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Kollia M, Iacovidou N, Iliodromiti Z, Pouliakis A, Sokou R, Mougiou V, Boutsikou M, Politou M, Boutsikou T, Valsami S. Primary hemostasis in fetal growth restricted neonates studied via PFA-100 in cord blood samples. Front Pediatr 2022; 10:946932. [PMID: 36160789 PMCID: PMC9492943 DOI: 10.3389/fped.2022.946932] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 08/01/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Platelet function of fetal growth restricted (FGR) neonates remains a field of debate. Platelet function analyzer (PFA-100) offers a quantitative in vitro assessment of primary, platelet-related hemostasis. Our aim was to examine platelet function using PFA-100 in FGR neonates and associate our results with perinatal parameters. METHODS PFA-100 was applied on 74 FGR neonates, 48 full-term (>37 weeks' gestation) and 26 preterm neonates (<37 weeks). The control group consisted of 118 healthy neonates. Two closure times (CTs) with COL/EPI and COL/ADP cartridges were determined on cord blood samples for each subject. Statistical analysis was performed by SAS 9.4. The statistical significance level was set at 0.05 and all tests were two-tailed. RESULTS COL/EPI CTs were prolonged in FGR (median 132 s, IQR 95-181 s) compared with control neonates (median 112.5 s, IQR 93-145 s), p = 0.04. Median COL/EPI CT for term and preterm FGR neonates was 126 s (IQR 90-157 s) and 137 s (IQR 104-203), respectively (p = 0.001), and COL/ADP CT was 70 s (IQR 62-80 s) for term and 75 s (IQR 68-82 s) for preterm FGR neonates (p = 0.08). Among FGR neonates, COL/EPI CT was related with delivery time (with preterm neonates exhibiting prolonged COL/EPI CTs), p = 0.05. No correlation was proved between both CTs and hematological parameters in FGR neonates. CONCLUSION FGR neonates showed impaired platelet function via PFA-100, with preterm FGR neonates confronting the greatest risk. Prolonged COL/EPI CTs in FGR neonates seemed to be independent of hematological parameters and could warn for closer evaluation during the first days of their lives.
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Affiliation(s)
- Maria Kollia
- Neonatal Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Nicoletta Iacovidou
- Neonatal Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Zoi Iliodromiti
- Neonatal Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Abraham Pouliakis
- 2nd Department of Pathology, "Attikon" University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Rozeta Sokou
- Neonatal Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Vasiliki Mougiou
- Neonatal Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Boutsikou
- Neonatal Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Marianna Politou
- Haematology Laboratory-Blood Bank, Aretaieio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Theodora Boutsikou
- Neonatal Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Serena Valsami
- Haematology Laboratory-Blood Bank, Aretaieio Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Maheshwari A. Role of platelets in neonatal necrotizing enterocolitis. Pediatr Res 2021; 89:1087-1093. [PMID: 32601461 PMCID: PMC7770063 DOI: 10.1038/s41390-020-1038-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/10/2020] [Accepted: 06/17/2020] [Indexed: 12/23/2022]
Abstract
Necrotizing enterocolitis (NEC) is an inflammatory bowel necrosis of premature infants and is a leading cause of morbidity and mortality in infants born between 23 and 28 weeks of gestation. Fifty to 95% of all infants with NEC develop thrombocytopenia (platelet counts <150 × 109/L) within 24-72 h of receiving this diagnosis. In many patients, thrombocytopenia is severe and is treated with one or more platelet transfusions. However, the underlying mechanism(s) and biological implications of NEC-related thrombocytopenia remain unclear. This review presents current evidence from human and animal studies on the clinical features and mechanisms of platelet depletion in NEC. Anecdotal clinical experience is combined with evidence from laboratory studies and from an extensive literature search in databases PubMed, EMBASE, and Scopus and the electronic archives of abstracts presented at the annual meetings of the Pediatric Academic Societies. To avoid bias in identification of existing studies, key words were short-listed prior to the actual search both from anecdotal experience and from PubMed's Medical Subject Heading (MeSH) thesaurus. IMPACT: Fifty to 95% of infants with necrotizing enterocolitis (NEC) develop idiopathic thrombocytopenia (platelet counts <150 × 109/L) within 24-72 h of disease onset. Early clinical trials suggest that moderate thrombocytopenia may be protective in human NEC, although further work is needed to fully understand this relationship. We have developed a neonatal murine model of NEC-related thrombocytopenia, where enteral administration of an immunological stimulant, trinitrobenzene sulfonate, on postnatal day 10 induces an acute necrotizing ileocolitis resembling human NEC. In this murine model, thrombocytopenia is seen at 15-18 h due to platelet consumption and mild-moderate thrombocytopenia is protective.
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Affiliation(s)
- Akhil Maheshwari
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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3
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Esiaba I, Mousselli I, M. Faison G, M. Angeles D, S. Boskovic D. Platelets in the Newborn. NEONATAL MEDICINE 2019. [DOI: 10.5772/intechopen.86715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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4
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Jakobsen C, Larsen JB, Fuglsang J, Hvas AM. Platelet function in preeclampsia - a systematic review and meta-analysis. Platelets 2019; 30:549-562. [PMID: 30983478 DOI: 10.1080/09537104.2019.1595561] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Preeclampsia is a serious pregnancy-related complication. Platelets are potentially important in the pathogenesis of preeclampsia, and platelet function analyses may prove as sensitive preeclampsia biomarkers. This study aimed to systematically review and summarise the literature on platelet function markers in preeclampsia. This systematic review was conducted according to PRISMA and registered in PROSPERO. Relevant studies were identified through PubMed and Embase on 15/08/17. As platelet function markers platelet activation, platelet aggregation and platelet adhesion markers were included. If possible, relevant data were extracted for each marker to perform a meta-analysis of the mean difference between women with and without preeclampsia. All 69 included articles underwent quality rating. Some platelet activation markers, especially p-selectin and mean platelet volume (MPV), were significantly increased comparing the two groups of women, while others were not. The meta-analysis demonstrated that, overall, women with preeclampsia had significantly higher MPV than in women without preeclampsia. No significant difference was found regarding platelet aggreg`ation comparing the two groups. Platelet adhesion was investigated in noneof the included studies. In conclusion, further studies are warranted to investigate platelet activation markers future role as predictive markers in preeclampsia. MPV is suggested as the most promising biomarker for evaluating platelet function in preeclampsia.
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Affiliation(s)
- Carina Jakobsen
- a Centre for Haemophilia and Thrombosis, Department of Clinical Biochemistry , Aarhus University Hospital , Aarhus , Denmark
| | - Julie Brogaard Larsen
- a Centre for Haemophilia and Thrombosis, Department of Clinical Biochemistry , Aarhus University Hospital , Aarhus , Denmark
| | - Jens Fuglsang
- b Department of Obstetrics and Gynaecology , Aarhus University Hospital , Aarhus , Denmark.,c Department of Clinical Medicine , Aarhus University , Aarhus , Denmark
| | - Anne-Mette Hvas
- a Centre for Haemophilia and Thrombosis, Department of Clinical Biochemistry , Aarhus University Hospital , Aarhus , Denmark.,c Department of Clinical Medicine , Aarhus University , Aarhus , Denmark
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5
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Stokhuijzen E, Koornneef JM, Nota B, van den Eshof BL, van Alphen FPJ, van den Biggelaar M, van der Zwaan C, Kuijk C, Mertens K, Fijnvandraat K, Meijer AB. Differences between Platelets Derived from Neonatal Cord Blood and Adult Peripheral Blood Assessed by Mass Spectrometry. J Proteome Res 2017; 16:3567-3575. [PMID: 28823163 DOI: 10.1021/acs.jproteome.7b00298] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
It has been proposed that differences may exist between umbilical cord blood (CB) platelets and adult peripheral blood (APB) platelets, including altered protein levels of the main platelet integrins. We have now compared the protein expression profiles of CB and APB platelets employing a label-free comparative proteomics approach. Aggregation studies showed that CB platelets effectively aggregate in the presence of thromboxane A2 analogue, collagen, and peptide agonists of the proteinase-activated receptors 1 and 4. In agreement with previous studies, higher concentrations of the agonists were required to initiate aggregation in the CB platelets. Mass spectrometry analysis revealed no significant difference in the expression levels of critical platelet receptors like glycoprotein (GP)Ib, GPV, GPIX, and integrin αIIbβ3. This was confirmed using flow cytometry-based approaches. Gene ontology enrichment analysis revealed that elevated proteins in CB platelets were in particular enriched in proteins contributing to mitochondrial energy metabolism processes. The reduced proteins were enriched in proteins involved in, among others, platelet degranulation and activation. In conclusion, this study reveals that the CB and APB platelets are distinct. In particular, changes were observed for proteins that belong to metabolic and energy generation processes and not for the critical adhesive platelet integrins and glycoproteins.
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Affiliation(s)
- Eva Stokhuijzen
- Department of Pediatric Hematology, Emma Children's Hospital, Academic Medical Center , 1105 AZ Amsterdam, The Netherlands.,Department of Plasma Proteins, Sanquin Research , 1066 CX Amsterdam, The Netherlands
| | | | - Benjamin Nota
- Department of Research Facilities, Sanquin Research , 1066 CX Amsterdam, The Netherlands
| | | | | | | | - Carmen van der Zwaan
- Department of Plasma Proteins, Sanquin Research , 1066 CX Amsterdam, The Netherlands
| | - Carlijn Kuijk
- Department of Hematopoiesis, Sanquin Research , 1066 CX Amsterdam, The Netherlands
| | - Koen Mertens
- Department of Plasma Proteins, Sanquin Research , 1066 CX Amsterdam, The Netherlands.,Department of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences, Utrecht University , 3584 CG Utrecht, The Netherlands
| | - Karin Fijnvandraat
- Department of Pediatric Hematology, Emma Children's Hospital, Academic Medical Center , 1105 AZ Amsterdam, The Netherlands.,Department of Plasma Proteins, Sanquin Research , 1066 CX Amsterdam, The Netherlands
| | - Alexander Benjamin Meijer
- Department of Plasma Proteins, Sanquin Research , 1066 CX Amsterdam, The Netherlands.,Department of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences, Utrecht University , 3584 CG Utrecht, The Netherlands
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6
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Brosens I, Gargett CE, Guo SW, Puttemans P, Gordts S, Brosens JJ, Benagiano G. Origins and Progression of Adolescent Endometriosis. Reprod Sci 2016; 23:1282-8. [DOI: 10.1177/1933719116637919] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Ivo Brosens
- Leuven Institute for Fertility and Embryology, Leuven, Belgium
| | - Caroline E. Gargett
- The Ritchie Centre, Hudson Institute of Medical Research and Department of Obstetrics and Gynaecology Monash University, Clayton, Australia
| | - Sun-Wei Guo
- Department of Gynecology, Shanghai Obstetrics and Gynecology Hospital, Fudan University, Shanghai, People’s Republic of China
| | | | - Stephan Gordts
- Leuven Institute for Fertility and Embryology, Leuven, Belgium
| | - Jan J. Brosens
- Division of Biomedical Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Giuseppe Benagiano
- Department of Gynaecology, Obstetrics and Urology, “Sapienza” University, Rome, Italy
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Abstract
Similarly to the development of the plasma coagulation system, which matures during the early weeks and months of life, age-dependent mechanisms and developmental changes influence platelet production and function in neonates. Platelet function testing on cord blood and peripheral blood demonstrates a generalized platelet hyporeactivity, during the first days of life. This reactivity reaches normal adult levels between the fifth and ninth day of life. The persistence of hyporeactivity after the tenth day of life might indeed suggest a platelet disorder.
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Affiliation(s)
- Antonio Del Vecchio
- Neonatal Intensive Care Unit, Di Venere Hospital, Via Ospedale Di Venere n.1, Bari 70131, Italy.
| | - Mario Motta
- Neonatology and Neonatal Intensive Care Unit, Children's Hospital of Brescia, Brescia, Italy
| | - Costantino Romagnoli
- Neonatal Intensive Care Unit, Division of Neonatology, Department of Pediatrics, Catholic University of the Sacred Heart, Rome, Italy
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8
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Yang J, Zhang H, Niu J, Mu X, Zhang X, Liu Y, Wang J, Chen Y. Impact of preeclampsia on megakaryocytopoesis and platelet homeostasis of preterm infants. Platelets 2015; 27:123-7. [DOI: 10.3109/09537104.2015.1048213] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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9
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Yip C, Linden MD, Attard C, Monagle P, Ignjatovic V. Platelets from children are hyper-responsive to activation by thrombin receptor activator peptide and adenosine diphosphate compared to platelets from adults. Br J Haematol 2014; 168:526-32. [PMID: 25266817 DOI: 10.1111/bjh.13153] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2014] [Accepted: 08/29/2014] [Indexed: 10/24/2022]
Abstract
Platelets are crucial subcellular elements of haemostasis at sites of vascular injury and are also known to be immune mediators in pathological thrombosis. Despite the integral role of platelets in many disease processes, there is very little information available on platelet function and response to agonists in healthy children. We recently reported important differences in the interaction of platelets with monocytes in the circulation, including increased formation of monocyte-platelet aggregates (MPAs) without concomitant increase in P-selectin expression. Our current study investigates parameters of platelet activation (PAC-1 binding and P-selectin expression) and MPA formation in response to a range of physiologically relevant platelet agonists in healthy children compared to healthy adults. All parameters were significantly higher in children in response to sub-maximal concentrations of thrombin receptor activator peptide and adenosine diphosphate, reflecting an age-specific difference in agonist-stimulated platelet reactivity in children. The results of our study challenge the general assumption that platelet reactivity in children is similar to adults. This finding is fundamental to investigating the role of platelets in diseases of childhood and pathogenesis of adult-based diseases that have their origins in childhood. Our findings underscore the need for age-specific reference ranges for platelet function in children rather than extrapolation from adult data.
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Affiliation(s)
- Christina Yip
- Haematology Research, Murdoch Childrens Research Institute, Melbourne, Vic., Australia; The University of Melbourne, Parkville, Vic., Australia
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10
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Freitas LG, Sathler-Avelar R, Vitelli-Avelar DM, Bela SR, Teixeira-Carvalho A, Carvalho MDG, Martins-Filho OA, Dusse LMS. Preeclampsia: Integrated network model of platelet biomarkers interaction as a tool to evaluate the hemostatic/immunological interface. Clin Chim Acta 2014; 436:193-201. [DOI: 10.1016/j.cca.2014.05.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 05/27/2014] [Accepted: 05/28/2014] [Indexed: 12/19/2022]
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11
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Hu Z, Slayton WB, Rimsza LM, Bailey M, Sallmon H, Sola-Visner MC. Differences between newborn and adult mice in their response to immune thrombocytopenia. Neonatology 2010; 98:100-8. [PMID: 20134184 PMCID: PMC2914362 DOI: 10.1159/000280413] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2009] [Accepted: 08/18/2009] [Indexed: 11/19/2022]
Abstract
BACKGROUND Sick neonates frequently develop severe thrombocytopenia. OBJECTIVE AND METHODS In order to test the ability of fetal mice to increase their megakaryocyte size and ploidy in response to thrombocytopenia, we injected an antiplatelet antibody (MWReg30) into pregnant mice daily for 7 days, and into nonpregnant adult mice to serve as controls. After that time, platelet counts were obtained and megakaryocytes in the bone marrow, liver, and spleen were stained with anti-von Willebrand factor antibody, individually measured, and quantified. RESULTS Our study demonstrated that megakaryocytopoiesis in newborn mice shares many features of human fetal/neonatal megakaryocytopoiesis, including the small size of megakaryocytes. In response to thrombocytopenia, adult mice increased megakaryocyte volume and concentration, primarily in the spleen. Newborn mice, in contrast, increased the megakaryocyte concentration in the spleen, but exhibited no increase in megakaryocyte volume in any of the organs studied. In fact, the megakaryocyte mass was significantly lower in the bone marrow of thrombocytopenic neonates than in age-matched controls. CONCLUSIONS We concluded that fetuses have a limited ability to increase their megakaryocyte mass in response to consumptive thrombocytopenia, compared to adult mice. These observations provide further evidence for the existence of biological differences between fetal/neonatal and adult megakaryocytopoiesis.
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Affiliation(s)
- Zhongbo Hu
- Department of Pediatrics, University of Florida, Gainesville, FL, USA
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12
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Israels SJ. Platelet Function in the Newborn. Platelets 2007. [DOI: 10.1016/b978-012369367-9/50784-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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13
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Levy-Shraga Y, Maayan-Metzger A, Lubetsky A, Shenkman B, Kuint J, Martinowitz U, Kenet G. Platelet function of newborns as tested by cone and plate(let) analyzer correlates with gestational Age. Acta Haematol 2006; 115:152-6. [PMID: 16549889 DOI: 10.1159/000090928] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
UNLABELLED The issue of platelet function in infants and neonates is of interest, and current data are debatable. A new method for assessing platelet function involves using the cone and plate(let) analyzer (CPA), applicable for small (0.2 ml) whole blood volumes. We used polystyrene surface-coated plates to evaluate cord blood neonatal platelet function under flow. One hundred and sixty full-term and 29 preterm infants born at the Sheba Medical Center between March 2003 and January 2004 were evaluated for platelet adhesion measured as surface coverage (SC; the percentage of total area covered by platelets) and platelet aggregation, defined as the average size (AS) of the aggregates. Platelets from preterm infants displayed less platelet adhesion than did those from full-term infants. Platelet SC correlated with gestational age in all infants (p < 0.05), and both groups exhibited similar aggregation (AS). AS values, however, were significantly lower than the normal adult range in our laboratory. Infants born to mothers with pregnancy-induced hypertension displayed significantly lower SC. No association was found between CPA and postnatal complications. CONCLUSION CPA provides a rapid, feasible option for testing platelet function in neonates. Its potential predictive value deserves further attention, and more extensive studies are warranted.
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Affiliation(s)
- Y Levy-Shraga
- Pediatric Department, The Edmond and Lily Safra Children's Hospital, Tel Hashomer, Israel
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15
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Sitaru AG, Holzhauer S, Speer CP, Singer D, Obergfell A, Walter U, Grossmann R. Neonatal platelets from cord blood and peripheral blood. Platelets 2005; 16:203-10. [PMID: 16011965 DOI: 10.1080/09537100400016862] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The haemostatic system in neonates is different from that of adults, possibly contributing to an increased incidence of bleeding disorders, such as intracranial hemorrhage. In this study, we analyzed platelets from cord blood and peripheral blood, collected at three time points after delivery from 20 term and 37 preterm neonates as well as blood from 20 healthy adults. Platelet membrane glycoproteins (GP) were quantified and P-selectin expression and PAC-1 binding ability before and after stimulation with TRAP were analyzed by whole blood flow cytometry. We found no significant differences in neonatal platelets from cord blood and peripheral blood within the first 24h of life. Platelets from infants less than 30 weeks of gestation expressed lower levels of GP (33271+/-9381 vs. 44085+/-17287 for GPIIIa, P<0.05) and were less reactive than platelets from term newborns (4.3+/-3.3 vs. 20.1+/-11.8% PAC-1 positive platelets after stimulation with TRAP, P<0.05). A significantly lower level of GPIIb/IIIa expression on platelets from peripheral blood was seen in term newborns as well as preterm infants, compared to adults. There was only a partial enhancement in the degranulation ability (alpha-granules) (13.4+/-12.3 vs. 50.3+/-16.1% P-selectin positive platelets, P<0.05) and no significant increase for PAC-1 binding (13.6+/-10.9 vs. 15.3+/-5.9% PAC-1 positive platelets, P=0.8) during the first 12 days of life. In conclusion, we could demonstrate that neonatal platelet reactivity increases with gestational age.
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Affiliation(s)
- A G Sitaru
- Institute of Clinical Biochemistry and Pathbiochemistry, Central Laboratory, University of Würzburg, Würzburg, Germany
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16
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Klein B, Faridi A, Amo-Takyi BK, Heilmann L, Von Tempelhoff GF, Rath W. Neonatal platelet activation in preeclampsia. Clin Appl Thromb Hemost 2001; 7:29-32. [PMID: 11190901 DOI: 10.1177/107602960100700107] [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: 11/16/2022] Open
Abstract
Preeclampsia is associated with an increased platelet activation; however, there are few studies concerning platelet activation of the newborn. The aim of our study was to compare platelet activation in newborns of preeclamptic mothers to newborns of healthy mothers by using whole blood flow cytometry. Blood samples were obtained from 20 newborns (10 healthy controls, 10 cases of preeclampsia/HELLP [hemolysis, elevated liver enzymes, and low platelet count] syndrome) during cesarean section. Antibodies against the following antigens were used as markers for platelet activation: CD 41, CD62P, CD 63, and platelet-bound fibrinogen. In addition to the basal platelet activation, the ability of platelets to undergo activation as a result of in vitro incubation with a weak agonist (adenosine diphosphate) was evaluated. A significant difference between the groups concerning basal platelet activation could only be seen for platelet-bound fibrinogen; the control group showed a higher extent of platelet activation (16.6 +/- 11.3 vs. 6.1 +/- 4.9; p = 0.03). Incubation with adenosine diphosphate in the control group resulted in minor increases of platelet activation, which was significant only for platelet-bound fibrinogen (16.6 +/- 11.3 vs. 42.5 +/- 22.1; p = 0.02). However, the preeclamptic group showed significantly increased levels of platelet activation for all used markers after in vitro activation (CD 41: 115.6 +/- 18.2 vs. 163.2 +/- 29.6; p = 0.002; CD62P: 2.4 +/- 0.4 vs. 3.9 +/- 0.3; p < 0.001; CD 63: 2.7 +/- 0.5 vs. 3.7 +/- 0.6; p = 0.002; platelet-bound fibrinogen: 6.1 +/- 4.9 vs. 55.1 +/- 9.1; p < 0.001). Preeclampsia or HELLP syndrome is therefore associated with an increased susceptibility to neonatal platelets, even against weak activators such as adenosine diphosphate. Whether this results from peculiarities in the fetal vascular environment or maternal influences is yet uncertain.
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Affiliation(s)
- B Klein
- Department of Obstetrics and Gynecology, University Hospital of the University of Technology, Aachen, Germany.
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Albert TS, Meng YG, Simms P, Cohen RL, Phibbs RH. Thrombopoietin in the thrombocytopenic term and preterm newborn. Pediatrics 2000; 105:1286-91. [PMID: 10835070 DOI: 10.1542/peds.105.6.1286] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Neonatal thrombocytopenia occurs commonly in neonatal intensive care units. The role of the thrombopoietin (Tpo) system in normal neonatal platelet regulation and neonatal thrombocytopenia is not well understood. The purpose of our study was to: 1) determine the normal Tpo level at birth in healthy nonthrombocytopenic term (NTT) and nonthrombocytopenic preterm (NTP) infants and in infants born to women with preeclampsia; and 2) measure Tpo levels in infants during and after the resolution of thrombocytopenia. Characterizing Tpo levels in the healthy and thrombocytopenic newborn is an important step in furthering our understanding of the pathophysiology of neonatal thrombocytopenia. METHODS This study is comprised of 2 parts. For the first part, cord blood was obtained at birth from both term (gestational age [GA]: 38-42 weeks) and preterm (GA: 25-36 weeks) infants. If birth platelet levels were >/=140 x 10(3)/microL and the infant fit criteria for being normal, or if the infant was born to a women with preeclampsia, Tpo levels were measured. For the second part, serial Tpo levels and concomitant platelet counts (Plts) were measured in both preterm and term infants during a period of marked thromboctyopenia (Plt < 100 x 10(3)/microL) until its resolution (Plt >/= 140 x 10(3)/microL). RESULTS Median cord blood Tpo levels from NTP infants (n = 35) were higher than those of NTT infants (n = 32; 95 pg/mL vs 48 pg/mL, respectively). In addition, preterm infants born to women with preeclampsia (n = 11) had lower Tpo levels than NTP infants with a similar GA (<41 pg/mL vs 95 pg/mL). For infants with marked thrombocytopenia, median Tpo levels during thrombocytopenia were similar between term (n = 12) and preterm (n = 14) groups (223 pg/mL and 179 pg/mL, respectively), with the majority of individuals showing a decrease in Tpo with resolution of thrombocytopenia. Within each group, there was large variability in the Tpo response to thrombocytopenia. IMPRESSION These data show that the Tpo system is intact in NTP and NTT neonates. Preeclampsia may be an example of a disorder that perturbs this system. The great variability in Tpo levels seen in infants during thrombocytopenia may be related to the mechanism of thrombocytopenia. The finding that, in general, Tpo levels decreased with resolution of thrombocytopenia is consistent with what has been described in adults and children.
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Affiliation(s)
- T S Albert
- Department of Pediatrics and Cardiovascular Research Institute, University of California, San Francisco, San Francisco, California 94131, USA
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Simák J, Holada K, Janota J, Stranák Z. Surface expression of major membrane glycoproteins on resting and TRAP-activated neonatal platelets. Pediatr Res 1999; 46:445-9. [PMID: 10509366 DOI: 10.1203/00006450-199910000-00014] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Platelets of full-term newborns and those of healthy adult donors were compared for constitutive expression of surface glycoproteins (GP) Ia-IIa, GP Ib, GP IIb-IIIa, and GP IV and for their activation responses to an agonist by detection of surface expression of activation markers P-selectin and CD63. Resting neonatal platelets showed significantly lower expression of GP Ia-IIa, GP Ib, and GP IIb-IIIa. In contrast, the expression of GP IV was significantly higher compared with platelets of adults. The expression of activation markers P-selectin and CD63 was assessed after in vitro activating of platelets with 0-15 microM human thrombin receptor-activating peptide. At low concentrations of thrombin receptor-activating peptide, the extent of surface expression of activation markers did not differ significantly between adult and neonatal platelets. However, after activation with 15 microM thrombin receptor-activating peptide, the extent of surface expression of P-selectin and CD63 was significantly lower in neonatal platelets. Because of ethical reasons, our study was conducted on neonates with a moderate neonatal hyperbilirubinemia. The remote possibility that hyperbilirubinemia could influence the expression of platelet surface receptors and the reactivity of neonatal platelet cannot be excluded. The role of higher expression of GP IV on neonatal platelets, also seen in certain hematologic malignancies in adults, remains to be elucidated. The lower expression of platelet adhesive receptors and the limited ability to up-regulate granular glycoproteins may play a role in the impairment of function of neonatal platelets.
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Affiliation(s)
- J Simák
- Department of Pathophysiology, 1st Medical Faculty, Charles University, Prague, Czech Republic
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Wang C, Mody M, Herst R, Sher G, Freedman J. Flow cytometric analysis of platelet function in stored platelet concentrates. TRANSFUSION SCIENCE 1999; 20:129-39. [PMID: 10539116 DOI: 10.1016/s0955-3886(99)00022-3] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Platelet activation occurs during the collection, processing and storage of platelet concentrates. The effect of the platelet activation on the functional state of stored platelets remains however undefined. We employed flow cytometric analysis to evaluate the extent of platelet activation and the physiological response to thrombin stimulation of platelets stored for up to five days under routine blood bank conditions. Platelet surface expression of the activation markers CD62 and CD63 was examined, along with modulation of platelet membrane glycoproteins (GP) Ib and IIbIIIa. Platelet dense granule content was determined using a mepacrine uptake assay and the extent of platelet microparticle generation was quantified. Thirteen random-donor platelet concentrates prepared under routine conditions by a platelet-rich-plasma protocol were examined. Platelets were found to be activated following preparation on day 1. Although a gradual increase was seen with increasing storage time, this was not statistically significant for CD62 or CD63 expression, GPIIbIIIa or GPIb modulation or dense granule release; the generation of platelet microparticles did, however, increase with increasing storage time. The characteristic increase in surface expression of CD62, CD63 and GPIIbIIIa and decrease in GPIb and dense granule content in response to thrombin stimulation was observed with all concentrates, but these measures of platelet functional reserve showed decreasing platelet function with increasing storage time. The results indicate that platelets are activated by day 1, likely as a consequence of manipulation during collection and processing, but are not further progressively activated with increasing storage time; they do, however, become relatively hypofunctional with increasing storage.
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Affiliation(s)
- C Wang
- Canadian Red Cross Blood Services, Toronto Centre, Canada
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