Changes In Platelet Count Research Articles

The effect of hyperglycinemic treatment in captive-bred Vervet monkeys (Chlorocebus aethiops).

Nonketotic hyperglycinemia (NKH) is a neuro-metabolic disorder caused by a deficiency in the glycine cleavage system (GCS) and glycine transporter 1 (GlyT1). A case of atypical late onset of NKH has been reported in a colony of captive-bred Vervet monkeys. The purpose of this study was to evaluate the effect of sodium benzoate and dextromethorphan in reducing glycine levels in hyperglycinemic monkeys. Twelve captive-bred Vervet monkeys were assigned into three groups consisting of four animals (control, valproate induced and cataract with spontaneous hyperglycinemia). Valproate was used to elevate glycine levels and the induced group was then treated with sodium benzoate and dextromethorphan together with group three to normalise glycine levels in cerebrospinal fluid (CSF) and plasma. Valproate induction elicited changes in phosphate, alkaline phosphatase and platelet count, however, no significant changes in the glycine levels were observed, and this might be due to the individual variability within the group. The treatment intervention was only obtained in the spontaneous group whereby the glycine levels were normalised in CSF and plasma. Therefore, it can be concluded that sodium benzoate and dextromethorphan treatment was effective and beneficial to the hyperglycinemic group.

Treatment with direct‐acting antiviral agents is associated with increased platelet count in patients with chronic hepatitis C

AbstractPlatelet count correlates with the liver fibrosis stage of patients with chronic hepatitis C (CHC). Patients with CHC exhibit improvement in platelet count after achieving a sustained virological response (SVR) to peg‐interferon and ribavirin (RBV) therapy. The temporal effect of direct‐acting antiviral agents (DAAs) on platelet count in patients with CHC throughout treatment and after 12 weeks of posttreatment follow‐up is unclear. From September 2012 to November 2016, 78 consecutive CHC patients who received a complete course of antiviral therapy with DAAs and without RBV were enrolled in this retrospective study. Demographic features, complete blood counts, biochemical data, and hepatitis C virus ribonucleic acid levels were collected at baseline, week 2, week 4, end of therapy (EOT), and 12 weeks after therapy (PW12). The mean age was 52.63 ± 10.11 years, and 40 (51.3%) patients were male. The baseline mean alanine aminotransferase (ALT) was 75.5 ± 50.0 U/L. The SVR rate at 12 weeks after therapy (SVR12) was 98.7% (77/78). Mean platelet count increased from 173.0 ± 58.3 × 109/L at baseline to 186.0 ± 59.0 × 109/L at week 2 (P < 0.001), 181.5 ± 59.0 × 109/L at week 4 (P = 0.001), 184.6 ± 59.3 × 109/L at EOT (P < 0.001), and 187.5 ± 56.1 × 109/L at PW12 (P < 0.001). Mean ALT levels decreased from 75.5 ± 50.0 U/L at baseline to 26.8 ± 18.1 U/L at week 2 (P < 0.001), 24.2 ± 17.4 U/L at week 4 (P < 0.001), 29.2 ± 59.2 U/L at EOT (P < 0.001), and 21.2 ± 10.7 U/L at PW12 (P < 0.001). Similar patterns of changes in platelet count and ALT levels throughout the treatment and follow‐up periods were observed in patients without cirrhosis (n = 70), those with thrombocytopenia (platelet count < 150 × 109/L) and SVR12 (n = 28), and those with nonthrombocytopenia and SVR12 (n = 49). However, platelet count did not significantly change throughout the treatment and follow‐up periods in patients with cirrhosis (n = 8). DAA therapy is associated with increased platelet count in CHC patients without cirrhosis. ALT normalization exhibits a temporal correlation with an increased platelet count. The effect of DAA therapy on platelet count in patients with cirrhosis requires further study.

PF698 LUSUTROMBOPAG RELIABLY INCREASES PLATELETS REGARDLESS OF BASELINE PLATELET COUNTS IN THROMBOCYTOPENIC CHRONIC LIVER DISEASE PATIENTS UNDERGOING PLANNED INVASIVE PROCEDURES: RESULTS OF 2 PHASE 3 TRIALS

Background:Lusutrombopag is an oral, small molecule thrombopoietin receptor agonist approved in Japan and US for improvement of thrombocytopenia, and in EU for severe thrombocytonia, associated with chronic liver disease in patients undergoing planned invasive procedures. The degree of thrombocytopenia may impact the treatment response to lusutrombopag and need for platelet transfusion.Aims:This analysis evaluates the increase in platelet count and maximum platelet count achieved according to baseline platelet count.Methods:L‐PLUS 1 and L‐PLUS 2 were two similar phase 3 multicenter, randomized, double‐blind, placebo‐controlled studies; L‐PLUS 1 (JapicCTI‐132323) was conducted in Japan and L–PLUS 2 (NCT02389621) was conducted globally. Patients with thrombocytopenia due to chronic liver disease received lusutrombopag 3 mg or placebo for up to 7 days prior to an invasive procedure scheduled 9–14 days after randomization. Patients were adults with platelet count (x109/L) <50 at baseline. Platelet transfusion was mandated if the platelet count remained <50 no more than two days prior to the planned invasive procedure. The change in platelet count over time was a key efficacy endpoint. A per‐protocol population from the two trials was integrated for this analysis; post‐platelet transfusion platelet counts were excluded from the analysis when calculating the proportion of patients who met a criterion and summary statistics for maximum platelet counts.Results:312 patients were randomized. Of the 270 patients in the per‐protocol population, 78.1% of patients in the lusutrombopag group (n = 137) achieved a platelet count ≥50 at least once during the study versus 30.1% of patients in the placebo group (n = 133). The platelet count increased by double or more in 47.4% and 3.8% in the lusutrombopag and placebo groups, respectively, and increased by 50% or more in 77.4% and 12.8%, respectively. The average maximum platelet count in the lusutrombopag group stratified according to baseline platelet count of <20, ≥20‐<30, ≥30‐<35, ≥35‐<40, and ≥40‐<50 was 56, 45, 64, 82, and 87, respectively (Figure). The average maximum change in platelet count in these strata were +41, 21, 32, 45, and 42, respectively.Summary/Conclusion:Patients on lusutrombopag experienced a clinically meaningful response in platelet count regardless of whether the baseline platelet count was above or below 35x109/L, thereby avoiding the need for use of platelet transfusion.image

PF684 ANAGRELIDE MODULATES PROPLATELET FORMATION RESULTING IN DECREASED NUMBER AND INCREASED SIZE OF PLATELETS

Background:In patients with essential thrombocythemia (ET) who have high risk factors for thrombotic events, cytoreductive therapy with anagrelide (ANA) or hydroxycarbamide (HC) is one of the treatment options. Despite the clinically evident platelet‐lowering effect of ANA, the detailed mechanism of its effect remains to be elucidated. In addition to the previously reported inhibition of megakaryocytic differentiation, we hypothesized that ANA affects the formation of proplatelets, the final process of platelet release.Aims:To determine platelet size change and proplatelet formation with ANA treatment, we retrospectively analyzed patients’ data and analyzed data obtained from an experimental model using a human megakaryocytic cell line (MEG‐01 cells), an accepted model of thrombopoiesis.Methods:We retrospectively evaluated 48 patients diagnosed with ET in Hokkaido University Hospital (male/female: 14/34, age, 18 to 87 years; median age, 61.5 years; ANA only, 3 patients; ANA after HC due to insufficient decrease in platelets, 11; HC only, 18; observed without ANA or HC, 16). We analyzed changes in platelet counts and mean platelet volume (MPV) after administering each medicine. This study was approved by the Institutional Review Board of Hokkaido University Hospital. Megakaryocytic differentiation of MEG‐01 cells was induced by PMA treatment with or without ANA. Morphological change of proplatelets and size of platelet‐like particles (PLPs) were analyzed.Results:The figure shows the relationship between decrease in platelet count and MPV change in each patient at the time of maximum response to ANA or HC. In patients treated with ANA (n = 14), the degree of platelet count reduction (‐83.4% to −27.1%; median, −56.6%) was strongly correlated with increase of MPV (‐6.6% to +28.7%; median, +16.7%) (left panel; R = 0.777, P = 0.001). On the other hand, in patients treated with HC (n = 29), the degree of platelet count reduction (‐78.7% to −20.8%; median, −55.5%) was not correlated with change of MPV (‐10.3% to +12.9%; median, +1.0%) (right panel; R = 0.245, P = 0.21). PMA‐induced megakaryocytic differentiation of MEG‐01 cells promoted production of PLPs. The number of PLPs was decreased in PMA + ANA‐treated MEG‐01 cells (P < 0.01 vs. PMA alone). PLP size measured by flow cytometry was significantly increased in PMA + ANA‐treated MEG‐01 cells (P < 0.05 vs. PMA alone). These results are consistent with the clinical findings. MGG staining of MEG‐01 cells revealed that ANA modified the formation of cytoplasmic protrusions (proplatelets). We compared morphological parameters including the length, width and number of protrusions. The protrusions were shorter and thicker and the number of protrusions was decreased in PMA + ANA‐treated MEG‐01 cells (P < 0.01 vs. PMA alone).The FAK‐RhoA‐ROCK‐MLC2‐myosin IIA pathway is an important pathway for the formation of proplatelets and production of platelets from megakaryocytes. We evaluated the effect of ANA on phosphorylation of FAK and MLC2. Western blot analysis showed that ANA treatment caused reduced phosphorylation of FAK and increased phosphorylation of MLC2 (PMA vs. PMA+ANA 5 μM, P < 0.01), which presumably resulted in suppression of actin remodeling.Summary/Conclusion:ANA reduces platelet counts and increases platelet size in ET patients. Analysis of ANA‐treated MEG‐01 cells suggested that suppression of proplatelet formation through modulation of the FAK‐RhoA‐ROCK‐MLC2‐myosin IIA pathway is a key mechanism. Morphological observation suggested that ANA induces premature release of platelets, resulting in increased platelet size.image

PS1577 PLATELET COUNT AND MEAN PLATELET VOLUME IN ACUTE STROKE: A SYSTEMATIC REVIEW AND META‐ANALYSIS

Background:Changes of platelet count (PC) and mean platelet volume (MPV) could be a marker or a predictor of acute stroke (AS).Aims:We conducted a systematic review and meta‐analysis of the published literature on the reporting of MPV and PC in AS.Methods:Medline, EBSCOhost, Web of Science, ScienceDirect, Google Scholar and Scopus were searched for studies. Studies were included in accordance with Patient Population or Problem, Intervention, Comparison, Outcomes, and Setting (PICOS) framework. The PRISMA strategy was used to report findings. Risk of bias was assessed with Newcastle‐Ottawa Scale. The inclusion criteria were case‐control or cross‐sectional studies, individuals suffered an acute stroke, with fatal or non‐fatal stroke outcomes. Standardized mean difference (SMD) was calculated with a confidence interval of 95% (95% CI).Results:We included 32 eligible articles retrieved from the literature. PC was significantly lower in AS patients [standardized mean difference (SMD) = 0.30, (95%CI: 0.49–0.11), N = 2492, P = 0.002] compared with controls (N = 3615). The MPV was significantly higher [SMD = 0.51, (95%CI: 0.27–0.74), N = 2413, P < 0.001] compared with controls (N = 3621). Subgroup analyses showed significantly lower PC in both ischemic stroke (Difference SMD = 0.18, 95%CI: 0.35‐0.01) and hemorrhagic stroke (0.94, 1.62–0.25), but only samples by citrate anticoagulant showed significantly lower result for patients compared to controls (0.36, 0.68–0.04). Ischemic stroke patients had higher MPV (0.55, 0.29–0.81), and samples by EDTA anticoagulant showed significantly higher result for patients compared to controls (0.79, 0.49–1.10).Summary/Conclusion:PC and MPV appeared to be significantly different between patients with AS and control populations. MPV was significantly higher in ischemic stroke and PC was significantly lower in both ischemic and hemorrhagic strokes. It is advisable to pay attention to the type of anticoagulant for hematology analyses in AS. Our results highlight the potential predictive role of PC and MPV in the occurrence of stroke.

Cardiovascular and bleeding outcomes in a population‐based cohort of patients with chronic immune thrombocytopenia

AbstractUnlabelled Box BackgroundAmong patients with chronic immune thrombocytopenia (cITP), little is known regarding risk factors for cardiovascular and bleeding outcomes and how these events influence mortality. ObjectivesWe examined the rate of cardiovascular events and bleeding requiring a hospital contact according to platelet count levels, as well as the prognostic impact of these events on all‐cause mortality in adult patients with cITP. MethodsWe identified all cITP patients registered in the Nordic Country Patient Registry for Romiplostim during 1996 to 2015. Absolute risks and hazard ratios across platelet count levels based on Cox regression analysis were computed, adjusting for age, sex, prevalent/incident cITP, smoking, and comorbidities. We also compared all‐cause mortality rates in cITP patients with and without cardiovascular and bleeding events. ResultsAmong 3 584 cITP patients, 1‐year risks were 1.9% for arterial cardiovascular events, 1.2% for venous thromboembolism, and 7.5% for bleeding. Rates of cardiovascular events were similar across platelet counts. Patients with platelet counts <50 × 109/L had >2‐fold higher rates of bleeding than patients with normal platelet counts. These associations were unchanged in time‐varying analyses that considered changes in platelet counts during follow‐up. Occurrences of cardiovascular and bleeding events were associated with 4‐fold to 5‐fold increases in 1‐year mortality. ConclusionsAmong patients with cITP, the 1‐year risks of cardiovascular events were 1% to 2%, while nearly 8% experienced a bleeding event within 1 year. Cardiovascular events occurred across all platelet levels, while low platelet counts were associated with increased hazards of bleeding. Cardiovascular and bleeding events were strong prognostic factors for mortality.

Body Weight and Platelet Count Changes in Zidovudine Administered Wistar Albino Rats Treated with Ethanolic Extracts of Annona muricata and Fagara zanthoxyloide

Zidovudine administration either in single or fixed-dose combination usually results in a decrease in body weight and in some cases thrombocytopenia. The present study investigated the body weight and platelet count changes observed in zidovudine pre-administered Wistar albino rats on treatment with ethanolic extracts of the leaves Annona muricata (AM) and roots of Fagara zanthoxyloide (FZ). Plants samples were collected from Alakahia community, Rivers state and Opoo community, Ogun state; while Wistar albino rats were grouped into normal control, negative control (receiving zidovudine at 100 g/ml/Kg bw), AM and FZ extract treatment (at 4.5 and 3.8 g/ml/Kg B.W respectively) groups with analysis performed bi-weekly. All tests were performed using standard procedures with all reagents of analytic grade. Phytochemical screening of the extracts showed significantly high amounts of alkaloids (10.47- 21.15 mg / 100 g), phenols (10.60-15.22 mg / 100 g) and tannins (14.23 - 50.19 mg / 100 g). The investigation into their proximate compositions also showed high fat (5.78 ± 0.02) in FZ, moisture (10.47 ± 0.05) in AM and fibre (7.37 ± 0.03) in FZ. The amino acid phenylalanine (5.10-6.01 g / 100 g), isoleucine (4.44-5.20 g / 100 g), lysine (4.03 -5.31 g / 100 g) was observed to be available in the extracts. In the normal control group body weight increased by 20.75 g at week 6 while administration of Zidovudine, resulted in a decreased in bodyweight by 1.14 g in week 2 and 3.32 g in week 6. Extract treatment caused a significant increase (p≤0.05) in body weight by 17.95g (AM) and 18.23g (FZ) at week 6. Platelet count was also observed to significantly decrease (p≤0.05) by 33.42% in the negative control group when compared to the normal control. This was observed to significant increases in extract treatment by 49.56% (AM) and 51.32% (FZ). The results thus suggest a possible beneficial effect of the extracts of AM and FZ in checkmating the weight and platelet loss observed as a side effect of zidovudine therapy as well as the possible use in haemorrhagic conditions to reduce bleeding without thromboembolism.

Time course of platelet counts in relation to the neurologic outcome in patients undergoing targeted temperature management after cardiac arrest

BackgroundThrombocytopenia is common and associated with mortality in critically ill patients. However, the time course of platelet counts and its association with the neurologic outcome after out-of-hospital cardiac arrest (OHCA) are not well known. The purpose of this study is to describe the time course of platelet counts in relation to the neurologic outcome in patients undergoing targeted temperature management (TTM) after CA. MethodsReview of consecutive patients receiving TTM after out-of-hospital CA between 2009 and 2016. The blood sample was collected daily until 7 days. The primary outcome was poor neurologic outcome at 6 months after CA defined as Cerebral Performance Category of 3–5 and secondary outcome was mortality at 6 months. ResultsA total of 261 consecutive patients treated with TTM after OHCA between 2009 and 2016. One hundred seventy-five patients (67.0%) had poor neurologic outcomes 6 months after CA. The changes in the platelet counts over time between the good and poor outcome groups were statistically significant (p < 0.001). The platelet counts declined during TTM in both groups. The platelet counts recovered to the normal range at the end of the first week in the good neurologic outcome group. However, the platelet counts remained low in the poor outcome group. Low platelet counts on the 7th day were associated with poor neurologic outcomes (aOR 0.975, 95% CI, 0.961–0.989) and mortality at 6 months (aOR 0.986, 95% CI, 0.975–0.997) after adjusting for covariates. ConclusionThe changes in platelet counts in OHCA patients have a biphasic pattern that is significantly different in patients with good neurologic outcomes and those with poor neurologic outcomes at 6 months. A low platelet count 7 days after CA was associated with a poor neurologic outcome and mortality at 6 months.

Prognostic Impact of Increased Perioperative Platelet Count in Gastric Cancer Patients

BackgroundSolid tumors are a common cause of secondary (reactive) thrombocytosis, a paraneoplastic syndrome that is also a prognostic factor for various cancers. However, cutoff values for platelet count specific to gastric cancer and their prognostic roles are unknown. MethodsWe retrospectively analyzed records of 4643 patients with gastric cancer who underwent radical surgery from 2007 to 2010. The minimum P-value approach was used with the log-rank test to determine the optimal prognosis predicting threshold for preoperative platelet count. Change in perioperative platelet count over time was evaluated with a generalized estimating equation. Clinicopathologic features and prognostic significance were analyzed according to platelet count. ResultsThrombocytosis prevalence (platelet count ≥40 × 104/μL) was 1.6% (75 of 4643 patients). The platelet count cutoff value with the lowest P-value was ≥25.5 × 104/μL, and patients with higher platelet count had more advanced disease. Multivariate analysis showed that cutoff value was an independent prognostic factor of overall survival (hazard ratio 1.19, 95% confidence interval 1.03-1.37, P = 0.017). Patients who underwent adjuvant chemotherapy (n = 1300) and had a greater than 10% increase in platelet count at postoperative 1 y compared to before surgery had significantly poorer overall survival (hazard ratio 1.65, 95% confidence interval 1.11-2.45, P = 0.013). ConclusionsElevated preoperative platelet count (≥25.5 × 104/μL) and increased platelet count (≥10%) at postoperative 1 y in an adjuvant chemotherapy group were unfavorable prognostic factors. Platelet count could be a cost-effective biomarker for screening and monitoring patients with unfavorable survival outcomes.

Platelet function, but not thrombin generation, is impaired in acute normovolemic hemodilution (ANH) blood

Study objectiveWe investigated the coagulation changes that might occur in acute normovolemic hemodilution (ANH) blood over several hours during cardiac surgery requiring cardiopulmonary bypass. DesignThis study was a prospective observational study. SettingThis study took place at a university teaching hospital. PatientsThis study included 26 patients, either ASA 3 or 4 and without known coagulation disorders, undergoing cardiac surgery. Patients were included if the use of cardiopulmonary bypass was expected to reach 2.5 h. InterventionsANH blood was collected into CPDA-1 collection bags before systemic heparinization. Samples were taken directly from the bags at time of collection and reinfusion to assess changes in platelet and thrombin generation parameters. MeasurementsWhole blood from citrated tubes was used immediately for rotational thromboelastometry and platelet aggregometry analyses. Thrombin generation was assessed using calibrated automated thrombography with platelet poor plasma. Main resultsDespite no significant change in platelet count over the ANH storage period, there was significant degradation in platelet function as measured by thrombin receptor activating peptide stimulation on Mulltiplate™ analysis and maximum clot formation on ROTEM™ EXTEM. Notably, there was no change in the ability to generate thrombin. ConclusionsLittle data exists regarding the quality of coagulation factors in autologous blood. Our study confirms ANH collection results in decreased platelet aggregation with TRAP stimulation; however, this is not appreciated with ADP stimulation. Thrombin generation capacity remains preserved.

G-CSF causes decrease in peripheral blood platelet counts unrelated to leukapheresis during autologous stem cell mobilization

Background & Aim Autologous transplant utilizing G-CSF mobilized peripheral blood stem cells (PBSC) is an established treatment for various conditions. PBSC collection has been reported to be associated with decrease in platelet counts, attributed to leukapheresis. Whether G-CSF directly affects platelet counts is unclear and studies show conflicting findings. We studied the change in platelet count, prior to start of leukapheresis, in patients receiving G-CSF for PBSC mobilization for autologous stem cell transplant Methods, Results & Conclusion Myeloma patients undergoing PBSC collection in our institution were retrospectively studied. Patients received 10 μg/kg G-CSF SQ daily. Stem cell collection started on day 4 (after 3 doses of G-CSF) if blood CD34 count on day 4 was at least 10 cells/μL (Good mobilizer). If not (Poor mobilizer), patients received plerixafor and another dose of G-CSF on day 4 followed by collection starting day 5. Complete blood count was measured before G-CSF on day 0 and on days 2,3,and 4 prior to start of leukapheresis. 163 patients were studied, median age 61 yr (39-74), 99(61%) were men. Platelet count (Mean ± SE) on day 0 was 230±5.9, which dropped to 192±4.4 (p We show a direct effect of G-CSF on platelet counts unrelated to leukapheresis. The decline is more severe in poor mobilizers. This together with known association of thrombocytopenia with poor mobilization, and expected further drop after leukapheresis is an important consideration when assessing safety and efficacy of G-CSF based mobilization in patient with low platelet count. The mechanism of G-CSF induced thrombocytopenia is likely multifactorial. Possibilities include G-CSF induced differentiation and proliferation of myeloid progenitors at the expense of megakaryocytic lineage, G-CSF induced activation and consumption (Platelets are known to have functional G-CSF receptors), or sequestration from G-CSF induced splenomegaly.

Efficacy of repeat doses of avatrombopag: a case series

Thrombocytopenia is a common hematologic complication in patients with chronic liver disease. Thrombocytopenia places these patients at risk who undergo invasive procedures. Patients with cirrhosis often require repeat procedures. Patients with chronic liver disease and platelet counts below 50,000/µL who underwent repeat doses of avatrombopag (AVA) prior to multiple invasive procedures. Changes in platelet count were measured with each course of AVA. The need for platelet transfusion and adverse events from AVA were noted. Four patients underwent repeat AVA dosing. The mean [± standard deviation (SD)] age of the patients who underwent repeat dosing was 65 (±29) years. The mean (± SD) platelet count prior to the procedure was 38,250 (±5,679)/µL, and the mean increase of platelets was 52,000 (±33,000)/µL. Similarly, the mean (± SD) increase after the repeat administration was 51,000 (±31,000)/µL. No patient required platelet transfusion or rescue therapy. No adverse effects were reported. Repeat use of AVA continues to be an effective tool to minimize the use of platelet transfusions in patients undergoing invasive procedures who have chronic liver disease. Repeat dosing does not appear to reduce AVA efficacy.

Factors predicting peripheral blood stem cell (PBSC) mobilization with plerixafor in multiple myeloma patients who had inadequate mobilization with G-CSF.

Background & Aim Autologous transplant utilizing G-CSF mobilized peripheral blood stem cells (PBSC) is considered standard practice for eligible multiple myeloma (MM) patients. G-CSF is often utilized as the preferred agent and Plerixafor added if there is inadequate PBSC mobilization with G-CSF alone. To the best of our knowledge, there are no studies predicting the response of the poor mobilizers to plerixafor. Methods, Results & Conclusion METHODS MM patients undergoing PBSC collection in our institution were retrospectively studied. Patients received 10 μg/kg G-CSF SQ daily. Stem cell collection started on day 4 (after 3 doses of G-CSF) if blood CD34 count on day 4 was at least 10 /μL (Good mobilizer). If not (Poor mobilizer), patients received 240 μg/kg plerixafor SQ and another dose of G-CSF on day 4 followed by collection starting day 5. Complete blood count was measured before G-CSF (day 0) and on days +2, +3, and +4, . and CD34 count on day +5 . Based on day +5 CD34 count patients were categorized into two groups; Above Median (AM) with CD34 count above median or Below Median (BM; CD34 = Results 73 patients were studied. Median age 61 yr, (39-74), 44 (61%) were men. Median CD34 count on day +5 was 41.9/µL, 37 were in BM and 36 in AM groups. Disease duration prior to mobilization strongly correlated with plerixafor response (25.9m v 15.1m in BM v AM, p=0.02) . Mean day 0, day 2 and day 3 platelet count was higher in AM compared to BM (236 v 192,P =0.0075 on day 0, 182 v 148, p=0.0003 on day 2, and 195 v 152 p=0.0001 on day 3). Platelet count dropped from day 0 to day 2 in the whole cohort but more so in the BM compared to AM group (mean drop 20.7% v 15.6%, p=0.04) . Day 0 ANC was not different (2.7 v 2.5,P =0.47) but ANC on day 2 was higher (25.9) in AM compared to 18.6 in BM group, p=0.007. Low CD34 count on day 3 prior to plerixafor administration strongly correlated with plerixafor response (4.5 v 6.7 in BM v AM, p=0.0006) Discussion We found that disease duration, day 0 and day + 2 platelet counts, day +2 ANC and day +3 CD34 counts were sensitive predictors for Plerixafor response. Also we observed that extent of platelet and ANC count change between day 0 and day +2 were predictors of plerixafor response.. These findings have implications for choosing mobilization strategies for patients who have inadequate CD34 mobilization with G-CSF alone.

SOFA coagulation score and changes in platelet counts in severe acute kidney injury: Analysis from the randomized evaluation of normal versus augmented level (RENAL) study.

To evaluate the prognostic value of baseline SOFA coagulation score (SOFA-CS) and change in platelet counts in patients with severe acute kidney injury (AKI) requiring continuous renal replacement therapy (CRRT). We performed a secondary analysis from the Randomized Evaluation of Normal versus Augmented Level of RRT (RENAL) study. The primary endpoint was all-cause mortality at 90 days after randomization. The association between baseline SOFA-CS, changes in platelet counts, process of care, and clinical outcomes were analyzed using multivariate Cox model adjusted for baseline variables. The complete SOFA-CS data were available in 1454 out of 1508 patients from the RENAL study. Among them, 708 patients had an abnormal SOFA-CS (defined as SOFA-CS ≥ 1), while 746 patients had normal SOFA-CS at baseline (SOFA-CS = 0). An abnormal SOFA-CS was independently associated with an increased risk of death at 90 days (HR = 1.27, 95% CI = 1.05-1.53, P = 0.015). An abnormal SOFA-CS was associated with prolonged length of ICU stay and duration of mechanical ventilation as well. Furthermore, there was no significant association between changes in platelet counts in patients who survived beyond 4 days and 90 day mortality (HR = 1.26, 95% CI = 0.29-5.56, P = 0.76). However, on multivariable analysis a decline of ≥60% (HR = 1.93, 95% CI = 1.23-3.05, P = 0.004) was associated with 90 day mortality in patients who survived beyond the first 4 days. In the RENAL study, thrombocytopaenia is a common phenomenon in patients with severe AKI receiving CRRT. An abnormal baseline SOFA-CS and reductions in platelet counts were associated with increased mortality at 90 days.

Effects of cigarette smoking on erythrocyte sedimentation rate, platelet count, total and differential leucocyte counts in adult male smokers

Smoking is one of the leading causes of death worldwide. Smokers have higher risk for coronary heart disease, atherosclerosis, acute myocardial infarction, hypertension, clotting disorders, inflammation, respiratory diseases, cancers, etc. A cigarette smoker is exposed to a number of harmful substances. In this study we hypothesized that smoking causes inflammatory reactions and induces hyperthrombic state in the body which may be reflected in erythrocyte sedimentation rate (ESR), total leucocyte count (TLC), differential leucocyte count (DLC) and platelet count values. The purpose of the study was to study the effects of cigarette smoking on erythrocyte sedimentation rate, total leucocyte count and platelet count in adult male smokers and to compare the results with non-smokers and to establish a relationship between the duration and quantity of smoking with the change in ESR, TLC, DLC and platelet count. A cross sectional study was conducted in the department of Pathology on 86 healthy male subjects (smokers=43 and non-smokers=43). ESR was estimated using Westergrens method. TLC, DLC and platelet counts were estimated using HORIBA Pentra ES60 autoanalyzer. TLC and basophil counts were significantly higher in smokers than in non-smokers (p&lt;0.05). The mean value of ESR was higher among smokers than non-smokers but it was statistically insignificant. Platelets counts showed no significant difference between smokers and non- smokers. No correlation was observed in various blood parameters and smoking (in pack years). We conclude that smoking initiates an inflammatory response as evidenced from raised TLC, monocyte and basophil counts.

Safety of tirofiban and dual antiplatelet therapy in treating intracranial aneurysms

BackgroundEndovascular treatment of intracranial aneurysms usually involves stent-assisted coiling (SAC) and flow diverters. Glycoprotein IIb/IIIa inhibitors such as tirofiban and dual antiplatelet therapy (DAPT) are required to prevent thromboembolic complications...

Therapeutic effects of rituximab combined with cyclophosphamide on refractory idiopathic thrombocytopenic purpura.

Therapeutic effects of rituximab combined with cyclophosphamide on refractory idiopathic thrombocytopenic purpura (ITP) were investigated. We retrospectively analyzed 249 patients with refractory ITP who were admitted to Qingdao Hiser Medical Group between March 2013 and March 2017. Curative effects of patients treated with rituximab, cyclophosphamide, and combination therapy were observed and the changes of platelet count, PA IgG, and lymphocyte CD20 before and after treatment, as well as the incidence of adverse reactions after treatment, were compared. There was no significant difference in the expression of lymphocyte CD20, PA IgG and platelet count among the three groups of refractory ITP patients before treatment (P>0.05). After treatment, the expression levels of CD20 and PA IgG in lymphocytes were significantly downregulated, and platelet counts significantly increased in the three groups (P<0.05). After treatment, CD20 and PA IgG levels in combined therapy group were significantly lower, and platelet count was significantly higher, than those in the rituximab and cyclophosphamide groups (P<0.05). Also, after rituximab treatment, the expression levels of CD20 and PA IgG in lymphocytes were significantly lower than those in cyclophosphamide group (P<0.05), and platelet count was higher than that in cyclophosphamide group (P<0.05). After treatment, the total effective rate in combined therapy group was higher than that in the rituximab and cyclophosphamide group (P<0.05). Total effective rate of rituximab group was significantly higher than that of cyclophosphamide group (P<0.05). The incidence of adverse reactions in combined therapy group was 14.29% (12/84), which was significantly lower than that in cyclophosphamide group (40.70%, 35/86, P<0.05) and rituximab group (29.11%, 23/79, P<0.05). The application of rituximab combined with cyclophosphamide in the treatment of refractory ITP can improve patients clinical symptoms. The efficacy of this technique is promising with no serious adverse reactions. This technique should be popularized in clinical practice.

Uso de extratos herbais e butirato de sódio em suínos na fase de 7 a 10kg

Objetivou-se avaliar o efeito da adição de um complexo contendo extratos herbais de Acacia minearnsii e Castanea sativa, associados a um blend de ácidos orgânicos contendo os ácidos butírico, cítrico, fumárico e ascórbico em substituição a antibióticos em dietas de leitões na fase de 7 a 10kg de peso corporal. O experimento foi executado nas instalações de uma granja comercial, situada no município de Xanxerê, Santa Catarina, Brasil. Foram utilizados 400 animais, na faixa de 7 a 10kg de peso, distribuídos em delineamento inteiramente ao acaso em quatro tratamentos com quatro repetições cada, compostas por 25 animais cada. Os tratamentos experimentais foram: T1: Controle Positivo (Colistina + Florfenicol) (1000ppm); T2: Complexo herbal + Butirato (300ppm); T3: Complexo herbal + Butirato (600ppm); T4: Complexo herbal + Butirato (1200ppm). Foram avaliados parâmetros sanguíneos (hemograma, leucograma, contagem plaquetária, glicemia e colesterolemia), parâmetros de desempenho (ganho de peso, consumo de ração e conversão alimentar) e ocorrência de diarreias. Os dados experimentais foram submetidos à análise de variância, e na presença de diferença significativa, as médias foram submetidas ao teste SNK a 5% de significância. Não foram constatadas alterações significativas sobre os parâmetros hematológicos ou leucocitários dos suínos avaliados. Não houve alteração na contagem plaquetária, nos níveis de glicose e de colesterol sanguíneos .O desempenho e a ocorrência de diarreias não foram afetadas pelos níveis do blend de extratos herbais e ácidos orgânicos em substituição aos antibióticos. Conclui-se que estes compostos podem ser utilizados como promotor de crescimento em substituição aos antibióticos, sem causar comprometimento nos parâmetros sanguíneos e no desempenho de leitões na fase pós-desmama.

Effects of ABO Matching of Platelet Transfusions in Critically Ill Children.

To determine if transfusing ABO compatible platelets has a greater effect on incremental change in platelet count as compared to ABO incompatible platelets in critically ill children. Secondary analysis of a prospective, observational study. Transfusions were classified as either ABO compatible, major incompatibility, or minor incompatibility. The primary outcome was the incremental change in platelet count. Transfusion reactions were analyzed as a secondary outcome. Eighty-two PICUs in 16 countries. Children (3 d to 16 yr old) were enrolled if they received a platelet transfusion during one of the predefined screening weeks. None. Five-hundred three children were enrolled and had complete ABO information for both donor and recipient, as well as laboratory data. Three-hundred forty-two (68%) received ABO-identical platelets, 133 (26%) received platelets with major incompatibility, and 28 (6%) received platelets with minor incompatibility. Age, weight, proportion with mechanical ventilation or underlying oncologic diagnosis did not differ between the groups. After adjustment for transfusion dose, there was no difference in the incremental change in platelet count between the groups; the median (interquartile range) change for ABO-identical transfusions was 28 × 10 cells/L (8-68 × 10 cells/L), for transfusions with major incompatibility 26 × 10 cells/L (7-74 × 10 cells/L), and for transfusions with minor incompatibility 54 × 10 cells/L (14-81 × 10 cells/L) (p = 0.37). No differences in count increment between the groups were noted for bleeding (p = 0.92) and nonbleeding patients (p = 0.29). There were also no differences observed between the groups for any transfusion reaction (p = 0.07). No differences were seen in the incremental change in platelet count nor in transfusion reactions when comparing major ABO incompatible platelet transfusions with ABO compatible transfusions in a large study of critically ill children. Studies in larger, prospectively enrolled cohorts should be performed to validate whether ABO matching for platelet transfusions in critically ill children is necessary.

Hematological changes in postmenopausal women

Background: Ovarian function declines subsequent to menopause. This can lead to undesirable alterations in metabolism, vascular endothelium function, and also fibrinolytic and coagulative properties of blood. Menopause may, therefore, result in enhanced risk for ischemic heart disease in women due to such altered properties of blood and vascular function. This risk gets further stratified if there are coexisting lifestyle-related factors such as physical inactivity, smoking, high calorie/high-fat diet, and stressful work. Aims and Objectives: Our study is designed to compare some hematological values in postmenopausal women with premenopausal women as control group. This helps us to know the risk of vascular and ischemic heart disease in postmenopausal women. Materials and Methods: Blood samples were drawn in 50 women who have attained menopause and have weight of 55–60 kg and height of 150–160 cm and 50 control subjects who were disease-free women aged 35–40 years with matching weight and height. These women had natural menopause and were not subjected to any hormonal or surgical intervention. The vital parameters were recorded, and general examination was done. Student t-test was used for statistical analysis. Results: There was a statistically significant increase in hematocrit, and there was no statistically significant change in platelet count, activated partial thromboplastin time (APTT), and prothrombin time (PT). Conclusion: A higher viscosity of blood can enhance the risk of coronary artery disease by elevating platelet aggregability and adhesiveness to sub-endothelium. However, the above effect may partially be offset by unchanged APTT and PT.