Thrombopoietic status of Egyptian patients with ESRD on different forms of renal replacement therapies

Thrombocytopenia is a frequent problem of ESRD patients. The factors affect platelet counts are unknown completely. Thrombocytopenia was most frequent in the HCV positive hemodialysis patients. The effect of HCV anti-genaemia on thrombocytopenia was not clarified. This study included 220 patients with ESRD treated by HD [150 patient, 81 M and 69 F], Renal transplantation [50 patient, 27 M and 23 F] and CAPD [20 patient, 9 M ana 11 F] as well a 50 patient with HCV infection but without renal affection and 50 healthy control matched for age and sex with the cases. They were divided into six groups. All patients and controls were subjected to full medical history and clinical examination, CBC, kidney function tests, liver function tests, HCV antibodies and abdominal ultrasonography. Hemodialysis group is subjected to other investigations [HCV RNA by PCR as well as PTH, Kt/V and Measurement of platelet-associated immunoglobulin PAIgG [for thrombocytopenic patients] was determined by a competitive micro-RLISA method]. The results of this study showed significant presence of thrombocytopenia among patients on different RRT and the HCV positive patients who don't undergone dialysis and among the HCV negative patients with CRF on regular hemodialysis. The results showed also significant presence and higher incidence of thrombocytopenia among HCV positive patients with CRF on regular HD as compared to other groups. We also found that thrombocytopenia significantly increases with increased duration of dialysis and with cellulose type of hemodialysis membranes and Platelet counts had no significant relation with any of the drugs prescribed or with serum creatinine, urea nitrogen, iPTH, or Kt/V. HCV - positive hemodialysis patients had a higher incidences and a higher PAIgG liters than HCV-negative hemodialysis patients. The present study showed that thrombocytopenia was found in CRF patients on different renal replacement therapies especially in HD patients and more evident among those with +ve HCV antigenaemia. Even more than non uremic patients with +ve HCV antigenaemia. Follow-up of platelet count may be beneficial in HD patients for early detection and treatment of thrombocytopenia in these patients

Study of non-fibrinolysis-related role of plasminogen activator inhibitor-1 activity in chronic hepatitis C

The plasminogen activator inhibitor-1 [PAI-1] activity was investigated in chronic hepatitis C in relation to disease severity and some associated metabolic changes. The study included 30 patients with chronic hepatitis C compared to 30 control subjects. Disease severity was assessed using prothrombin time and serum albumin as parameters. Plasma plasminogen, PAI-1 and tissue plasminogen activator PAI-1 complex were determined, as well as serum lipid parameters and blood glucose level. We found decrease in PAI-1 activity, reflected by complex, more expressed in severe cases, with inadequate rise of PAI-1 level, associated with decreased VLDL, raised cholesterol and triglycerides and insignificant correlation to blood glucose level. We conclude that apart from its fibrinolysis-related role in chronic liver disease, PAI-1 activity is altered in chronic hepatitis C, resulting from chronic inflammation and associated lipid disturbances. This alteration contributes to the progression of the disease and its complications. Therapy directed at regulation of hepatic stellate cell function and control of lipid metabolism needs detailed investigation in order to regulate PAI-1 activity