesting dilution by an older platelet population. ITP and HIV-ITP patients' responses to i.v. gammaglobulins were similar. Thrombopoietin levels of ITP patients did not correlate with PC, %RP, or RP count. Estimation of thrombopoiesis by RP assay provides useful information for differentiation among thrombocytopenias.
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Affiliation(s)
- Maria I C Gyongyossy-Issa
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC Canada.
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Wang FS, Kubota F. A novel apoptosis research method with imaging-combined flow cytometer and HITC or IR-125 staining. CYTOMETRY 2002; 50:267-74. [PMID: 12360577 DOI: 10.1002/cyto.10143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The most commonly used methods for apoptotic research include terminal transferase-mediated dUTP nick end-labeling, annexin V testing of phosphatidylserine translocation from the inner leaflet to the outer plasma membrane by flow cytometry, DNA electrophoresis, and cell morphology. These methods provide apoptotic information from different aspects. To find a new way in apoptosis research and potential clinical application, we recently developed a novel method with an imaging-combined flow cytometer (IFC) and an innovative cell staining process by using 2-[7-(1,3-dihydro-1,3,3-trimethyl-2H-indol-2-ylidene)-1,3,5-heptatrienyl]-1,3,3-trimethyl-3H-indolium iodide (HITC) and 2-[7-[1,3-dihydro-1,1-dimethyl-3-(4-sulfobutyl)-2H-benz[e]indol-2-ylidene]-1,3,5-heptatrienyl]-1,1-dimethyl-3-(4-sulfobutyl)-1H-benz[e]indolium hydroxide, inner salt, sodium salt (IR-125). The IFC used in the research is a new generation of cytometry designed for simultaneous observations of cell populations and images. This is possible because the IFC is equipped with dual laser beams, one argon and one infrared. A promyelocytic leukemia cell line, HL-60, was used in the research. The cells were stained with our newly developed HITC or IR-125 staining method and a traditional nucleic acid dye, propidium iodide. The cells stained with HITC or IR-125 appeared completely dark in the IFC image window before washing. Phosphate buffered saline wash did not change the cell appearance. A wash with 50% methanol caused the cells to have a clear cell image with bright nuclei on the IFC. To obtain apoptotic cells, we treated the HL-60 cells with 0.15 microM of camptothecin (CAM), a topoisomerase I inhibitor and experimental apoptosis inducer, for 4 h. The control showed larger round cells with bright nuclei and one to three dark nucleoli. The CAM-induced apoptotic cells were smaller, with fragmented and condensed nuclei on the IFC. These appearances were identical to the cell morphology of with light and electron microscopy. We used other methods including FACScan and DNA electrophoresis to confirm the apoptotic changes after CAM treatment and compared them with the IFC method. In addition, we found that the novel method with the IFC and HITC or IR-125 staining can show not only cell apoptotic changes but also peripheral blood cell populations and images simultaneously. This study suggests many potential applications of the IFC and this novel staining method in other cellular biological researches and clinical assays.
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Affiliation(s)
- Fu-sheng Wang
- Department of Pathology and Laboratory Medicine, Loma Linda University School of Medicine, Loma Linda, California, USA.
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28
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Louwes H, De Wolf JTM, Houwerzijl E, Vellenga E. Evaluation assays measuring platelet kinetics in bone marrow and peripheral blood. An overview. Nucl Med Commun 2002; 23:581-90. [PMID: 12029215 DOI: 10.1097/00006231-200206000-00012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Platelets play an important role in haemostasis and thrombosis. For an understanding of the pathophysiology and treatment of thrombocytopenia, it is not sufficient to measure only the platelet count. Platelet kinetic parameters, such as platelet survival and turnover, might be useful because many thrombocytopenia related disorders result from the interaction between production, utilization or destruction, and sequestration of platelets. Therefore, measuring platelet turnover with radiolabelled platelets could be a sensitive and qualitative tool for clinicians. However, the method does not enjoy widespread use because it has some serious drawbacks, such as the problems associated with the manipulation of blood and platelets, and the use of radioactivity. Recently, other useful assays for measuring platelet fluxes have been described in the literature, including plasma thrombopoietin and glycocalicin. In this review, these new tests will be described, compared with the classical method using radiolabelled platelets, and finally evaluated for their usefulness in clinical practice.
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Affiliation(s)
- H Louwes
- Department of Nuclear Medicine, Martini Hospital, Groningen, the Netherlands.
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29
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Nakamura T, Uchiyama S, Yamazaki M, Okubo K, Takakuwa Y, Iwata M. Flow cytometric analysis of reticulated platelets in patients with ischemic stroke. Thromb Res 2002; 106:171-7. [PMID: 12297121 DOI: 10.1016/s0049-3848(02)00131-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Reticulated platelets are newly formed platelets containing a residual amount of RNA, and percentage of reticulated platelets (%RP) has been shown to reflect platelet turnover. Recently, a new flow cytometric approach for analyzing %RP in patients with thrombocytopenic disorders has been reported. We measured %RP by flow cytometry using the fluorescent dye thiazole orange (TO) to evaluate platelet kinetics in patients with different clinical categories of ischemic stroke. Patients with ischemic stroke were categorized into lacunar (n=25), atherothrombotic (n=26) and cardioembolic stroke (n=17). %RP was significantly higher in patients with cardioembolic stroke than in controls (n=140). Stepwise multiple regression analysis also showed cardioembolic stroke (R(2)=0.14) to be significant independent predictors of %RP among stroke patients even after adjustment for other factors. We concluded that %RP is increased in patients with cardioembolic stroke, which may reflect increased platelet turnover as a consequence of platelet consumption during thrombogenesis.
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Affiliation(s)
- Tomomi Nakamura
- Department of Neurology, Neurological Institute, Tokyo Women's Medical University, 8-1-Kawada-cho, Shinjuku, Tokyo 162-8666, Japan.
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Gyongyossy-Issa MI, Miranda J, Devine DV. Generation of reticulated platelets in response to whole blood donation or plateletpheresis. Transfusion 2001; 41:1234-40. [PMID: 11606821 DOI: 10.1046/j.1537-2995.2001.41101234.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND There are few reports about thrombopoietic responses in whole blood (WB) and platelet-pheresis donors. This study compares the thrombopoietic responses of such donors and their platelet values. STUDY DESIGN AND METHODS The effect of WB donation or selective platelet loss (plateletpheresis) was evaluated prospectively. WB and platelet donor samples before donation and for 7 days thereafter were assessed for platelet count, mean platelet volume, and platelet reticulocytes. RESULTS Reticulated platelets appeared in the circulation of plateletpheresis donors by 24 hours. The proportion of reticulated platelets was highest on Day 2, and above-normal levels of reticulated platelets persisted until Day 7. The mean platelet volume was high on Days 2 and 3, which corresponded with the appearance of reticulated platelets. After plateletpheresis, platelet counts were higher than could be accounted for by new platelets, which suggested the release of sequestered platelets. WB donors manifested no changes in platelet counts but had a peak of circulating platelet reticulocytes 2 days after the donation. CONCLUSION The thrombopoietic peak in WB and plateletpheresis donors occurs 2 days after donation, and the response level is related to the amount of platelets lost. The impact of platelet loss on the number of circulating platelets is modulated by the release of platelets from the spleen.
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Affiliation(s)
- Y Dror
- Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
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Abstract
PURPOSE The objective of this study was to evaluate the clinical course, laboratory findings, and outcomes of children with essential thrombocythemia (ET). PATIENTS AND METHODS The authors analyzed 36 children, ages 6 weeks to 18 years, by combining descriptions of 2 patients observed at their institution with 34 patients reported in the English medical literature. RESULTS Fifteen patients (10 at diagnosis and 5 later on) had symptoms directly related to ET, including 9 who had severe thrombohemorrhagic phenomena. Common abnormalities included large platelets, increased marrow megakaryocytes with hyperlobulated forms, and abnormal platelet aggregation. Symptomatic patients had significantly higher platelet counts (2,419 versus 904 x 10(9)/L, P < 0.001); however, three patients with platelet counts that were only moderately elevated (600-800 x 10(9)/L) had thrombotic events. Eleven patients received various therapeutic agents. Interestingly, three patients who had one thrombotic event, and did not receive therapy, went on to have a benign clinical course. Leukemia developed in two treated patients, and they died; two others died of thrombotic complications; and myelofibrosis developed in one patient. Seventeen cases (47%) were familial. Patients with familial cases had significantly lower platelet counts, a lower incidence of hepatomegaly, and no thrombotic complications. CONCLUSIONS This analysis of children with ET found that severe vascular complications developed in a substantial number. Platelet counts usually, but not always, correlate with the occurrence of complications. The indications for treatment and the best treatment of children with ET are currently not known, and guidelines for the management of children with ET are needed. Familial thrombocythemia is common among children with primary thrombocytosis and appears to be a different disease from ET, with a more benign course.
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Affiliation(s)
- Y Dror
- Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
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Saxon BR, Mody M, Blanchette VS, Freedman J. Reticulated platelet counts in the assessment of thrombocytopenic disorders. ACTA PAEDIATRICA (OSLO, NORWAY : 1992). SUPPLEMENT 1998; 424:65-70. [PMID: 9736223 DOI: 10.1111/j.1651-2227.1998.tb01238.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Reticulated platelets (RP) are the youngest platelets in the circulation and can be measured by analysing the RNA content of platelets from whole blood or platelet-rich plasma by flow cytometry. Increased RP are indicative of increased production of platelets. Despite the current lack of standardization for the measurement of RP, it is useful in the assessment of patients with ITP by aiding the distinction of these patients from those with decreased platelet production. RP counts also have a role in the assessment of the complicated patient with multiple possible aetiologies for thrombocytopenia. Measurement of the RP count may hold predictive value for marrow recovery following myelosuppressive or myeloablative chemotherapy, and may play a role in monitoring the administration of the various thrombopoietins currently under clinical trial.
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Affiliation(s)
- B R Saxon
- The Hospital for Sick Children, Department of Paediatrics, University of Toronto, Ontario, Canada
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Rapi S, Ermini A, Bartolini L, Caldini A, Del Genovese A, Miele AR, Buggiani A, Fanelli A. Reticulocytes and reticulated platelets: simultaneous measurement in whole blood by flow cytometry. Clin Chem Lab Med 1998; 36:211-4. [PMID: 9638345 DOI: 10.1515/cclm.1998.036] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Reticulated platelets are a fraction of newly released circulating elements characterized by a residual amount of RNA. It has been suggested that the reticulated platelet count, providing an estimate of thrombopoiesis in the same way as erythrocyte reticulocyte count is a measure of erythropoiesis, may be useful in the study of thrombocytopenic disorders. Reticulated red cells and platelets can be analyzed by flow cytometry using specific stains for nucleic acids such as Thiazole Orange and Auramine-O. The aim of our work was to perform the simultaneous evaluation of reticulated elements in whole blood using a standard flow cytometer and to correlate the results obtained with a dedicated cytometer. A group of 14 patients with abnormal absolute reticulocyte counts (range 1.1-11%) and a group of 41 patients showing a platelet discrimination error when analyzed with a dedicated flow cytometer (Sysmex R1000) were enrolled. Linear amplification of both scatter and fluorescence was used to perform reticulocyte count. A gate was set on platelet dimensions, and logarithmic amplification of scatter and fluorescence was used to count reticulated platelets. A good correlation was obtained both for results of reticulocyte count (r2 = 0.9825) and for reticulated platelets (r2 = 0.8717) between our method and those using dedicated instruments. These data show that reticulated platelet count may be easily introduced in clinical laboratories that routinely perform reticulocyte count by flow cytometry.
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Affiliation(s)
- S Rapi
- Laboratory Department, Azienda Ospedaliera Careggi, Florence, Italy
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Robinson MS, Mackie IJ, Khair K, Liesner R, Goodall AH, Savidge GF, Machin SJ, Harrison P. Flow cytometric analysis of reticulated platelets: evidence for a large proportion of non-specific labelling of dense granules by fluorescent dyes. Br J Haematol 1998; 100:351-7. [PMID: 9488626 DOI: 10.1046/j.1365-2141.1998.00563.x] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The labelling of platelets with thiazole orange (TO) has been utilized by various laboratories to determine the percentage of reticulated platelets within whole blood or platelet-rich plasma (PRP). A proportion of TO labelling, however, is not entirely mRNA specific and remains to be fully defined. Almost half of the total TO-positive signal within normal platelets (n = 5) was shown to be abrogated upon degranulation with 80 microM thrombin receptor activating peptide (TRAP) (P = 0.006), strongly suggesting that platelet granules are non-specifically labelling with dye. We have confirmed this hypothesis by studying TO labelling of platelets within whole blood from dense granule deficient patients, e.g. Hermansky-Pudlak syndrome (HPS) (n = 5) and storage pool disease (SPD) (n = 4). The levels of TO-positive platelets were found to be significantly lower than normal (P = 0.0003 and P = 0.0002 respectively), but not significantly different from TRAP degranulated platelets. Upon degranulation of HPS and SPD platelets there was very little further reduction in the TO signal. Incubation of normals and SPD whole blood with different concentrations of either TO or coriphosphine-O confirmed that dense granules were non-specifically labelling even at high concentrations of both dyes. These findings suggest that although TO labelling is in part RNA specific, the dense granular pool of nucleotides appears to cause a substantial amount (approximately 50%) of non-specific labelling observed under these conditions of assay. This can easily be controlled for by a degranulation step with a non-enzymatic platelet agonist such as TRAP, and may have important consequences for the eventual standardization. clinical utilization and automation of reticulated platelet assays.
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Affiliation(s)
- M S Robinson
- Department of Haematology, University College Hospital, London
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Saxon BR, Blanchette VS, Butchart S, Lim-Yin J, Poon AO. Reticulated platelet counts in the diagnosis of acute immune thrombocytopenic purpura. J Pediatr Hematol Oncol 1998; 20:44-8. [PMID: 9482412 DOI: 10.1097/00043426-199801000-00007] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE Bone marrow aspiration is often performed to diagnose childhood acute immune thrombocytopenic purpura (ITP) because no non-invasive investigation to confirm the diagnosis is routinely available. Reticulated platelets (RPs--young platelets characterized by a high RNA content--increase with increased platelet production and may be useful in the diagnosis of ITP. METHODS To assess the role of RP counts in distinguishing ITP, we compared counts from 15 consecutive patients with ITP with counts from 20 patients with acute lymphoblastic leukemia (ALL), 10 with aplasia, and 27 healthy normal children. Whole blood in edetic acid (EDTA) was labelled with a platelet-specific monoclonal antibody and incubated with thiazole orange (TO). A standard gate was set to achieve a fluorescence value of 1.3 +/- 0.5% for control lyophilized platelets. RESULTS Patients with ITP had a mean (+/- 1 standard deviation) RP level of 32.9 +/- 10.2%; patients with ALL, 6.6 +/- 3.1%; patients with aplasia, 3.4 +/- 2.0%; and normal patients, 7.9 +/- 2.9%. The difference in RPs between the ITP group and the ALL, aplasia, and normal groups was highly significant (p < 0.0001 each), with no significant difference between the non-ITP groups (p = 0.12). CONCLUSIONS Measuring RPs by this simple whole-blood cytometric technique discriminated very well between the acute ITP and non-ITP groups. This test has a strong positive predictive value and may prove very useful in the assessment of childhood acute ITP and the screening of candidates for bone marrow aspiration.
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Affiliation(s)
- B R Saxon
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
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Abstract
Accepted mechanisms of coagulation are being challenged as new proteins and feedback mechanisms are discovered and evaluated. These new proteins, including tissue factor pathway inhibitor, not only change the way we look at the coagulation mechanism, but also give us potential alternatives in treatment of hemophilia. Gene therapy continues to be a challenging research area, with hemophilia serving as the prototypic hereditary disease target. As acquired disorders of coagulation secondary to immune-mediated events are studied and better understood, our approaches to management of these cases will also change to the benefit of our patients.
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Affiliation(s)
- M K Boudreaux
- Department of Pathobiology, College of Veterinary Medicine, Auburn University, Alabama, USA
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Peterec SM, Brennan SA, Rinder HM, Wnek JL, Beardsley DS. Reticulated platelet values in normal and thrombocytopenic neonates. J Pediatr 1996; 129:269-74. [PMID: 8765626 DOI: 10.1016/s0022-3476(96)70253-6] [Citation(s) in RCA: 54] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Reticulated platelets (RPs) are newly synthesized platelets with increased ribonucleic acid content. The percentage of RPs is elevated in adults with thrombocytopenia as a result of increased platelet destruction. The objectives of this study were to determine normal RP values in neonates at birth and to determine whether neonates with thrombocytopenia as a result of increased platelet destruction have an increased percentage of RPs. STUDY DESIGN The RP percentages were measured at birth in 89 neonates without thrombocytopenia in three gestational age groups (<30,30 to 36, and >36 weeks), six neonates with immune thrombocytopenia, and one neonate with thrombocytopenia as a result of decreased platelet production. RESULTS The RP percentages in neonates without thrombocytopenia >36 weeks and 30 to 36 weeks of gestation were 4.0% +/- 2.4% (mean +/- SD) and 4.6% +/- 1.7%, respectively, similar to values reported in healthy adults. Neonates younger than 30 weeks of gestation had significantly higher RP percentages (8.8% +/- 5.1%) than older neonates (p </= 0.0001). Term neonates with immune thrombocytopenia had significantly higher RP percentages (38.3% +/- 23.1%) than term neonates without thrombocytopenia (p = 0.0001), with no overlap in RP values. A lower RP percentage (1.5%) and significantly lower absolute RP count were measured in the one neonate with decreased platelet production. CONCLUSIONS These preliminary data establish normal RP percentages in term and preterm neonates at birth and demonstrate elevated RP percentages in neonates with immune platelet destruction. The RP values may be helpful in evaluating the causes of neonatal thrombocytopenia.
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Affiliation(s)
- S M Peterec
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA
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