Clot Waveform Analysis Demonstrates Low Blood Coagulation Ability in Patients with Idiopathic Thrombocytopenic Purpura.

Hideo Wada,Yuhuko Ichikawa,Minoru Ezaki,Katsuya Shiraki,Motomu Shimaoka,Isao Moritani,Yoshiki Yamashita,Hideto Shimpo,Isao Tawara,Takeshi Matsumoto,Masahiro Masuya

doi:10.3390/jcm10245987

Abstract

Background: Although platelets, which contain large amounts of phospholipids, play an important role in blood coagulation, there is still no routine assay to examine the effects of platelets in blood coagulation. Methods: Hemostatic abnormalities in patients with thrombocytopenia, including those with idiopathic thrombocytopenic purpura (ITP), were examined using clot wave analysis (CWA)–small-amount tissue-factor-induced FIX activation (sTF/FIXa) and thrombin time (TT). Results: Although there were no marked differences in the three parameters of activated partial thromboplastin time (APTT) between normal healthy volunteers and typical patients with ITP, the peak heights of the CWA-sTF/FIXa were markedly low in patients with ITP. The three peak times of the CWA-sTF/FIXa in patients with a platelet count of ≤8.0 × 1010/L were significantly longer than those in patients with a platelet count > 8.0 × 1010/L and the peak heights of the CWA-sTF/FIXa in patients with a platelet count of ≤8.0 × 1010/L were significantly lower than those in patients with >8.0 × 1010/L. The peak heights of the CWA-APTT in patients with ITP were significantly lower than in patients with other types of thrombocytopenia. The three peak heights of the CWA-sTF/FIXa in ITP patients were significantly lower than those in patients with other types of thrombocytopenia. The CWA-TT showed lower peak heights and longer peak times in patients with ITP in comparison to patients with other types of thrombocytopenia. Conclusions: The CWA-sTF/FIXa and CWA-TT results showed that blood coagulation is enhanced by platelets and that the blood coagulation ability in ITP patients was low in comparison to healthy volunteers and patients with other types of thrombocytopenia.

Highlights

Immune thrombocytopenia (ITP), known as idiopathic thrombocytopenic purpura, is an autoimmune bleeding disorder that is characterized by isolated thrombocytopenia caused by increased platelet destruction and impaired platelet production
It is general considered that routine clotting assays, such as prothrombin time (PT) and activated partial and thromboplastin time (APTT), show normal results [4]
Platelets play an important role in the coagulation system and ITP patients may have blood coagulation abnormalities that cannot be detected by routine assays

Summary

Introduction

Immune thrombocytopenia (ITP), known as idiopathic thrombocytopenic purpura, is an autoimmune bleeding disorder that is characterized by isolated thrombocytopenia caused by increased platelet destruction and impaired platelet production. Platelets play an important role in the coagulation system and ITP patients may have blood coagulation abnormalities that cannot be detected by routine assays For this reason, the small-amount tissue factor (TF)-induced FIX activation (sTF/FIXa) assay, which reflects physiological coagulation using platelet-rich plasma, was established [5]. Methods: Hemostatic abnormalities in patients with thrombocytopenia, including those with idiopathic thrombocytopenic purpura (ITP), were examined using clot wave analysis (CWA)–small-amount tissue-factor-induced FIX activation (sTF/FIXa) and thrombin time (TT). Results: there were no marked differences in the three parameters of activated partial thromboplastin time (APTT) between normal healthy volunteers and typical patients with ITP, the peak heights of the CWA-sTF/FIXa were markedly low in patients with ITP. The three peak heights of the CWA-sTF/FIXa in ITP patients were significantly lower than those in patients with other types of thrombocytopenia

Methods

Discussion

Conclusion