Changing profile of platelet activity and turnover indices during treatment response of immune thrombocytopenia.

Chewei Ou,Yu-Shin Hung,Hung Chang,Tung-Liang Lin,Pei-Ling Li,Ming-Chung Kuo

doi:10.1007/s10238-022-00790-8

Chewei Ou, Yu-Shin Hung + Show 4 more

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https://doi.org/10.1007/s10238-022-00790-8

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Abstract

Both platelet count and function change after treatment of immune thrombocytopenia. Platelet function can be measured by plasma markers, including platelet activity [e.g., soluble P-selectin (sP-selectin) and soluble CD40 ligand (sCD40L)] and platelet turnover markers [e.g., glycocalicin (GC)]. Patients were classified into no response (NR, including new diagnosis), partial response (PR) and complete response (CR). One hundred and sixteen samples (29 CR, 32 PR, 55 NR) from 79 patients were collected. Plasma markers (sP-selectin, sCD40L and GC) were measured by ELISA. Platelet counts and mean platelet volume (MPV) were obtained in the clinical laboratory using GenS System-2. The results showed that responsive patients (PR + CR) had higher levels of sP-selectin (P = 0.026) and sCD40L (P = 0.001). Although there was no difference in MPV (P = 0.077) or GC (P = 0.078), there was a marked decrease of GC index (P < 0.001) in responsive patients. Paired sample analysis showed no difference in sP-selectin, sCD40L, MPV or GC but significant difference in GC index (P = 0.017) between NR and PR. Another paired sample analysis showed no difference in sP-selectin, sCD40L, MPV or GC but significant difference in GC index (P = 0.029) between PR and CR. Patients with refractory and newly diagnosed disease had a significant difference in GC (P = 0.020) and sCD40L (P = 0.001), despite similarly low platelet counts. In conclusion, platelet activity markers (sP-selectin and sCD40L) and GC indices change in parallel with treatment response. Plasma levels of GC and sCD40L may be predictors of treatment response.

Highlights

Severity of bleeding symptoms is highly variable among patients with immune thrombocytopenia (ITP)
15 subjects with severe thrombocytopenia due to myelodysplastic syndrome (MDS) or acute myeloid leukemia (AML) were recruited and samples collected in the same manner
ITP is characterized by increased platelet activity and rapid platelet turnover

Summary

Introduction

Severity of bleeding symptoms is highly variable among patients with immune thrombocytopenia (ITP). The classical platelet function assay, light transmission platelet aggregometry, cannot be reliably performed in ITP due to its relatively low platelet counts [1]. Alternative assays, such as impedance aggregometry [1], flow cytometry [2,3] and plasma markers of platelet activity (e.g. soluble P-selectin [sP-selectin] and soluble CD40 ligand[sCD40L]) may be used [4,5]. Platelet turnover can be directly measured by the radioisotope-labeling method [7,8] It can be indirectly measured by flow cytometry or plasma markers (e.g. glycocalicin [GC]) [9,10]

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