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La trombocitopenia inmune primaria (TIP) es una enfermedad hematológica autoinmune que se distingue por tener plaquetas en un número inferior a 100.000, la cual provoca en los pacientes manifestaciones clínicas como la presencia de equimosis, petequias hasta hemorragias masivas que pueden comprometer la vida del paciente. Para su diagnóstico se realizan exámenes complementarios, ya que es una patología en la que no existe una prueba estándar o específica para diagnosticarla, y su tratamiento sea de primera, segunda o línea va a depender del número de plaquetas y de la fase de la enfermedad, sobresaliendo los agonistas de la trombopoyetina. Objetivo. Describir el manejo farmacológico de la Trombocitopenia Inmune Primaria (TIP) mediante la administración de los agonistas de la trombopoyetina. Metodología. Se realizó una revisión sistemática utilizando la metodología PRISMA, la información recopilada se hizo en bases de datos científicas como Pubmed, Science Direct, incluyendo artículos publicados dentro de los últimos 5 años, en inglés y español, relacionada al uso de los agonistas de la trombopoyetina y de la trombocitopenia inmune primaria. Resultados. Fueron seleccionados inicialmente 102 en PubMed y ScienceDirect, después de los procesos de verificación quedaron 18 artículos para la extracción y análisis de datos. Conclusión. Los agonistas de la trombopoyetina son fármacos seguros, pero siempre se debe valorar el riesgo-beneficio antes de usarlos en pacientes con TIP, porque cada paciente es único y su respuesta al tratamiento puede variar. Sin embargo, deben ser usados con precaución en pacientes con antecedentes de enfermedad tromboembólica o que presenten un riesgo elevado de desarrollarla.
Primary immune thrombocytopenia (PIT) is an autoimmune hematological disease that is distinguished by having platelets in a number lower than 100,000, which causes in patients clinical manifestations such as the presence of ecchymosis, petechiae to massive hemorrhages that can compromise the patient's life. For its diagnosis, complementary tests are performed, since it is a pathology in which there is no standard or specific test to diagnose it, and its treatment, whether first, second or third line, will depend on the number of platelets and the stage of the disease, with thrombopoietin agonists standing out. Objective. To describe the pharmacological management of Primary Immune Thrombocytopenia (PIT) through the administration of thrombopoietin agonists. Methodology. A systematic review was performed using PRISMA methodology, the information collected was done in scientific databases such as Pubmed, Science Direct, including articles published within the last 5 years, in English and Spanish, related to the use of thrombopoietin agonists and primary immune thrombocytopenia. Results. Initially 102 were selected in PubMed and ScienceDirect, after the verification processes, 18 articles remained for data extraction and analysis. Conclusion. Thrombopoietin agonists are safe drugs, but the risk-benefit should always be assessed before using them in patients with PIT, because each patient is unique and their response to treatment may vary. However, they should be used with caution in patients with a history of thromboembolic disease or who are at high risk of developing it.
A trombocitopenia imune primária (TPI) é uma doença hematológica autoimune que se distingue pela contagem de plaquetas abaixo de 100.000, o que causa manifestações clínicas como equimoses, petéquias e até hemorragias maciças que podem ser fatais. São realizados exames complementares para o diagnóstico, pois não existe um exame padrão ou específico para diagnosticá-la, e seu tratamento, seja de primeira, segunda ou terceira linha, depende do número de plaquetas e do estágio da doença, destacando-se os agonistas da trombopoetina. Objetivo. Descrever o manejo farmacológico da Trombocitopenia Imune Primária (TPI) por meio da administração de agonistas da trombopoetina. Metodologia. Foi realizada uma revisão sistemática utilizando a metodologia PRISMA, as informações coletadas foram feitas em bancos de dados científicos como Pubmed, Science Direct, incluindo artigos publicados nos últimos 5 anos, em inglês e espanhol, relacionados ao uso de agonistas da trombopoetina e trombocitopenia imune primária. Resultados. Um total de 102 artigos foi inicialmente selecionado no PubMed e no ScienceDirect e, após o processo de verificação, restaram 18 artigos para extração e análise de dados. Conclusão. Os agonistas da trombopoetina são medicamentos seguros, mas o risco-benefício deve ser sempre avaliado antes de usá-los em pacientes com TPI, pois cada paciente é único e sua resposta ao tratamento pode variar. No entanto, eles devem ser usados com cautela em pacientes com histórico de doença tromboembólica ou que tenham alto risco de desenvolver doença tromboembólica.
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Objective:To investigate the predictive value of systemic immune-inflammatory index (SII) for hemorrhagic transformation (HT) and symptomatic intracranial hemorrhage (sICH) after intravenous thrombolysis in patients with acute ischemic stroke (AIS).Methods:Patients with AIS received intravenous thrombolysis in the Department of Neurology, Huai’an First People’s Hospital from July 2019 to July 2022 were included retrospectively. The head CT was performed at 24 h after intravenous thrombolysis and determined whether HT existed. sICH was defined as brain parenchymal hematoma, and the National Institutes of Health Stroke Scale (NIHSS) scores increased by ≥4 compared with the baseline, or the patient died within 36 h after onset. Multivariate logistic regression analysis was used to determine the independent correlation between SII and HT and sICH after intravenous thrombolysis. The receiver operating characteristics (ROC) curve was used to evaluate the predictive value of SII for HT and sICH after intravenous thrombolysis. Results:A total of 352 patients with AIS received intravenous thrombolysis were enrolled, including 240 males (68.1%), aged 66.46±12.00 years. The median baseline NIHSS score was 8 (interquartile range, 5-13), and the median SII is 531.91×10 9/L (interquartile range, 351.20-896.91×10 9/L). HT occurred in 62 patients (17.6%) and sICH occurred in 27 patients (7.7%). Univariate analysis showed that the SII of the HT group was significantly higher than that of the non-HT group ( Z=–2.731, P=0.006), and the SII of the sICH group was significantly higher than that of non-sICH group ( Z=–4.125, P<0.01). Multivariate logistic regression analysis showed that the increased SII was the independent risk factor for HT (odds ratio [ OR] 1.001, 95% confidence interval [ CI] 1.000-1.001; P=0.004) and sICH ( OR 1.001, 95% CI 1.001-1.002; P<0.01). ROC curve analysis shows that the area under curve of SII predicting HT was 0.610 (95% CI 0.535-0.686; P=0.006), and the best cutoff value was 488.48×10 9/L. The corresponding sensitivity and specificity were 69% and 47% respectively. The area under the curve of SII predicting sICH was 0.739 (95% CI 0.636-0.842; P<0.01), and the best cutoff value was 846.56×10 9/L, the corresponding sensitivity and specificity were 70% and 77% respectively. Conclusion:The increased SII at admission can predict the risks of HT and sICH in patients with AIS after intravenous thrombolysis.
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SUMMARY OBJECTIVE: In our study, we aimed to find simple, useful biomarkers in patients with non-ST elevation myocardial infarction to predict coronary artery severity. METHODS: Between May 2022 and December 2022, patients diagnosed with non-ST elevation myocardial infarction according to the European cardiology guidelines were included in our study. The Synergy between PCI with Taxus and Cardiac Surgery score was calculated to determine the severity of coronary artery disease. These patients were classified into two groups according to Synergy between PCI with Taxus and Cardiac Surgery≥23 and Synergy between PCI with Taxus and Cardiac Surgery<23 scores. Biochemical markers such as platelet-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio were studied in blood tests taken before coronary angiography in patients diagnosed with non-ST elevation myocardial infarction according to current guidelines. These two groups were compared in terms of the data obtained. RESULTS: There were 281 patients in group 1 and 67 patients in group 2. There was no significant difference between the two groups in terms of demographic data such as age and gender. Platelet-to-lymphocyte ratio [group 1=125 (26-134) and group 2=156 (73-293); p=0.001] and neutrophil-to-lymphocyte ratio [group 1=2.71 (1.3-30.2) and group 2=3.2 (2.1-32.1); p=0.002] were higher in the group of patients with a Synergy between PCI with Taxus and Cardiac Surgery score of <23, while lymphocyte-to-monocyte ratio [group 1=3.6 (0.56-11) and group 2=3.4 (0.64-5.75); p=0.017] was lower in group 2. CONCLUSION: We observed that elevated platelet-to-lymphocyte and neutrophil-to-lymphocyte ratios showed coronary artery severity. Multivessel disease and chronic total occlusion rates were observed to be higher in patients with high platelet-to-lymphocyte and neutrophil-to-lymphocyte ratios.
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SUMMARY OBJECTIVES: The coronavirus disease pandemic has become a major global health crisis since 2019. Recent data show the association of diabetes, hypertension, and obesity with poor related outcomes in coronavirus disease infection. This descriptive study aimed to identify the clinical and laboratory parameters in patients with acute respiratory syndrome and confirmed severe acute respiratory syndrome coronavirus 2 infection. METHODS: In this cross-sectional study, we analyzed data of 409 patients admitted to a referral hospital in Rio Grande do Sul, Brazil, with coronavirus disease infection confirmed by reverse transcription polymerase chain reaction. Clinical, laboratory, and imaging data were collected retrospectively from electronic medical records using a template with the variables of interest. RESULTS: The average age was 64 years (52-73), and the body mass index was 27 kg/m² (22.1-31.2). Hypertension, diabetes, and obesity were observed in 58, 33, and 32% of the patients, respectively. Patients admitted to an intensive care unit were older [66 years (53-74) vs. 59 years (42.2-71.7)], with significantly higher impairment on chest computed tomography [75% (50-75) vs. 50% (25-60)] and received higher doses of corticosteroid therapy [39.4 mg (14.3-70.3) vs. 6 mg (6-14.7)]. Hematological parameters were lower in critically ill patients, with greater differences observed on the fifth day of hospitalization [hemoglobin 11.5 g/dL (9.5-13.1) vs. 12.8 g/dL (11.5-14.2), platelets 235,000 μL (143,000-357,000) vs. 270,000 μL (192,000-377,000), and lymphocytes 900 μL (555-1,500) vs. 1,629 μL (1,141-2,329)]. C-reactive protein levels and kidney function were also worse in intensive care unit patients. The mortality rate was significantly higher in the intensive care unit compared to the basic care unit (62.8 vs. 12.2%). CONCLUSION: Our findings suggest that metabolic and cardiovascular comorbidities, as well as abnormal hematological parameters, are common findings among patients with severe respiratory syndrome related to coronavirus disease.
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Objective To investigate the association between platelet count (PLT) and the prognosis of hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF), to establish a new PLT-related scoring model, and to assess its value in predicting the short-term prognosis of HBV-ACLF. Methods A retrospective cohort study was conducted among the patients with HBV-ACLF who were hospitalized and treated in Department of Gastroenterology, The General Hospital of Western Theater Command, from January 2018 to January 2022. Clinical data within 24 hours after admission were collected from all patients, and according to the survival after 180 days of follow-up, the patients were divided into survival group and death group. The independent-samples t test was used for comparison of normally distributed continuous data between groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups; the chi-square test was used for comparison of categorical data between groups. The Pearson correlation coefficient was used to investigate the correlation between different indicators, and the logistic regression model was used to analyze the influencing factors for prognosis. The receiver operating characteristic (ROC) curve was used to assess the predictive value of the prognostic model, and the Kaplan-Meier curve analysis was used to investigate the survival condition of the high AIP group and the low AIP group. Results A total of 236 patients were enrolled, with a 180-day survival rate of 75.85% (179/236). Compared with the survival group, the death group had significantly higher age (53.98±10.45 vs 47.44±12.46, P =0.001), international normalized ratio (INR) [1.78 (1.46-2.04) vs 1.47 (1.23-1.68), P < 0.001], total bilirubin [275.60 (165.00-451.45) vs 230.60 (154.90-323.70), P =0.035], Model for End-Stage Liver Disease (MELD) score [21.47 (18.14-24.76) vs 18.67 (15.70-21.62), P < 0.001], and albumin-bilirubin (ALBI) score [-1.06 (-1.64~-0.86) vs-1.32 (-1.73~-1.01), P =0.034], as well as significantly lower PLT [80.00 (50.00~124.50) vs 115.00 (82.00~143.00), P =0.001] and platelet-to-white blood cell ratio (PWR) [13.40 (9.54~20.70) vs 18.49 (13.95~24.74), P =0.001]. The Pearson correlation analysis showed that PLT was negatively correlated with liver cirrhosis and INR ( r =-0.332 and -0.194, P < 0.001 and P =0.003). The multivariate logistic regression analysis showed that age (odds ratio [ OR ]=1.045, 95% confidence interval [ CI ]: 1.015-1.076), PLT ( OR =0.990, 95% CI : 0.983-0.998), and INR ( OR =2.591, 95% CI : 1.363-4.925) were independent risk factors for the 180-day prognosis of HBV-ACLF patients. The new predictive model was established as follows: AIP=0.006×age+0.187×INR-0.001×PLT. The AIP scoring model had an area under the ROC curve (AUC) of 0.718 in predicting the 180-day prognosis of HBV-ACLF patients, with a sensitivity of 81.1% and a specificity of 54.1%, while PLT, PWR, LPACLF score, MELD score, and ALBI score had an AUC of 0.673, 0.659, 0.588, 0.647, and 0.578, respectively. The AIP scoring model had an optimal cut-off value of 0.48. The Kaplan-Meier survival analysis showed that the high AIP group had a significantly lower survival rate than the low AIP group ( P < 0.001). Conclusion The PLT-related scoring model has a better value than other models in predicting the prognosis of HBV-ACLF, and HBV-ACLF patients with a relatively high PLT level tend to have a high overall survival rate.
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Objective:To explore the relationship between serum albumin (ALB), erythrocyte sedimentation rate (ESR), platelet/lymphocyte ratio (PLR), neutrophil/lymphocyte ratio (NLR) and coronary artery disease in children with Kawasaki disease (KD).Methods:120 KD children diagnosed in the Affiliated Hospital of Jining Medical College from December 2016 to November 2021 were selected as the research objects. They were divided into observation group (KD with coronary artery disease) and control group (KD with coronary artery disease) according to whether they had coronary artery disease, with 60 cases in each group; the serum ALB, ESR, PLR, NLR values of the two groups of children were compared. Receiver operating characteristic (ROC) curve was used to analyze the value of the above indicators in diagnosing KD children with coronary artery disease. The serum ALB, ESR, PLR, NLR levels of KD children with different degrees of coronary artery disease were analyzed.Results:The main manifestations of coronary artery disease in 60 children with KD combined with coronary artery disease were left main coronary artery and left anterior descending branch widening [56.67%(34/60)], left main coronary artery and left anterior descending branch widening [20.00%(12/60)], left anterior descending branch widening [16.67%(10/60)], left main coronary artery widening [11.67%(7/60)]. The serum ALB in the observation group was significantly lower than that in the control group ( P<0.05), and ESR was significantly higher than that in the control group ( P<0.05). There was no significant difference in serum PLR and NLR between observation group and control group (all P>0.05). The sensitivity, specificity and area under curve (AUC) value of serum ALB in diagnosing coronary artery disease in KD children were 73.61%, 78.42% and 0.813 respectively; The sensitivity, specificity and AUC of ESR in diagnosing coronary artery disease in KD children were 88.36%, 83.14% and 0.892 respectively; The sensitivity, specificity and AUC value of ESR combined with ALB in diagnosing coronary artery disease in KD children were 90.67%, 97.54% and 0.953 respectively. Among 60 children with KD complicated with coronary artery disease, 39 were diagnosed as coronary artery dilatation and 21 had coronary artery aneurysm. The serum ALB of children in the coronary artery aneurysm group was significantly lower than that in the coronary artery dilatation group ( P<0.05), and ESR was significantly higher than that in the coronary artery dilatation group ( P<0.05). There was no significant difference in PLR and NLR between the coronary artery aneurysm group and the coronary artery dilatation group (all P>0.05). Conclusions:Children with KD and coronary artery disease have lower serum ALB levels and higher ESR level. The above two indicators are of great value for the diagnosis of children with KD and coronary artery disease.
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La aféresis es el procedimiento más utilizado para la obtención de concentrados plaquetarios de alto rendimiento, calidad y para mejorar las terapias transfusionales en pacientes trombocitopénicos, oncohematológicos,cirugias e incluso, en pacientes con factores clínicos adversos a la refractariedad. Objetivo. Determinar la eficacia de un separador celular en la colecta de plaquetas en un Instituto Nacional de Salud de Lima. Material y métodos. Estudio descriptivo; la muestra fue de 80 concentrados plaquetarios, obtenidos por plaquetoaferesis y utilizando el equipo de separador celular americano. La colecta de plaquetas se realizó en un servicio de Hemoterapia y Banco de Sangre de una institución de salud de Lima, durante los meses de febrero a julio de 2018. La eficacia se realizó evaluando el rendimiento, la eficiencia y el cumplimiento de estándares de calidad aprobados. Uno de los parámetros utilizados fue el recuento de plaquetas y leucocitos residuales, procesados en el analizador hematológico. Resultados. Las evaluaciones fueron: concentración promedio de plaquetas por concentrado plaquetario (rendimiento)= 3,4 x 1011 plaquetas /ml, recuento de leucocitos residuales = 0,07 x 10 6 leucocitos/ml, volumen promedio de sangre procesado = 2480 ml, volumen final promedio = 217,5 ml, eficiencia en la colecta = 56,9 a 63,9 %, el tiempo medio por procedimiento de colecta = 72 minutos. Conclusiones. Los concentrados plaquetarios obtenidos con el procedimiento de plaquetoaferesis cumplen con los estándares de calidad nacional e internacionales, por lo que, se concluye que este procedimiento es eficaz en la colecta de productos de alta calidad que logran la eficacia en la transfusión.
Apheresis is the most widely used procedure to obtain high yield and quality platelet concentrates and to improve transfusion therapies in thrombocytopenic patients, oncohematological patients, surgical patients and even patients with adverse clinical factors to refractoriness. Objective. To determine the efficacy of a cell separator in the collection of platelets in a National Health Institute in Lima. Material and methods. Descriptive study; the sample consisted of 80 platelet concentrates, obtained by plateletpheresis and using American cell separator equipment. The platelet collection was performed in a Hemotherapy and Blood Bank service of a health institution in Lima, during the months of February to July 2018. Effectiveness was performed by evaluating performance, efficiency and compliance with approved quality standards. One of the parameters used was the residual platelet and leukocyte count, processed in the hematological analyzer. Results. The evaluations were: average platelet concentration per platelet concentrate (yield)= 3.4 x 1011 platelets/ml, residual leukocyte count = 0.07 x 10 6 leukocytes/ml, average volume of blood processed = 2480 ml, average final volume = 217.5 ml, collection efficiency = 56.9 to 63.9 %, average time per collection procedure = 72 minutes. Conclusions. The platelet concentrates obtained with the plateletpheresis procedure comply with national and international quality standards, therefore, it is concluded that this procedure is effective in the collection of high quality products that achieve transfusion efficiency.
A aférese é o procedimento mais utilizado para obter concentrados plaquetários de alto rendimento e alta qualidade e para melhorar as terapias transfusionais em pacientes trombocitopênicos, oncohematológicos, cirúrgicos e até mesmo pacientes com fatores clínicos adversos à refratariedade. Objetivo. Para determinar a eficácia de um separador de células na coleta de plaquetas em um Instituto Nacional de Saúde em Lima. Material e métodos. Estudo descritivo; a amostra consistiu de 80 concentrados de plaquetas, obtidos por plaquetaferese e utilizando equipamento separador de células americano. A coleta de plaquetas foi realizada em um serviço de Hemoterapia e Banco de Sangue de uma instituição de saúde em Lima, durante os meses de fevereiro a julho de 2018. A eficácia foi avaliada através da avaliação do desempenho, eficiência e conformidade com os padrões de qualidade aprovados. Um dos parâmetros utilizados foi a contagem residual de plaquetas e leucócitos, processada no analisador hematológico. Resultados. As avaliações foram: concentração média de plaquetas por concentrado de plaquetas (rendimento) = 3,4 x 1011 plaquetas/ml, contagem de leucócitos residuais = 0,07 x 10 6 leucócitos/ml, volume médio de sangue processado = 2480 ml, volume final médio = 217,5 ml, eficiência da coleta = 56,9 a 63,9%, tempo médio por procedimento de coleta = 72 minutos. Conclusões. Os concentrados de plaquetas obtidos com o procedimento de plaquetférese atendem aos padrões de qualidade nacionais e internacionais, portanto, conclui-se que este procedimento é eficaz na coleta de produtos de alta qualidade que alcançam eficiência transfusional.
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Blood Platelets , Blood Banks , Blood Component Removal , PlateletpheresisABSTRACT
RESUMEN Introducción: la concentración plasmática del factor de crecimiento epidérmico pudiera encontrarse alterada en pacientes con cáncer de pulmón de células no pequeñas y trombocitopenia/trombocitosis por quimioterapia. Objetivo: determinar la asociación existente entre la concentración plasmática plaquetaria y la concentración plasmática de factor de crecimiento epidérmico en pacientes con cáncer de pulmón de células no pequeñas tratados con quimioterapia, entre marzo de 2019 y febrero de 2020 en el Hospital Provincial Saturnino Lora. Métodos: se realizó un estudio observacional descriptivo transversal en el Hospital Provincial Saturnino Lora, provincia Santiago de Cuba, Cuba, entre marzo de 2019 y febrero de 2020. El universo estuvo constituido por 54 pacientes con diagnóstico de cáncer pulmonar de células no pequeñas tratados con quimioterapia. Por muestreo probabilístico aleatorio simple se seleccionó una muestra de 12 pacientes. Se midieron las variables: concentración plasmática plaquetaria (pre y post-quimioterapia), concentración plasmática de factor de crecimiento epidérmico (pre y post-quimioterapia), y modificación de la concentración plasmática de factor de crecimiento epidérmico (castración, no castración). Para el procesamiento de los datos se empleó el test estadístico T student y la correlación lineal de Pearson, así como la media y desviación estándar como medidas de resumen y dispersión, respectivamente. Resultados: entre las concentraciones plasmáticas plaquetaria y del factor de crecimiento epidérmico se halló una relación lineal de -0,37 previo a la quimioterapia y de -0,51, posterior a esta; no se encontraron diferencias estadísticamente significativas. Conclusiones: se concluye que la modificación de la concentración plasmática del factor de crecimiento epidérmico no guarda relación aparente con la modificación plasmática plaquetaria, con posible relación espuria, dada por la quimioterapia.
ABSTRACT Introduction: the plasma concentration of epidermal growth factor may be altered in patients with non-small cell lung cancer and thrombocytopenia/thrombocytosis due to chemotherapy. Objective: to determine the association between platelet plasma concentration and epidermal growth factor plasma concentration in patients with non-small cell lung cancer treated with chemotherapy between March 2019 and February 2020 at Saturnino Lora Provincial Hospital. Methods: a cross-sectional, descriptive and observational study was conducted at Saturnino Lora Provincial Hospital, Santiago de Cuba province, Cuba, between March 2019 and February 2020. The target group comprised 54 patients diagnosed with non-small cell lung cancer treated with chemotherapy. A sample of 12 patients was chosen by simple probability-random sampling: platelet plasma concentration (pre- and post-chemotherapy), epidermal growth factor plasma concentration (pre- and post-chemotherapy), and modification of epidermal growth factor plasma concentration (castration, non-castration) were measured. For data processing, the statistical T-student test and Pearson's linear correlation were applied, as well as the mean and standard deviation as summary and dispersion measures, respectively. Results: a linear relationship of -0.37 before chemotherapy and -0.51 after the chemotherapy was found between platelet and epidermal growth factor plasma concentrations; no statistically significant differences were found. Conclusions: it is concluded that the modification of the plasma concentration of epidermal growth factor has no apparent relationship with the platelet plasma modification, with possible spurious relationship, given by chemotherapy.
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Abstract Thrombocytopenia is frequently observed in hemodialysis patients, and its correct investigation and control remain a challenge. It is estimated that during the hemodialysis session there is a drop of up to 15% in the platelet count, with recovery after the end of treatment. This reduction in platelets is due to platelet adhesion and complement activation, regardless of the membrane material. Several studies with platelet surface markers demonstrate increased platelet activation and aggregation secondary to exposure to cardiopulmonary bypass. This case report describes a patient on hemodialysis who developed severe thrombocytopenia during hospitalization. Investigation and exclusion of the most common causes were carried out: heparin-related thrombocytopenia, adverse drug reaction, hypersplenism, and hematological diseases. Afterwards, the possibility of hemodialysis-related thrombocytopenia was raised, since the fall was accentuated during the sessions with partial recovery after the dialyzer change. Attention to the sterilization method and dialyzer reuse must be considered for correction. In the current case, reusing the dialyzer minimized the drop in platelet counts associated with hemodialysis.
Resumo Plaquetopenia é frequentemente observada em pacientes em hemodiálise, e sua correta investigação e controle permanecem um desafio. Estima-se que, durante a sessão de hemodiálise, ocorra queda de até 15% da contagem de plaquetas, com recuperação após o término do tratamento. Essa queda de plaquetas é decorrente de adesão plaquetária e ativação do complemento, independentemente do material da membrana. Vários estudos com marcadores de superfície plaquetária demonstram aumento da ativação e agregação plaquetária secundários à exposição à circulação extracorpórea. Este relato de caso mostra um paciente dialítico que evoluiu com plaquetopenia severa durante internação. Realizada investigação e exclusão de causas mais comuns: plaquetopenia relacionada à heparina, reação adversa a medicamentos, hiperesplenismo e doenças hematológicas, foi então aventada a possibilidade de plaquetopenia relacionada à hemodiálise após observação de que a queda se acentuava durante as sessões de hemodiálise com recuperação parcial após. Mudança do dialisador, atenção ao método de esterilização e realização do reuso devem ser consideradas para correção. No presente caso, a utilização do reuso minimizou a plaquetopenia associada a hemodiálise.
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ABSTRACT Objective: To determine the association of red cell blood counts, and liver panel tests to predict outcomes in patients with gastroenteropancreatic neuroendocrine tumors who underwent systemic antineoplastic treatments. Methods: Patients with gastroenteropancreatic neuroendocrine tumors in systemic treatment were assessed according to laboratory tests within the same period. Progression free survival was determined by the period between the beginning of treatment and the date of progression. We used conditional models (PWP model) to verify the association between laboratory tests and tumor progression. The level of significance used was 5%. Results: A total of 30 treatments given to 17 patients in the intention-to-treat population were evaluated. Treatment included octreotide, lanreotide, everolimus, lutetium, and chemotherapy. We had statistically significant results in chromogranin A, neutrophils and platelets-to-lymphocyte ratio. The risk of progression increases by 2% with the addition of 100ng/mL of chromogranin A (p=0.034), 4% with the increase of 100 neutrophil units (p=0.006), and 21% with the addition of 10 units in platelets-to-lymphocyte ratio (p=0.002). Conclusion: Chromogranin A, neutrophils and platelets-to-lymphocyte ratio were associated with disease progression during systemic treatment in gastroenteropancreatic neuroendocrine tumors. Further prospective studies with larger cohorts are necessary to validate our findings.
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Abstract Genetic changes in platelet serotonin receptors (5-HTR2A) impair the initial process of tissue repair, regardless of the triggering factor of the skin wound. Objective was to determine the prevalence of the 102T-C polymorphism in the 5-HTR2A gene in Brazilian patients with and without skin wounds. Cross-sectional case-control study, in which 100 patients were evaluated as Cases Group (subdivided into I-with Chronic Wound and II-with Acute Wound) and 100 individuals as Controls, of both genders. DNA was extracted from leukocytes of peripheral blood and the region that covers the polymorphism was amplified by the molecular techniques Polymerase Chain Reaction/Restriction Fragment Length Polymorphism. The TT genotype was significantly associated with the protective factor against alterations in the healing process of skin wounds (OR: 0.4833; 95%CI: 0.2704-0.8638; p<0.05) in the Control Group. The genotypic analysis between Cases Group (I-Chronic Wound and II-Acute Wound) determined that the TT genotype was significantly associated with the protection factor in Case II (OR: 0.3333; 95%CI: 0.1359-0.8177; p<.005) and the CC genotype was significantly associated with the chance to develop chronic ulcers in the Case I (OR: 6.667; 95%CI: 1.801-24.683; p<0.05). Patients with chronic skin wounds have a higher prevalence of the 102T-C polymorphism in the 5-HTR2A gene, which is associated to alterations in the healing process in this population. There are differences, at the molecular level, in patients, with and without these lesions, and the probable role of the serotonergic system in wound healing.
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Platelet surface is rich in glycocalyx. It has been found that platelet glycosylation plays an important role in the physiological hemostasis mechanism, regulating the interaction between platelets and receptor proteins, and dynamically reshaping the surface glycosylation through its own glucose metabolism system. Platelet glycosylation also participates in platelet aging and clearance, and regulates platelet counts. Meanwhile, abnormal platelet glycosylation is closely related to primary immune thrombocytopenia, coronary heart disease and other related diseases, being a potential therapeutic target.
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Objective:To study the different factors affecting platelet production post transplantation of hematopoietic stem cells (HSCs) isolated from different sources in order to explore novel options for treating platelet depletion following HSCs transplantation.Methods:HSCs and their downstream derivatives including myeloid and lymphoid cells (i.e., collective of mononuclear cells (MNCs)), were isolated from E14.5 fetal liver (FL) and bone marrow (BM) of 8-week-old mice by Ficoll separation technique. These cells were subsequently transplanted into the tibia bone marrow cavity of recipient mice post lethal myeloablative treatment in order to construct the FL-MNCs and BM-MNCs transplantation mouse model. Routine blood indices were examined in these recipient mice. The chimeric rate of donor cells in recipient peripheral blood cells were determined by flow cytometry. Different groups of cells involved in platelet reconstruction were analyzed. CD41 +megakaryocytes were sorted from fetal liver or bone marrow using magnetic beads, which were then induced to differentiate into platelets in an in vitro assay . Quantitative RT-PCR was used to detect the expression of platelet-related genes in CD41 +megakaryocytes from the two sources. Results:Both the FL-MNCs and the BM-MNCs transplantation groups resumed normal hematopoiesis at the 4th week after transplantation, and the blood cells of the recipient mice were largely replaced by the donor cells. Compared with the mice transplanted with BM-MNCs, the platelet level of mice transplanted with FL-MNCs recovered faster and were maintained at a higher level. At week 4, the PLT level of the FL-MNCs group was (1.45±0.37)×10 12/L, and of the BM-MNCs group was (1.22±0.24)×10 12/L, P<0.05. The FL-MNCs contain a higher proportion of hematopoietic stem cells (Lin -Sca-1 +c-Kit +)(7.60%±1.40%) compared to the BM-MNCs (1.10%±0.46%), P<0.01; the proportion of the megakaryocyte progenitor cells (Lin -Sca-1 -c-Kit +CD41 +CD150 +) and mature megakaryocyte cells (CD41 +CD42b +), also differ significantly between the FL-MNCs (3.05%±0.22%, 1.60%±0.06%, respectively) and the BM-MNCs (0.15%±0.02%, 0.87%±0.11%, respectively) groups, both P<0.01. In vitro functional studies showed that FL-MNCs-CD41 +megakaryocytes could produce proplatelet-like cells more quickly after induction, with proplatelet-like cells formation on day 3 and significant platelet-like particle formation on day 5, in contrast to bone marrow-derived BM-MNCs-CD41 +megakaryocytes that failed to form proplatelet-like cell on day 5. In addition, FL-MNCs-CD41 +cells expressed higher levels of platelet-related genes, Mpl (3.25-fold), Fog1 (3-fold), and Gata1 (1.5-fold) ( P<0.05). Conclusion:Compared with the BM-MNCs group, the FL-MNCs transplantation group appears to have a more efficient platelet implantation effect in the HSCs transplantation recipient in vivo , as well as a higher platelet differentiation rate in vitro. This might be related to a higher proportion of megakaryocytes and higher expression levels of genes such as Mpl, Fog1, and Gata1 that could be important for platelet formation in FL-MNCs-CD41 +cells. Further exploration of the specific functions of these genes and the characteristics of the different proportions of the donor cells will provide valuable clues for the future treatment of platelets reconstitution after HSCs transplantation clinically.
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Objective:To explore the correlation of neutrophil-to-lymphocyte ratio(NLR) and platelet-to-lymphocyte ratio (PLR) with lower extremity arterial disease (LEAD) in type 2 diabetes mellitus (T2DM).Methods:A total of 314 T2DM patients hospitalized in Tengzhou Central People′s Hospital from January 2018 to December 2019 were collected and divided into LEAD group (168 cases) and control group (146 cases) according to the results of color Doppler ultrasound of lower extremity arteries. General clinical data were collected. Fasting venous blood samples were collected to detect blood routine and biochemical indicators. NLR and PLR values were calculated. Patients were divided into 4 groups according to the NLR and PLR quartiles. The differences of data in each group were analyzed; Spearman correlation was used to analyze the correlation between NLR, PLR and each index; The risk factors of LEAD in T2DM patients were analyzed by logistic regression. The receiver operating characteristic (ROC) curve was used to determine the efficiency of the model predicting LEAD in T2DM patients.Results:The age, white blood cells count (WBC), neutrophil count, NLR, PLR and C-reactive protein (CRP) in LEAD group were significantly higher than those in control group (all P<0.05). With the increase of NLR and PLR quartiles, the age, body mass index, WBC, neutrophils and platelets increased gradually ( P<0.05), and the lymphocytes decreased gradually ( P<0.05). Spearman correlation analysis showed that NLR and PLR were positively correlated with age, neutrophils and platelets (all P<0.01), but negatively correlated with lymphocytes (all P<0.01). Logistic regression analysis showed that age, NLR, PLR, total cholesterol (TC), low density lipoprotein cholesterol (LDL-C) and CRP were the risk factors of LEAD in T2DM patients (all P<0.01). The area under the curve (AUC) of NLR, PLR, CRP and age were 0.813, 0.683, 0.668 and 0.630, respectively; The sensitivity was 82.49%, 84.37%, 72.58% and 62.87%, respectively. Conclusions:NLR and PLR are closely related to LEAD in T2DM patients. NLR is superior to PLR and CRP in the diagnosis of LEAD.
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Objective:Four methods were used to count platelets to recommend suitable retest methods for abnormal blood platelet count.Methods:A total of 300 patients who received treatment in the Second People's Hospital of Lianyungang during August-September 2020 were included in this study. They were divided into low-value, median-value, and high-value groups ( n = 100/group) according to blood platelet counts determined by the electrical impedance method. The consistency in blood platelet counting was analyzed between flow cytometry and electrical impedance method, Neubauer chamber method, and modified blood smear method. Results:There was no significant difference in blood platelet count between the electrical impedance method [low-value group: (86.1 ± 10.3) × 10 9/L, median-value group: (221.8 ± 41.8) × 10 9/L, high-value group: (441.3 ± 51.4) × 10 9/L, Neubauer chamber method [low-value group: (85.2 ± 10.1) × 10 9/L, median-value group: (219.3 ± 37.7) × 10 9/L, high-value group: (443.1 ± 54.5) × 10 9/L, modified blood smear technique [low-value group: (86.1 ± 10.1) × 10 9/L, median-value group: (218.1 ± 37.7) × 10 9/L, high-value group: (442.6 ± 53.3) × 10 9/L], and flow cytometry [low-value group: (85.4 ± 10.1) × 10 9/L, median-value group: (220.7 ± 42.0) × 10 9/L, high-value group: (440.9 ± 50.0) × 10 9/L] (all P > 0.05). The Bland-Altman analysis revealed that the electrical impedance method, Neubauer chamber method and modified blood smear method, and flow cytometry showed consistency in blood platelet count. Conclusion:The modified blood smear method showed consistency with the electrical impedance method, Neubauer chamber method, and flow cytometry in blood platelet counting. It does not require a special instrument and can help observe cell morphology for blood platelet counting. In addition, the blood smears are easy to be preserved. The modified blood smear technique should be the first choice for re-checking blood platelet counts.
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Hepatocellular carcinoma is one of the common causes of tumor-related death, and it has high morbidity and mortality rates in China. Recent studies have shown that platelets are closely associated with the development of hepatocellular carcinoma. Literature review shows that platelets not only participate in hemostasis, but also act on liver cells and tumor microenvironment, promote the formation of new blood vessels, and participate in the development and progression of hepatocellular carcinoma as a cell mediator through immune response and other pathways. In addition, platelets and their derivatives can be used as potential therapeutic targets for hepatocellular carcinoma. Therefore, antiplatelet therapy is expected to become a new adjuvant strategy for the treatment of hepatocellular carcinoma, which has important clinical significance.
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Ischemic stroke is one of the primary causes of death and disability worldwide. Neutrophils can release depolymerized chromatin and proteins to form neutrophil extracellular traps (NETs) and participate in intravascular thrombus formation. In recent years, NETs have received increasing attention in the study of acute ischemic stroke. The results indicate that NETs play an important role in the pathogenesis of acute ischemic stroke. This review presented recent advances in the study of NETs in acute ischemic stroke.
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Objective:To investigate the predictive value of platelet-to-neutrophil ratio (PNR) on hemorrhagic transformation (HT) and poor outcomes at 90 d after intravenous thrombolysis (IVT) in patients with acute ischemic stroke (AIS).Methods:Patients with AIS received IVT in Hefei Second People's Hospital from July 2019 to June 2021 were retrospectively enrolled. HT was defined as intracerebral hemorrhage found by CT reexamination within 24 h after IVT, and the poor outcome was defined as the modified Rankin Scale score ≥3 at 90 d after onset. Multivariate logistic regression analysis was used to determine the independent predictors of HT and poor outcomes at 90 d, and the predictive value of PNR on HT and poor outcomes at 90 d was analyzed by receiver operating characteristic (ROC) curve. Results:A total of 202 patients with AIS treated with IVT were included, of which 32 had HT and 50 had poor outcomes at 90 d after onset. Multivariate logistic regression analysis showed that PNR at 24 h after IVT was significantly and independently negatively correlated with the poor outcomes (odds ratio [ OR] 0.959, 95% confidence interval [ CI] 0.928-0.991; P=0.012); PNR at admission ( OR 0.886, 95% CI 0.827-0.948; P<0.001) and PNR at 24 h after IVT ( OR 0.923, 95% CI 0.879-0.969; P=0.001) were significantly independently and negatively correlated with HT. ROC curve analysis showed that the area under the curve of PNR at 24 h after IVT for predicting poor outcomes was 0.733 (95% CI 0.659-0.807; P=0.012), the best cutoff value was 35.03, and the predictive sensitivity and specificity were 70.4% and 74%, respectively. The area under the curve of PNR at admission for predicting HT was 0.830 (95% CI 0.774-0.886; P<0.001), the best cutoff value was 34.81, and the predictive sensitivity and specificity were 70% and 93.7%, respectively. The area under the curve of PNR at 24 h after IVT for predicting HT was 0.770 (95% CI 0.702-0.839; P=0.001), the best cutoff value was 41.73, and the predictive sensitivity and specificity were 53.5% and 96.9%, respectively. Conclusion:For patients with AIS treated with IVT, lower PNR at 24 h after IVT is an independent predictor of the poor outcomes at 90 d, while PNR at admission and 24 h after IVT are the independent predictors of HT.
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Abstract Background: Multiple infections, nutrient deficiencies and inflammation (MINDI) occur in indigenous communities, but their associations with perinatal outcomes have not been described. Objective: To assess maternal and cord blood micronutrient and inflammation status in peripartum mothers from the Ngäbe-Buglé comarca in Panama, and their associations with placental and infant outcomes. Methods: In 34 mother-newborn dyads, placental weight and diameter were measured, and maternal and cord blood were processed for complete cell counts, serum C-reactive protein, ferritin, serum transferrin receptor (sTfR), vitamins A and D. Blood volumes were calculated using Nadler's formula. Results: Mothers had low plasma volume (<2.8 L, 96%), vitamin A (52.9%), vitamin D (29.4%), iron (58.8%) and hemoglobin (23.5%), but high hematocrit (>40%, 17.6%) and inflammation (C-reactive protein >8.1 mg/L, 85.3%). Birthweights were normal, but low placental weight (35.3%), low head circumference Z-scores (17.6%), and low cord hemoglobin (5.9%), iron (79.4%), vitamin A (14.7%) and vitamin D (82.3%) were identified. Maternal and cord vitamin D were highly correlated. Higher maternal plasma volume was associated with heavier placentae (β= 0.57), and higher cord D (β= 0.43) and eosinophils (β= 0.43) with larger placentae. Hemoconcentration (higher cord hematocrit) was associated with lower newborn weight (β= -0.48) and head circumference (β= -0.56). Inflammation [higher maternal neutrophils (β= -0.50), and cord platelets (β= -0.32)] was associated with lower newborn length and head circumference. Conclusion: Maternal-newborn hemoconcentration, subclinical inflammation and multiple nutrient deficiencies, particularly neonatal vitamin D deficiency, were identified as potential targets for interventions to improve pregnancy outcomes in vulnerable communities.
Resumen Antecedentes: Las Múltiples Infecciones, Nutrición Deficiente e Inflamación (MINDI), son frecuentes en comunidades indígenas, sin embargo, sus asociaciones con resultados de salud perinatales no han sido descritos. Objetivo: Evaluar la inflamación y los micronutrientes en sangre materna y de cordón de madres en trabajo de parto en la comarca Ngäbe-Buglé en Panamá, así como sus asociaciones con medidas placentarias y del recién nacido. Métodos: En 34 pares madre-recién nacido, se midieron peso y diámetro placentario, y se analizaron muestras de sangre materna y de cordón umbilical para hemograma completo, proteína-C reactiva (PCR), ferritina, receptor sérico de transferrina (RsTf), vitaminas A y D. Se usó la fórmula de Nadler para calcular volúmenes sanguíneos. Resultados: Las madres presentaron volumen plasmático (<2.8 L, 96%), vitamina A (52.9%), vitamina D (29.4%), hierro (58.8%) y hemoglobina (23.5%) bajos, pero el 17.6% presentaron hematocrito >40% y 85.3% presentaron inflamación (PCR >8.1 mg/L). Los pesos al nacer fueron normales, pero se identificó bajo peso placentario (35.3%), bajo puntaje-z de circunferencia cefálica neonatal, y en sangre de cordón, bajos hemoglobina (5.9%), hierro (79.4%), vitamina A (14.7%) y vitamina D (82.3%). Se encontró una fuerte correlación positiva entre la vitamina D materna y de sangre de cordón. Un mayor volumen plasmático materno se asoció con placentas de mayor peso (β= 0.57), en tanto que concentraciones más altas de vitamina D (β= 0.43) y mayor número de eosinófilos (β= 0.43) se asociaron con mayor diámetro placentario. Una mayor hemoconcentración (hematocrito en cordón más alto) se asoció con menores peso al nacer (β= -0.48) y circunferencia cefálica (β= -0.56). La inflamación [mayor número de neutrófilos maternos (β= -0.50) y plaquetas en sangre de cordón (β= -0.32)] se asoció con menor talla y circunferencia cefálica neonatales. Conclusión: La hemoconcentración materna y del recién nacido, la inflamación subclínica y las múltiples deficiencias en micronutrientes, particularmente la deficiencia de vitamina D neonatal, se identificaron como potenciales áreas de intervención para mejorar los resultados de salud del embarazo en comunidades vulnerables.
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Resumo Fundamento O volume plaquetário médio (VPM), uma medida simples de ativação plaquetária, tornou-se recentemente um tópico interessante no campo da pesquisa cardiovascular. A reabilitação cardíaca (RC) baseada em exercícios é uma intervenção abrangente que diminui a morbidade-mortalidade em pacientes com doença arterial coronariana (DAC). Estudos sobre os efeitos do exercício físico na ativação plaquetária têm produzido resultados conflitantes. Objetivo O objetivo deste estudo foi determinar o efeito de um programa de RC baseado em exercícios sobre o VPM em pacientes com DAC estável. Métodos A amostra foi composta por 300 pacientes consecutivos com DAC estável. Os pacientes foram divididos em dois grupos: grupo RC (n = 97) e grupo não RC (n = 203). Foi feito um hemograma. As medidas de correlação ponto-bisserial foram tiradas para mostrar a correlação entre a alteração do VPM e a RC. Valor de p<0,05 foi considerado estatisticamente significativo. Resultados A diminuição do VPM foi maior no grupo CR do que no grupo não CR [(-1,10 (-1,40-(-0,90)) vs. (-0,10 (-2,00-0,00)); p<0,001]. ΔVPM teve correlação positiva com Δ neutrófilos (r = 0,326, p<0,001), ΔTG (r = 0,439, p<0,001), ΔLDL-c (r = 0,478, p<0,001), ΔGB (r = 0,412, p<0,001) e ΔPCR (r = 0,572, p <0,001). Foi encontrada uma correlação significativa entre ΔVPM% e CR (r = 0,750, p <0,001). Conclusões Pudemos mostrar que a RC baseada em exercícios tem forte relação com a redução do VPM em pacientes com DAC. Consideramos que a diminuição da ativação plaquetária com RC baseada em exercícios pode desempenhar um papel importante na redução do risco trombótico em pacientes com DAC estável. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)
Abstract Background Mean platelet volume (MPV), which is a simple measure of platelet activation, has recently become an interesting topic in cardiovascular research. Exercise-based cardiac rehabilitation (CR) is a comprehensive intervention that decreases mortality-morbidity in patients with coronary artery disease (CAD). Studies on the effects of exercise on platelet activation have yielded conflicting results. Objective The purpose of this study was to determine the effect of an exercise-based CR programs on MPV in patients with stable CAD. Methods The sample was composed of 300 consecutive stable CAD patients. The patients were divided into two groups: CR group (n = 97) and non-CR group (n = 203). Blood analysis was performed. Point-Biserial correlation measures were performed to show correlation between MPV change and CR. A p value of <0.05 was considered statistically significant. Results The decrease in MPV was greater in the CR group than in the non-CR group [(-1.10(-1.40-(-0.90)) vs. (-0.10 (-2.00-0.00)); p< 0.001]. ΔMPV had a positive correlation with Δ neutrophil (r = 0.326, p < 0.001), ΔTG (r = 0.439, p < 0.001), ΔLDL-c (r = 0.478, p < 0.001), ΔWBC (r = 0.412, p < 0.001), and ΔCRP (r = 0.572, p < 0.001). A significant correlation was found between ΔMPV% and CR (r=0.750, p<0.001). Conclusions We were able to show that exercise-based CR has a strong relationship with MPV reduction in patients with CAD. We consider that decreased platelet activation with exercise-based CR might play an important role in reducing thrombotic risk in patients with stable CAD. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)