Platelet Function Tests and Inflammatory Markers for the Differentiation of Primary Thrombocytosis and Secondary Thrombocytosis.

Piyapong Kanya,Adisak Tantiworawit,Ekarat Rattarittamrong,Ornkamon Wongtakan,Lalita Norrasethada,Chatree Chai-Adisaksopha,Thanawat Rattanathammethee

doi:10.31557/apjcp.2019.20.7.2079

Abstract

Background:The prognosis and management of primary thrombocytosis (PT) and secondary thrombocytosis (ST) are different. This study aims to evaluate the role of platelet function tests by light transmission platelet aggregometry (LTA), plasma von Willebrand factor antigen (vWF:Ag), ristocetin cofactor activity (vWF:RCo) and inflammatory markers [erythrocyte sedimentation rate (ESR), C-reactive protein (CRP)] for the differentiation between PT and ST. Methods:This prospective study was carried out in patients with platelet counts greater than 450 x 109/L. Primary outcomes were the sensitivity and specificity of platelet function tests by LTA for the differentiation of PT and ST. Secondary outcomes were sensitivity and specificity of ESR, CRP, vWF:Ag, and vWF:RCo for the differentiation of PT and ST. Results:Fifty-two patients were enrolled onto the study of which 26 (50%) had PT. The sensitivity and specificity of epinephrine, collagen, and arachidonic acid (AA) induced abnormal LTA for the differentiation of PT from ST were sensitivity of 50%, 38.5%, 26.9% and specificity of 88.5%, 100%, 100% respectively. The sensitivity and specificity of abnormal ESR, CRP, and either abnormal ESR or CRP in the differentiation of ST from PT were sensitivity of 88.5%, 80.8%, 100% and specificity of 65.4%, 61.5%, 46.2% respectively. The sensitivity and specificity of low vWF:Ag and vWF:RCo in the differentiation of PT from ST were sensitivity of 7.69%, 42.3% and specificity of 100%, 88.5% respectively. Conclusions:Abnormal platelet function determined by LTA with collagen, AA, epinephrine had high specificity ratings enabling the differentiation between PT and ST. vWF:RCo, ESR and CRP levels could be helpful in differentiating between PT and ST.

Highlights

Thrombocytosis is defined as the presence of a high platelet count, more than the upper limit of normal or more than 450 x 109/L
This study aims to evaluate the role of platelet function tests by light transmission platelet aggregometry (LTA), plasma von Willebrand factor antigen, ristocetin cofactor activity and inflammatory markers [erythrocyte sedimentation rate (ESR), C-reactive protein (CRP)] for the differentiation between primary thrombocytosis (PT) and secondary thrombocytosis (ST)
Abnormal platelet function determined by LTA with collagen, arachidonic acid (AA), epinephrine had high specificity ratings enabling the differentiation between PT and ST. von Willebrand factor antigen (vWF):RCo, ESR and CRP levels could be helpful in differentiating between PT and ST

Summary

Introduction

Thrombocytosis is defined as the presence of a high platelet count, more than the upper limit of normal or more than 450 x 109/L. This condition can be classified as primary thrombocytosis (PT) resulting from a clonal bone marrow abnormality such as myeloproliferative neoplasm (MPN), reactive or secondary thrombocytosis (ST) and inherited thrombocytosis(Rodgers et al, 2014; Beer et al, 2011). ET, polycythemia vera(PV), primary myelofibrosis(PMF), and chronic myeloid leukemia (CML) are MPNs characterized by clonal proliferation of hematopoietic stem cells Platelets in these disorders show quantitative and qualitative changes by switching from resting to pro-coagulant phenotypes (Barbui et al, 2013). Conclusions: Abnormal platelet function determined by LTA with collagen, AA, epinephrine had high specificity ratings enabling the differentiation between PT and ST. vWF:RCo, ESR and CRP levels could be helpful in differentiating between PT and ST

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