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Alessi MC, Coxon C, Ibrahim-Kosta M, Bacci M, Voisin S, Rivera J, Greinacher A, Raster J, Pulcinelli F, Devreese KMJ, Mullier F, McCormick AN, Frontroth JP, Pouplard C, Sachs UJ, Diaz I, Bermejo N, Camera M, Fontana P, Bauters A, Stepanian A, Cozzi MR, Sveshnikova AN, Faille D, Hollon W, Chitlur M, Casonato A, Lasne D, Lavenu-Bombled C, Fiore M, Hamidou B, Hurtaud-Roux MF, Saultier P, Goumidi L, Gresele P, Lordkipanidzé M. Multicenter evaluation of light transmission platelet aggregation reagents: communication from the ISTH SSC Subcommittee on Platelet Physiology. J Thromb Haemost 2023; 21:2596-2610. [PMID: 37331519 DOI: 10.1016/j.jtha.2023.05.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 05/23/2023] [Accepted: 05/24/2023] [Indexed: 06/20/2023]
Abstract
BACKGROUND Light transmission aggregation (LTA) is used widely by the clinical and research communities. Although it is a gold standard, there is a lack of interlaboratory harmonization. OBJECTIVES The primary objective was to assess whether sources of activators (mainly adenosine diphosphate [ADP], collagen, arachidonic acid, epinephrine, and thrombin receptor activating peptide6) and ristocetin contribute to poor LTA reproducibility. The secondary objective was to evaluate interindividual variability of results to appreciate the distribution of normal values and consequently better interpret pathologic results. METHODS An international multicenter study involving 28 laboratories in which we compared LTA results obtained with center-specific activators and a comparator that we supplied. RESULTS We report variability in the potency (P) of activators in comparison with the comparator. Thrombin receptor activating peptide 6 (P, 1.32-2.68), arachidonic acid (P, 0.87-1.43), and epinephrine (P, 0.97-1.34) showed the greatest variability. ADP (P, 1.04-1.20) and ristocetin (P, 0.98-1.07) were the most consistent. The data highlighted clear interindividual variability, notably for ADP and epinephrine. Four profiles of responses were observed with ADP from high-responders, intermediate-responders, and low-responders. A fifth profile corresponding to nonresponders (5% of the individuals) was observed with epinephrine. CONCLUSION Based on these data, the establishment and adoption of simple standardization principles should mitigate variability due to activator sources. The observation of huge interindividual variability for certain concentrations of activators should lead to a cautious interpretation before reporting a result as abnormal. Confidence can be taken from the fact that difference between sources is not exacerbated in patients treated with antiplatelet agents.
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Affiliation(s)
- Marie-Christine Alessi
- Laboratory of Hematology, Centre de référence des pathologies plaquettaires, C2VN, INRAE, INSERM, Aix Marseille Université, Marseille, France.
| | - Carmen Coxon
- National Institute for Biological Standards and Control, Blanche Lane, South Mimms, Potters Bar, Hertfordshire, United Kingdom
| | - Manal Ibrahim-Kosta
- Laboratory of Hematology, Centre de référence des pathologies plaquettaires, C2VN, INRAE, INSERM, Aix Marseille Université, Marseille, France
| | - Monica Bacci
- Center for Thrombosis and Hemorrhagic Diseases, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Sophie Voisin
- Laboratoire d'Hématologie, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - José Rivera
- Servicio de Hematología y Oncología Médica, Hospital Universitario Morales Meseguer, Centro Regional de Hemodonación, Universidad de Murcia, Instituto Murciano De Investigación Biosanitaria, IMIB-Arrixaca, Murcia, Spain
| | - Andreas Greinacher
- Institut für Transfusionsmedizin, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Johannes Raster
- Institut für Transfusionsmedizin, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Fabio Pulcinelli
- Department of Experimental Medicine, Sapienza University of Rome, Roma, Italy
| | - Katrien M J Devreese
- Department of Diagnostic Sciences, Coagulation Laboratory, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Francois Mullier
- Namur Thrombosis and Hemostasis Center, CHU UCLouvain Namur, Université Catholique de Louvain, Yvoir, Belgium
| | - Aine N McCormick
- Haemostasis and Thrombosis Laboratory, Viapath Analytics, St Thomas' Hospital, London, United Kingdom
| | - Juan Pablo Frontroth
- Laboratorio de Hemostasia y Trombosis, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan," Buenos Aires, Argentina
| | - Claire Pouplard
- Department of Hemostasis, University Hospital of Tours, University of Tours, Tours, France
| | - Ulrich J Sachs
- Department of Thrombosis and Haemostasis, Giessen University Hospital, Giessen, Germany
| | - Isabelle Diaz
- Laboratory of Hematology, University Hospital of Montpellier, Montpellier, France
| | - Nuria Bermejo
- Servicio de Hematología, Hospital San Pedro de Alcántara, Complejo Hospitalario Universitario de Cáceres, Cáceres, Spain
| | - Marina Camera
- Centro Cardiologico Monzino, Istituto di Ricerca e Cura a Carattere Scientifico, Milan, Italy
| | - Pierre Fontana
- Division of Angiology and Haemostasis, Geneva University Hospitals, and Geneva Platelet Group, Faculty of Medicine, Geneva, Switzerland
| | - Anne Bauters
- Hemostasis Unit, Hospital University Center Lille, Lille, France
| | - Alain Stepanian
- Hematology Laboratory and Thrombosis Unit, Université Paris Cité, Hospital Group Lariboisière-Fernand Widal, Assistance Publique-Hôpitaux de Paris AP-HP, Paris, France
| | - Maria R Cozzi
- Immunopathology and Cancer Biomarkers Unit Centro di Riferimento Oncologico di Aviano, Aviano, Italy
| | - Anastasia N Sveshnikova
- Hemostasis Research Department, Dmitry Rogachev Pediatric Hematology and Immunology Hospital, Moscow, Russia
| | - Dorothée Faille
- Département d'Hématologie Biologique, Assistance Publique-Hôpitaux de Paris AP-HP, Centre Hospitalo-Universitaire CHU Bichat-Claude Bernard, Paris, France
| | - Wendy Hollon
- Jeanne M. Lusher Special Coagulation Laboratory, Children's Hospital of Michigan, Wayne State University, Detroit, Michigan, USA
| | - Meera Chitlur
- Central Michigan University, Jeanne M. Lusher Special Coagulation Laboratory, Children's Hospital of Michigan, Detroit, Michigan, USA
| | - Alessandra Casonato
- Department of Medicine, University of Padua Medical School, First chair of Internal Medicine, Padua, Italy
| | - Dominique Lasne
- Laboratoire d'Hématologie, Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants malades, Paris, France
| | - Cécile Lavenu-Bombled
- Service Hématologie Biologique, Centre de ressources et compétences de la filière de santé des maladies Hémorragiques constitutionnelles MHEMO, Centre Hospitalo-Universitaire CHU Bicêtre, Assistance Publique-Hôpitaux de Paris, Faculté de médecine Paris Saclay, Le Kremlin-Bicêtre, France
| | - Mathieu Fiore
- Bordeaux University Hospital, Laboratory of Hematology, Centre de Reference des Pathologies Plaquettaires Pessac, France
| | - Bello Hamidou
- Laboratory of Hematology, Centre de référence des pathologies plaquettaires, C2VN, INRAE, INSERM, Aix Marseille Université, Marseille, France
| | - Marie-Francoise Hurtaud-Roux
- Assistance Publique-Hôpitaux de Paris, Centre de Reference des Pathologies Plaquettaires, Hôpital Robert Debré, Paris, France
| | - Paul Saultier
- Laboratory of Hematology, Centre de référence des pathologies plaquettaires, C2VN, INRAE, INSERM, Aix Marseille Université, Marseille, France
| | - Louisa Goumidi
- Laboratory of Hematology, Centre de référence des pathologies plaquettaires, C2VN, INRAE, INSERM, Aix Marseille Université, Marseille, France
| | - Paolo Gresele
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Marie Lordkipanidzé
- Faculté de Pharmacie, Research Center and The Montreal Heart Institute, Université de Montréal, Montréal, Quebec, Canada
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Hamilton A, Ozelo M, Leggo J, Notley C, Brown H, Pablo Frontroth J, Angelillo-Scherrer A, Baghaei F, Enayat S, Favaloro E, Lillicrap D, Othman M. Frequency of Platelet type versus Type 2B von Willebrand Disease. Thromb Haemost 2017; 105:501-8. [DOI: 10.1160/th10-08-0523] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2010] [Accepted: 12/27/2010] [Indexed: 11/05/2022]
Abstract
SummaryLess than 50 patients are reported with platelet type von Willebrand disease (PT-VWD) worldwide. Several reports have discussed the diagnostic challenge of this disease versus the closely similar disorder type 2B VWD. However, no systematic study has evaluated this dilemma globally. Over three years, a total of 110 samples/data from eight countries were analysed. A molecular approach was utilised, analysing exon 28 of the von Willebrand factor (VWF) gene, and in mutation negative cases the platelet GP1BA gene. Our results show that 48 cases initially diagnosed as putative type 2B/PT-VWD carried exon 28 mutations consistent with type 2B VWD, 17 carried GP1BA mutations consistent with a PT-VWD diagnosis, three had other VWD types (2A and 2M) and five expressed three non-previously published exon 28 mutations. Excluding 10 unaffected family members and one acquired VWD, 26 cases did not have mutations in either genes. Based on our study, the percentage of type 2B VWD diagnosis is 44% while the percentage of misdiagnosis of PT-VWD is 15%. This is the first large international study to investigate the occurrence of PT-VWD and type 2B VWD worldwide and to evaluate DNA analysis as a diagnostic tool for a large cohort of patients. The study highlights the diagnostic limitations due to unavailability/poor application of RIPA and related tests in some centres and proposes genetic analysis as a suitable tool for the discrimination of the two disorders worldwide. Cases that are negative for both VWF and GP1BA gene mutations require further evaluation for alternative diagnoses.
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Frontroth JP, Hepner M, Sciuccati G, Torres AF, Pieroni G, Bonduel M. Prospective study of low-dose ristocetin-induced platelet aggregation to identify type 2B von Willebrand disease (VWD) and platelet-type VWD in children. Thromb Haemost 2017; 104:1158-65. [DOI: 10.1160/th10-04-0213] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2010] [Accepted: 08/09/2010] [Indexed: 11/05/2022]
Abstract
SummaryType 2B von Willebrand disease (VWD2B) and platelet-type von Wille-brand disease (PT-VWD) are rare bleeding disorders characterised by an increased ristocetin-induced platelet aggregation (RIPA) at low dose of ristocetin. It was the objective of this study to detect children with VWD2B and PT-VWD using RIPA at low dose of ristocetin (0.5 mg/ml) in the screening evaluation of bleeding disorders, and to analyse the phenotypic data along with the molecular findings. Over a 14-year period, 641 children with personal and family bleeding symptoms or bleeding from birth with previously uncharacterised haemostatic disorders were prospectively studied. Six unrelated patients (0.93%) showed RIPA at low dose of ristocetin. RIPA-based mixing studies identified that the plasma of the six probands and at least one parent from five unrelated families induced aggregation of normal platelets with the addition of low-dose ristocetin. None of the probands’ platelets showed aggre-gation with cryoprecipitate. Low ristocetin cofactor activity/VWF antigen ratio with absent collagen binding activity or thrombocytopenia were detected respectively in only two patients. Molecular analysis of exon 28 of the VWF gene identified mutations in only three patients. No mutation in the GP1BA gene was found. In this large prospective paediatric study, the screening approach including RIPA at low dose of ristocetin permitted the detection of patients with VWD2B that would otherwise have been missed. No patient with phenotype or genotype of PT-VWD was identified. Heterogeneity of bleeding symptoms and phenotypic parameters were found among members of the same family.
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Abstract
Ristocetin-induced platelet aggregation (RIPA) is used as an in vitro test to determine the presence and integrity of the platelet glycoprotein (GP) Ibα-V-IX complex and von Willebrand factor (VWF) interaction and is usually performed using platelet-rich plasma (PRP). Impairment in the response of VWF/GPIbα-V-IX is measured with reference to several established concentrations of ristocetin and may indicate defects in VWF or in GPIbα-V-IX function. RIPA-based mixing studies comprise an additional approach to testing this interaction to help define whether defects identified by RIPA lie in VWF or in GPIbα-V-IX. For example, the correction of an abnormal RIPA trace after mixing PRP with normal plasma and rechallenging with ristocetin at 1.0 mg/mL suggests VWF function/quantity defect. RIPA mixing studies at lower doses of ristocetin (0.5 mg/mL) are recommended for discrimination of von Willebrand disease type 2B (VWD2B) from the rarer platelet-type (PT) VWD and for the phenotypic laboratory diagnosis of VWD2B. The demonstration of a plasma factor capable of inducing platelet aggregation at such low doses of ristocetin represents the hallmark for the phenotypic laboratory diagnosis of VWD2B. Moreover, since both VWD2B and PT-VWD may present with thrombocytopenia, RIPA-based mixing studies are also useful in thrombocytopenic patients in whom RIPA testing is difficult to assess.
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Affiliation(s)
- Juan Pablo Frontroth
- Laboratorio de Hemostasia y Trombosis, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan", Buenos Aires, C1245AAM, Argentina.
| | - Emmanuel J Favaloro
- Haematology Department, Sydney Centres for Thrombosis and Haemostasis, Institute of Clinical Pathology and Medical Research (ICPMR), Westmead Hospital, NSW Health Pathology, Westmead, NSW, 2145, Australia
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Abstract
Laboratory testing of platelet function is essential for the diagnosis of several congenital and acquired platelet disorders. Moreover, it is increasingly being utilized to monitor the efficacy of antiplatelet therapy. Light transmission platelet aggregation is the most useful in vitro test of platelet function currently available, and it is still the gold standard to detect platelet disorders and to initiate a more precise characterization.
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Affiliation(s)
- Juan Pablo Frontroth
- Laboratorio de Hemostasia y Trombosis, Hospital de Pediatría, Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
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Bonduel M, Frontroth JP, Hepner M, Sciuccati G, Feliu-Torres A, Pieroni G. Von Willebrand disease in children: diagnosis and management of a pediatric cohort in one single center in Argentina. Semin Thromb Hemost 2011; 37:560-7. [PMID: 22102200 DOI: 10.1055/s-0031-1281043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
Clinical and laboratory data of children with von Willebrand disease (VWD) types have been derived from retrospective studies and small case series. This article reports on the clinical and laboratory data of a large pediatric cohort in one single Argentinian center. The biological and clinical responses to desmopressin and replacement therapies are also described. Over a 15-year period, 194 of 1150 children (16.9%) were diagnosed as having type 1 VWD (80%), type 2 VWD (19%), and type 3 VWD (1%). The distribution of the different type 2 VWD subtypes was type 2A VWD, 43%; type 2B VWD, 32%; type 2M VWD, 19%; and type 2N VWD, 6%. Eighty patients with type 1 VWD and 12 patients with type 2 VWD were prospectively evaluated to desmopressin (DDAVP) response. A complete response was observed in all children with type 1 VWD, whereas 40% of the children with severe type 1 VWD and with type 2 VWD achieved a complete response. All the children who received DDAVP as prophylaxis or treatment for bleeding had good clinical evolution. Considering the restricted availability of specialized hemostasis centers, we believe our clinical and laboratory approach appropriate for the detection of patients with different types of VWD. Further studies are necessary to determine epidemiological aspects of VWD in Argentina to estimate the necessary facilities and trained personnel for the diagnosis and management of patients with VWD.
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Affiliation(s)
- Mariana Bonduel
- Laboratorio de Hemostasia y Trombosis, Servicio de Hematología-Oncología, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina.
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Bonduel M, Frontroth JP, Hepner M, Sciuccati G, Feliú-Torres A. Platelet aggregation and adenosine triphosphate release values in children and adults. J Thromb Haemost 2007; 5:1782-3. [PMID: 17663744 DOI: 10.1111/j.1538-7836.2007.02621.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Bonduel M, Sciuccati G, Hepner M, Pieroni G, Torres AF, Frontroth JP, Tenembaum S. Arterial ischemic stroke and cerebral venous thrombosis in children: a 12-year Argentinean registry. Acta Haematol 2006; 115:180-5. [PMID: 16549893 DOI: 10.1159/000090932] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Over a 12-year period, 112 consecutive children with arterial ischemic stroke (AIS) and 38 children with cerebral venous thrombosis (CVT) were prospectively recruited at a single pediatric center in Argentina. One or more underlying clinical conditions were identified in most patients (55%) with AIS and in almost all patients with CVT. Inherited and/or acquired prothrombotic disorders were detected in 17% of the patients with AIS and in 34% of the children with CVT. No associations between factor V Leiden or prothrombin G20210A mutation and children with AIS or CVT were found. Antithrombotic agents (i.e., aspirin, low-molecular-weight heparin and acenocoumarol) were administered without major hemorrhagic complications. In our cohorts, mortality due to the thrombotic episode was 1.8% in children with AIS. No child with CVT died from his or her thrombotic episodes. Three children (3.2%) and 1 adolescent (1.1%) with AIS had thrombotic progression and recurrence, respectively. A large percentage of children with AIS (68%) and CVT (32%) have had some kind of sequels that caused serious disability in approximately half the cases.
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Affiliation(s)
- Mariana Bonduel
- Servicio de Hematología-Oncología, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina.
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Abstract
To determine guidelines for administering and monitoring acenocoumarol therapy in children, 93 patients (median 5.1 years, range: 0.2-18 years) were prospectively evaluated over a 33-month period. The loading doses used were: <1 year, 0.20 mg x kg-1; >1-5 years, 0.09 mg x kg-1; 6-10 years, 0.07 mg x kg-1; 11-18 years, 0.06 mg x kg-1. In this study, the loading dose and the dose to achieve and maintain target therapeutic range (TTR) for acenocoumarol are age-dependent, with infants having the highest and teenagers having the lowest requirements. The use of a different loading dose according to age has allowed most of the children (80%) in all the age groups to achieve TTR in less than 1 week. No patients had serious bleeding or thrombotic complications. We conclude that there is an age-dependent response to acenocoumarol in pediatric patients. The implementation of an age-adjusted loading dose regimen reduces the length of hospitalization required to achieve effective anticoagulant therapy.
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Affiliation(s)
- M Bonduel
- Departamento de Haematología-Oncología, Hospital de Pediatría 'Prof Dr Juan P. Garrahan', Combate de los Pozos 1881, Buenos Aires, Argentina.
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Bonduel M, Sciuccati G, Hepner M, Pieroni G, Torres AF, Mardaraz C, Frontroth JP. Factor V Leiden and prothrombin gene G20210A mutation in children with cerebral thromboembolism. Am J Hematol 2003; 73:81-6. [PMID: 12749008 DOI: 10.1002/ajh.10326] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We investigated whether there is an association between factor V Leiden (FVL) and/or prothrombin gene G20210A mutation (PT20210A) and cerebral thromboembolism in a pediatric Argentinean population. From May 1992 to January 2002, 44 consecutive children with arterial ischemic stroke (AIS) and 23 children with cerebral sinovenous thrombosis (SVT) were prospectively studied at a single center. The prevalence of both mutations was compared with a 102 age-matched controls. In children with AIS, the frequencies (patients vs. controls), odds ratio (OR), and 95% confidence interval (95% CI) for the presence of FVL were as follows: 2.3% vs. 2%, OR/95% CI, 1.16/0.2 to 13.2; P value = 0.99. No cases of PT20210A were found in this group. In children with SVT, the frequencies (patients vs. controls), OR, and 95% CI were as follows: FVL (4.3% vs. 2%, OR/95% CI, 2.27/0.22 to 6.2; P value = 0.99) and PT20210A (4.3% vs. 1%; OR/95% CI, 4.6/0.3 to 76.3; P value = 0.3354). One child with PT20210A also had an inherited protein C deficiency. In 12 (18%) out of the 67 children with cerebral thromboembolism, without the aforementioned mutations, other prothrombotic disorders were detected. Although a multi-center prospective study with a large number of Argentinean pediatric patients is needed to obtain considerable evidence, no association between factor V Leiden and/or prothrombin gene G20210A mutation and cerebral thromboembolism was found in this pediatric series.
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Affiliation(s)
- Mariana Bonduel
- Servicio de Hematología-Oncología, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina.
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Bonduel M, Hepner M, Sciuccati G, Pieroni G, Feliú-Torres A, Mardaraz C, Frontroth JP. Factor V Leiden and prothrombin gene G20210A mutation in children with venous thromboembolism. Thromb Haemost 2002; 87:972-7. [PMID: 12083504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
To determine whether factor V Leiden (FVL) and/or prothrombin gene G20210A mutation (PT20210A) are risk factors for venous thromboembolism (VTE) in Argentinean children. One hundred and thirty consecutive children with VTE were prospectively assisted at a single centre. Blood samples were available from 110 of them for detailed haematological analysis. The prevalence of both mutations was compared with a control group. The odds ratio for VTE was significantly increased in patients with FVL (OR 3.64; 95% CI: 1.14-11.6, p < 0.029) whereas odds ratio for VTE was not significantly increased in patients with PT20210A (OR 1.06; 95% CI: 0.24-4.73, p = 0.938). Combined disorders were found in 5 of the 10 children with the aforementioned mutations. In 21 children (19%) without these mutations other inherited and acquired disorders were detected. Our data show that FVL is a risk factor for VTE whereas PT20210A does not seem to be a risk factor in our paediatric population.
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Affiliation(s)
- Mariana Bonduel
- Servicio de Hematología-Oncología, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina.
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Abstract
PURPOSE The aim of this study was to determine the frequency of acquired or inherited prothrombotic disorders in a pediatric population with venous thromboembolism (VTE). PATIENTS AND METHODS From May 1992 to April 1998, 56 consecutive children with VTE were prospectively studied at a single center. RESULTS The median age was 8.4 years (range, 0.1-18 years). There was a male predominance. Fifty (89%) children had thrombosis in the lower venous system. Risk factors were detected in 54 (96%) children. Twenty-one (38%) thrombotic episodes were related to central venous lines. Family history of thrombosis was positive in 13 (23%) patients. In 26 (46%) patients, a prothrombotic disorder was detected. Nine of them had inherited disorders (protein C deficiency, 5 patients; protein S deficiency, 3 patients; Factor V Leiden mutation, 1 patient), and 13 children had acquired disorders (antiphospholipid antibodies, 5 patients; antithrombin deficiency, 8 patients). The remaining four showed combined abnormalities (Factor V Leiden mutation associated with inherited protein S deficiency, 1 patient; acquired antithrombin deficiency, 2 patients and inherited antithrombin deficiency, 1 patient). CONCLUSIONS In the series, a high percentage of prothrombotic disorders was detected; thus, a complete hemostatic evaluation should be performed in all of the children with VTE whether the patients have one or more risk factors.
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Affiliation(s)
- M Bonduel
- Hematology-Oncology Department, Hospital de Pediatría, Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
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Bonduel M, Sciuccati G, Hepner M, Torres AF, Pieroni G, Frontroth JP. Prethrombotic disorders in children with arterial ischemic stroke and sinovenous thrombosis. Arch Neurol 1999; 56:967-71. [PMID: 10448802 DOI: 10.1001/archneur.56.8.967] [Citation(s) in RCA: 81] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Arterial ischemic stroke (AIS) and sinovenous thrombosis (SVT) are relatively rare events in children. The contribution of prethrombotic disorders to the etiology of these entities has not been completely elucidated. OBJECTIVES To determine the frequency of inherited and acquired prethrombotic disorders in a pediatric population with AIS and SVT and to report clinical and radiological features. METHODS From May 1992 to April 1997, 30 consecutive children with AIS and 10 children with SVT were assisted at a single institution. Hemostatic evaluation was performed for all the children. Evaluation included the following assays: protein C, protein S, antithrombin, plasminogen, activated protein C resistance, factor V Leiden mutation, and the detection of antiphospholipid antibodies. Data concerning baseline demographics, risk factors, presenting features, family history of thrombosis, and radiological findings were also recorded. RESULTS One or more prethrombotic disorders were present in 9 children (30%) with AIS (inherited protein S deficiency, 2 patients; inherited protein C deficiency, 1 patient; acquired antithrombin deficiency, 2 patients; antiphospholipid antibodies, 3 patients; and antiphospholipid antibodies and plaminogen deficiency, 1 patient) and in 5 children (50%) with SVT (inherited protein S deficiency, 1 patient; acquired antithrombin deficiency, 3 patients; and antiphospholipid antibodies, 1 patient). CONCLUSIONS Most children studied presented both a variety of risk factors for thrombosis and concomitant prethrombotic disorders. Therefore, a complete hemostatic evaluation for all children with AIS and SVT should be performed, despite the presence of obvious clinical risk factors or lack of family history of thrombosis.
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Affiliation(s)
- M Bonduel
- Hematology-Oncology Department, Hospital de Pediatria "Prof. Dr. Juan P. Garrahan," Buenos Aires, Argentina
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Hepner M, Roldan A, Pieroni G, Frontroth JP, Serviddio RM, Torres AF, Sciuccati G, Bonduel M. Factor V Leiden mutation in the Argentinian population. Thromb Haemost 1999; 81:989. [PMID: 10404780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
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Bermejo EI, Kempfer AC, Narbaitz M, Frontroth JP, Lazzari MA. Differential formation of a bioactive antiaggregating substance (BAS) by layers of the vein wall. Platelets 1997; 8:143-6. [PMID: 20297935 DOI: 10.1080/09537109709169329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Human umbilical veins were analyzed with and without endothelium in order to study the ability of endothelial cells and subendothelium to release a bioactive anti-aggregating substance (BAS: MW > 30kDa) independent of prostacyclin (PGI(2)). To evaluate the role of the subendothelium, the endothelial cells were removed by rubbing on filter paper for 1 min. We performed a histopathological study of the vessels using hematoxylin and eosine, and stained for elastic tissue fibers in order to confirm the presence of endothelium. The supernatant from incubated vascular rings was partially purified by Sephadex G-50 to rule out PGI(2). The void volume fractions were collected and the anti-aggregating activity was tested on platelet aggregation induced by arachidonic acid, ADP, collagen and epinephrine. We observed that the activity was taking place with the use of the intact endothelium while there was no activity in the denuded vein. These observations could help to explain the well known antithrombotic properties of vascular endothelium.
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Affiliation(s)
- E I Bermejo
- 'Mariano R. Castex', Academia Nacional de Medicina., Capital Federal, Argentina
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Schattner M, Kempfer A, Geffner J, Bermejo E, Frontroth JP, Lazzari M. Reduction of platelet surface GPIb expression induced by polymorphonuclear leukocytes. Thromb Res 1995; 79:319-24. [PMID: 8533127 DOI: 10.1016/0049-3848(95)00118-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
It has been demonstrated that soluble factors released from PMNs such as proteases, free radicals and arachidonic acid metabolites are able to induce platelet activation (1). More recently, it has been demonstrated that PMNs can also inhibit platelet functional responses. It has been suggested that the inhibitory effect of PMNs could be related to the release of nitric oxide (NO) (2-3). In contrast, we have previously observed that coincubation of platelets with unstimulated PMNs, results in the inhibition of platelet aggregation and ATP release by a yet non-identified mechanism that does not involves NO (4). Considering that an alteration in surface receptors could be one of the phenomena accounting for impaired platelet responses, in the present study we evaluated the ability of PMNs to modulate the expression of the glycoproteins (GP) involved in platelet adhesion and aggregation, GPIb-IX and GPIIb-IIIa.
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Affiliation(s)
- M Schattner
- Departamento de Trombosis y Hemostasia, Instituto de Investigaciones Hematologicas, Academia Nacional de Medicina, Buenos Aires, Argentina
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17
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Kempfer AC, Frontroth JP, Farías C, Bermejo E, Lazzari MA. A simple enzyme-immunoassay test for von Willebrand factor binding in human arterial subendothelium. Thromb Res 1992; 68:131-6. [PMID: 1475775 DOI: 10.1016/0049-3848(92)90028-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
In order to determine the binding of vWF, subendothelium from everted human umbilical arteries was perfused with dialysed serum containing different concentrations of purified vWF using an annular perfusion chamber at a wall shear rate of 1100 sec-1 for 30 min. After perfusion, control (not perfused) and perfused vessel segments were washed and incubated with a diluted rabbit antibody against human vWF. Then the nonbound anti-vWF from both samples were used to determine indirectly vWF by EIA. Although in our experiments normal vWF serum concentrations were not enough to exert vWF binding, a substantial binding could be attained with vWF levels around 2.5 U/ml. To estimate the pre-existing subendothelial vWF amount, three different experiments were developed: a) diluted IgG from a nonimmunized rabbit, b) a diluted rabbit antibody to human vWF, c) PBS-BSA. After washing, vessel segments were incubated with rabbit antibody to human vWF. After incubation, the nonbound anti-vWF was used to determine indirectly vWF by EIA. The results obtained showed that the amount of pre-existing vWF was approximately 1.1x10(-3) U vWF/cm2 subendothelium.
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Affiliation(s)
- A C Kempfer
- Instituto de Investigaciones Hematológicas Mariano R. Castex, Academia Nacional de Medicina, Buenos Aires, Argentina
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18
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Kempfer AC, Frontroth JP, Lazzari MA. Visualization of platelet glycoproteins Ib and IIIa by immunoenzymatic stain using avidin-biotin peroxidase complex. Thromb Res 1991; 64:395-404. [PMID: 1788826 DOI: 10.1016/0049-3848(91)90340-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
A method is described here for the identification and quantitation of antigens by monoclonal antibodies. This method is based upon 1) separation (crossed-immunoelectrophoresis) and immunoprecipitation (rocket immunoelectrophoresis and crossed immunoelectrophoresis) of glycoproteins Ib and IIIa with a polyspecific antiserum; 2) binding of the non precipitating monoclonal antibody to glycoproteins precipitated by the rabbit antibody; 3) visualization of the monoclonal antibody with secondary biotinylated antibody and after addition of avidin biotin peroxidase complex, the peroxidase activity is detected by 4-Cl-1-naphtol. By this technique, the agarose gel plate could be stained directly and this allowed us to eliminate electrophoretic transblotting and radioactive compounds.
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Affiliation(s)
- A C Kempfer
- Instituto de Investigaciones Hematológicas, Mariano R. Castex, Academia Nacional de Medicina, Buenos Aires, Argentina
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19
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Kempfer AC, Maugeri N, Farias C, Bermejo E, Gimeno M, Frontroth JP, Lazzari M. Purification and partial characterization of a bioactive substance from rat's vessel wall independent of prostacyclin production. Thromb Res 1988; 52:127-35. [PMID: 3057678 DOI: 10.1016/0049-3848(88)90091-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The bioactive substance from rat's vessel wall was purified by Sephadex G-75 gel filtration and by a combination of DEAE Cellulose ion exchange and Sephadex G-50 gel filtration chromatographies. Purifications of 12.5 fold and 70 fold over the initial material were achieved. PAGE of the purified material resulted in a single major band with a molecular weight estimated at 55kd-65kd. Trypsin (0.3 mg/ml) and chymotrypsin (30 mg/ml) abolished platelet antiaggregating activity. Neuraminidase (1.2 units) had no effect on platelet antiaggregating activity. This is the report of purification of aortic vessel wall antiaggregating activity independent of prostacyclin production.
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Affiliation(s)
- A C Kempfer
- Department of Hemostasis and Thrombosis, Academia Nacional de Medicina, Buenos Aires, Argentina
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Farias C, Patrao de Macedo M, Kempfer AC, Frontroth JP, Lazzari M. Relationship of fibrinogen-bound sialic acid and liver disease in patients with lymphoma. Thromb Res 1988; 51:325-9. [PMID: 3175986 DOI: 10.1016/0049-3848(88)90109-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- C Farias
- Department of Hemostasis and Thrombosis, Instituto de Investigaciones Hematologicas Mariano R. Castex, Academia Nacional de Medicina, Buenos Aires, Argentina
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