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Vianello F, Vettore S, Tezza F, Toni LD, Scandellari R, Sambado L, Treleani M, Fabris F. Serum Thrombopoietin and cMpl Expression in Thrombocytopenia of Different Etiologies. Hematol Rep 2014; 6:4996. [PMID: 24711916 PMCID: PMC3977153 DOI: 10.4081/hr.2014.4996] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Revised: 01/21/2014] [Accepted: 02/10/2014] [Indexed: 12/20/2022] Open
Abstract
The relationship between thrombopoietin (TPO) and its receptor cMpl in thrombocytopenic conditions has not been entirely clarified. To elucidate this interplay may expand the spectrum of indications of TPO mimetics. In this study we have explored the relationship between TPO and cMpl in platelets and megakaryocytes of 43 patients with thrombocytopenia due to idiopathic thrombocytopenic purpura (ITP), bone marrow hypoplasia, myelodysplastic syndromes (MDS), and familial thrombocytopenia. Data were compared to cMpl and TPO in patients with a normal platelet count and in patients with thrombocytosis due to essential thrombocythemia (ET). All but familial patients showed higher TPO compared to controls. All thrombocytopenic states were invariably associated with increased expression of platelet cMPL compared to healthy controls. ET patients showed normal TPO and a trend toward a reduced cMpl expression. Immunofluorescence of bone marrow sections from patients with ITP and MDS failed to show a peculiar pattern compared to controls. Multiple mechanisms regulate TPO and cMpl in thrombocytopenic conditions.
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Affiliation(s)
- Fabrizio Vianello
- Internal Medicine Unit, Department of Medicine DIMED, University of Padova Medical School , Padova, Italy
| | - Silvia Vettore
- Internal Medicine Unit, Department of Medicine DIMED, University of Padova Medical School , Padova, Italy
| | - Fabiana Tezza
- Internal Medicine Unit, Department of Medicine DIMED, University of Padova Medical School , Padova, Italy
| | - Luca De Toni
- Centre for Human Reproduction Pathology, Department of Medicine DIMED, University of Padova Medical School , Padova, Italy
| | - Raffaella Scandellari
- Internal Medicine Unit, Department of Medicine DIMED, University of Padova Medical School , Padova, Italy
| | - Luisa Sambado
- Internal Medicine Unit, Department of Medicine DIMED, University of Padova Medical School , Padova, Italy
| | - Martina Treleani
- Internal Medicine Unit, Department of Medicine DIMED, University of Padova Medical School , Padova, Italy
| | - Fabrizio Fabris
- Internal Medicine Unit, Department of Medicine DIMED, University of Padova Medical School , Padova, Italy
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Vianello F, Furian L, Nordio M, Treleani M, Fabris F. Concomitant use of argatroban and warfarin during hemodialysis in heparin-induced thrombocytopenia. Hematology 2014; 20:48-9. [DOI: 10.1179/1607845414y.0000000157] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Affiliation(s)
| | - Lucrezia Furian
- Kidney and Pancreas Transplantation UnitDepartment of Surgery and Organ Transplantation, University of Padua, Padua, Italy
| | - Maurizio Nordio
- Nephrology and Dialysis UnitCamposampiero District Hospital, Padua, Italy
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Abstract
Venous thrombosis usually involves the veins of the limbs, most frequently the leg veins. All other venous districts may sometimes be affected by the thrombotic process. Sometimes, the thrombotic occlusion of the veins of a given region show typical signs and symptoms. In other cases, the picture may not be clear and a high degree of clinical suspicion is needed for a correct approach to patient diagnosis and management. Thrombosis of retinal and jugular veins, right heart thrombosis including thrombosis of coronary sinus and thrombosis of the azygos system may be included in this group. In addition, thromboses of umbilical, renal, ovarian, spermatic, and iliac veins also require attention. Finally, the dorsal veins of the penis may also be affected by thrombotic events. The main clinical features of these thromboses are reviewed herein with suggestions for a correct diagnostic approach. The importance of sonography and of other imaging techniques is emphasized. A prompt diagnosis is of paramount importance as most of these thromboses in rare or unusual sites may still cause severe systemic complications (pulmonary embolism, sepsis, and heart failure).
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Affiliation(s)
- Antonio Girolami
- Department of Medicine, University of Padua Medical School, Padua, Italy
| | - Martina Treleani
- Department of Medicine, University of Padua Medical School, Padua, Italy
| | - Emanuela Bonamigo
- Department of Medicine, University of Padua Medical School, Padua, Italy
| | - Valentina Tasinato
- Department of Medicine, University of Padua Medical School, Padua, Italy
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Girolami A, Bertozzi I, Tasinato V, Sambado L, Treleani M. Bleeding manifestations apparently unrelated to coagulation or other organic disorders: A tentative classification and diagnostic clues. Hematology 2013; 19:293-8. [PMID: 24164712 DOI: 10.1179/1607845413y.0000000133] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE To study the features of bleeding conditions apparently not associated with vascular, platelet, or clotting dysfunctions. METHOD Conditions that may meet these criteria are: Münchausen syndrome factitious or fictitious, suicidal or homicidal bleeding, bleeding due to self-punishment, stigmatization, the battered child syndrome, and psychogenic bleeding. RESULTS The importance of these variegate conditions is not trivial in clinical practice. Differential diagnosis may be difficult and involve other specialists besides hematologists. Occasionally, invasive procedures are involved. DISCUSSION The occurrence of bleeding in patients, without a clotting defect or a systemic disorder and a negative family history for bleeding represents a diagnostic challenge. A careful examination of the physical and psychological status of the patient and an appropriate evaluation of the environment in which bleeding occurs, is always needed.
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Girolami A, Scarparo P, Bonamigo E, Treleani M, Lombardi AM. Homozygous FVII deficiencies with different reactivity towards tissue thromboplastins of different origin. Hematology 2013; 17:350-4. [DOI: 10.1179/1024533212z.000000000144] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Affiliation(s)
- A. Girolami
- Department of Medical and Surgical Sciences and Northeastern Italy Association for the Study of Coagulation Disorders, University of Padua Medical School, Padua, Italy
| | - P. Scarparo
- Department of Medical and Surgical Sciences and Northeastern Italy Association for the Study of Coagulation Disorders, University of Padua Medical School, Padua, Italy
| | - E. Bonamigo
- Department of Medical and Surgical Sciences and Northeastern Italy Association for the Study of Coagulation Disorders, University of Padua Medical School, Padua, Italy
| | - M. Treleani
- Department of Medical and Surgical Sciences and Northeastern Italy Association for the Study of Coagulation Disorders, University of Padua Medical School, Padua, Italy
| | - A. M. Lombardi
- Department of Medical and Surgical Sciences and Northeastern Italy Association for the Study of Coagulation Disorders, University of Padua Medical School, Padua, Italy
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Girolami A, de Marinis GB, Treleani M, Tasinato V, Girolami B. Congenital Thrombophilia and Intracardiac Thrombosis: Probably an Underdiagnosed Event. Cardiol Res 2013; 4:109-115. [PMID: 28352430 PMCID: PMC5358248 DOI: 10.4021/cr278e] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2013] [Indexed: 11/05/2022] Open
Abstract
Background To investigate the number of patients with congenital thrombophilia who presented an intracardiac thrombosis. Methods Personal files were reevaluated together with a time-unlimited search of the literature. Results Twenty-five patients with intracardiac thrombosis and congenital thrombophilia have been gathered from the literature including the two personal cases. The distribution observed in thrombophilia patients is similar for left side or right side heart (9 vs 11 cases). The left ventricle and the right ventricle were involved in six or five instances, respectively. In one case, both ventricles were involved. On the contrary, the left atrium was involved in three cases whereas the right atrium was affected in six cases. In the remaining cases, more than one heart chamber was involved. Conclusions In “normal” subjects, left side thromboses are predominant once catheter-associated thrombi are excluded. The reason of this discrepancy lies in the greater prothrombotic effect exercised by congenital thrombophilia on venous thrombosis compared to arterial thrombosis. The relative high prevalence of cardiac thrombosis seen in patients with antithrombin and protein C deficiencies indicated that a cardiac evaluation should be carried out in all patients with these two defects.
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Affiliation(s)
- Antonio Girolami
- Department of Medicine, University of Padua, Medical School, Padua, Italy
| | | | - Martina Treleani
- Department of Medicine, University of Padua, Medical School, Padua, Italy
| | - Valentina Tasinato
- Department of Medicine, University of Padua, Medical School, Padua, Italy
| | - Bruno Girolami
- Division of General Medicine, Padua City Hospital, Padua, Italy
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Girolami A, de Marinis GB, Bonamigo E, Treleani M, Vettore S. Arterial and venous thromboses in patients with idiopathic (immunological) thrombocytopenia: a possible contributing role of cortisone-induced hypercoagulable state. Clin Appl Thromb Hemost 2012; 19:613-8. [PMID: 22790661 DOI: 10.1177/1076029612452114] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [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] [Indexed: 11/15/2022] Open
Abstract
Immunological thrombocytopenias, as other forms of thrombocytopenia, are associated with bleeding. Occasionally, these patients manifest thrombotic events. A total of at least 29 patients were reported to have had either arterial (20 cases) or venous (9 cases) thrombosis while platelet count was less than 50 × 10(3)/μL. The most frequent clinical manifestation was a myocardial infarction. Thrombosis occurred in the large majority of patients during prednisone therapy. Patients receiving cortisone or patients with Cushing syndrome show a hypercoagulable state characterized by elevated factor VIII levels, decreased fibrinolysis, and abnormal von Willebrand factor multimers composition. The same is probably true for prednisone-treated patients with thrombocytopenia. However, the 2 conditions are not identical since prednisone is a mainly glycoactive compound, whereas cortisol produced in excess in Cushing syndrome is mainly mineraloactive. The presence of large, young, hyperactive platelets may also play a role. Prednisone-treated patients with thrombocytopenia have to be considered as potentially thrombophilic.
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Affiliation(s)
- Antonio Girolami
- 1Department of Medical and Surgical Sciences, University of Padua Medical School, Padua, Italy
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Girolami A, Treleani M, Scarparo P, Bonamigo E, Lombardi AM. Considerations on a tentative classification of FVII deficiency suited for practical clinical purposes. Clin Appl Thromb Hemost 2012; 18:654-7. [PMID: 22411998 DOI: 10.1177/1076029611434529] [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: 11/17/2022] Open
Abstract
Adequate classifications of disorders are of paramount importance in the management of congenital bleeding disorders. Classification of congenital FVII deficiency should be simple, based on few tests using thromboplastins of different origin. The first thromboplastin to be used is a rabbit brain preparation since it has been proven that this is the one that, overall, yields the lowest activity level. This is particularly so since molecular biology techniques have supplied important information with regard to the structure-function relation but have failed to supply a satisfactory classification of the defect. Mutations in the same domain have yielded different forms of FVII deficiency. Furthermore, molecular biology techniques are time consuming and are not feasible in every laboratory. A classification of FVII deficiency based on clinical, clotting, and immunological assays is proposed. This classification is suited for practical clinical purposes and may represent a useful preparatory basis for molecular biology studies.
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Affiliation(s)
- Antonio Girolami
- Department of Medical and Surgical Sciences, University of Padua Medical School, Padua, Italy
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Nardoni A, Marchetti E, Di Piazza V, Rossi G, Treleani M. [Disorders of cardiac rhythm in the alcohol abstinence syndrome. Holter monitoring]. Minerva Cardioangiol 1987; 35:19-24. [PMID: 2436095] [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: 12/31/2022]
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Nardoni A, Marchetti E, Di Piazza V, Treleani M, Geatti O. [Comparative evaluation of the prolactinogenic activity of domperidone and metoclopramide by the study of the pituitary prolactin reserve]. Clin Ter 1986; 118:19-22. [PMID: 3742972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Nardoni A, Marchetti E, Di Piazza E, Treleani M, Geatti O. [Prolactin and obesity: aspects of hypothalamic pathology]. G Clin Med 1985; 66:111-8. [PMID: 4029528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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