Different Degrees Of Thrombocytopenia Research Articles

Diagnostic Ideas and Management Strategies for Thrombocytopenia of Unknown Causes in Pregnancy.

ObjectiveTo summarize the clinical characteristics and treatment options together with the maternal and neonatal prognoses in women with different degrees of thrombocytopenia of unknown causes during pregnancy.Materials and MethodsOne hundred twenty-nine cases meeting the inclusion and exclusion criteria were retrospectively analyzed. Patients were divided into group A (50*109/L) and group B (50*109/L to 100*109/L) according to the lowest level of platelet count during pregnancy. Patients were divided into those found to have thrombocytopenia in the relatively early, middle, and late stages according to the detection period of maternal thrombocytopenia during pregnancy.ResultsThere were 72 cases in group A, and 57 cases in group B. There existed statistically significant differences in terms of the proportion of primipara, the proportion with a history of thrombocytopenia, and the median length of pregnancy between the two groups (p < 0.05). The proportion of patients with severe thrombocytopenia as an indication for cesarean delivery was higher in group A than in group B (p < 0.05). More cases were detected at the relatively early stages of pregnancy in group A than in group B (p < 0.05). There was no difference in neonatal hemorrhage and events of thrombocytopenia between the two groups.ConclusionPatients with platelet counts below 50*109/L were mostly primipara with a history of thrombocytopenia, most often detected at a relatively early stage of pregnancy, and continued pregnancy might lead to aggravation of the disease. Combination therapy was required for patients with platelet counts below 30*109/L to maintain the platelet counts within a safe range. Cesarean delivery was selected to terminate the pregnancies, and platelet counts should be raised above 50*109/L before surgery. Close monitoring was required for those with platelet counts above 30*109/L. There was no direct correlation between the maternal and neonatal platelet counts.

The Interface Between Inflammatory Mediators and MicroRNAs in Plasmodium vivax Severe Thrombocytopenia.

Severe thrombocytopenia can be a determinant factor in the morbidity of Plasmodium vivax, the most widespread human malaria parasite. Although immune mechanisms may drive P. vivax-induced severe thrombocytopenia (PvST), the current data on the cytokine landscape in PvST is scarce and often conflicting. Here, we hypothesized that the analysis of the bidirectional circuit of inflammatory mediators and their regulatory miRNAs would lead to a better understanding of the mechanisms underlying PvST. For that, we combined Luminex proteomics, NanoString miRNA quantification, and machine learning to evaluate an extensive array of plasma mediators in uncomplicated P. vivax patients with different degrees of thrombocytopenia. Unsupervised clustering analysis identified a set of PvST-linked inflammatory (CXCL10, CCL4, and IL-18) and regulatory (IL-10, IL-1Ra, HGF) mediators. Among the mediators associated with PvST, IL-6 and IL-8 were critical to discriminate P. vivax subgroups, while CCL2 and IFN-γ from healthy controls. Supervised machine learning spotlighted IL-10 in P. vivax-mediated thrombocytopenia and provided evidence for a potential signaling route involving IL-8 and HGF. Finally, we identified a set of miRNAs capable of modulating these signaling pathways. In conclusion, the results place IL-10 and IL-8/HGF in the center of PvST and propose investigating these signaling pathways across the spectrum of malaria infections.

The Pharmacological Approach to Oncologic Patients with Acute Coronary Syndrome.

Among acute coronary syndrome (ACS) patients, 15% have concomitant cancer, especially in the first 6 months after their diagnosis, as well as in advanced metastatic stages. Lung, gastric, and pancreatic cancers are the most frequent malignancies associated with ACS. Chemotherapy and radiotherapy exert prothrombotic, vasospastic, and proinflammatory actions. The management of cancer patients with ACS is quite challenging: percutaneous revascularization is often underused, and antiplatelet and anticoagulant pharmacological therapy should be individually tailored to the thrombotic risk and to the bleeding complications. Sometimes oncological patients also show different degrees of thrombocytopenia, which further complicates the pharmacological strategies. The aim of this review is to summarize the current evidence regarding the treatment of ACS in cancer patients and to suggest the optimal management and therapy to reduce the risk of adverse coronary events after ACS in this high-risk population.

The relationship between platelet indices and patent ductus arteriosus in preterm infants: a systematic review and meta-analysis.

Patent ductus arteriosus (PDA), one of the most common disorders in newborns, is associated with many complications in premature infants such as respiratory distress syndrome (RDS) and bronchopulmonary dysplasia (BPD). However, the diagnosis of hemodynamically significant patent ductus arteriosus (hsPDA) is still an ongoing debate. The relationship between platelet parameters and hsPDA has been explored in many studies over the last decade, but there is still no definite conclusion. We aim to explain the relationship between platelet parameters and hsPDA through this meta-analysis. Therefore, we used PubMed, Embase, the Cochrane Library, and Web of Science databases as well as the Google Scholar to search for studies up to May 2020. Three reviewers independently screened the articles, evaluated the quality of the articles, and collected the data. The random-effects model and fixed-effects model were used to evaluate pooled results. We used the I-square (I2) test to examine heterogeneity and the funnel plot; Egger's test and meta-regression analysis were used to test for publication bias. Influence analysis was also carried out in this study. Stata version 12.0 software was used for data analysis. Fourteen studies, which included 3330 newborns, were extracted from 986 studies. The weighted mean difference (WMD) of the platelet count was - 17.98 (p < 0.001), the platelet distribution width (PDW) was 0.27 (p = 0.266), the mean platelet volume (MPV) was 0.01 (p = 0.958), the plateletcrit (PCT) was - 0.03 (p < 0.001), and the platelet mass was - 150.10 (p = 0.001).Conclusion: Platelet count, PCT, and platelet mass of the first 3 days of life are potentially helpful in identifying premature infants at risk of hsPDA. More prospective studies on the relationship between different degrees of thrombocytopenia and platelet function and hsPDA should be conducted. What is Known: • Platelets are involved in the formation of thrombi during closure of the arterial duct. • The diagnosis of hsPDA by Doppler echocardiography and clinical signs is not precise enough. What is New: • Preterm newborns with hsPDA in the first week of life demonstrated a significant reduction in platelet count, platelet mass, and plateletcrit in the first 3 days of life. • No significant difference was shown between hsPDA and non-hsPDA infants in platelet distribution width and mean platelet volume in the first 3 days of life.

Incidence of Thrombocytopenia and Heparin Induced Thrombocytopenia in Patients Receiving Extracorporeal Membrane Oxygenation (ECMO) Compared to Cardiopulmonary Bypass and the Limited Sensitivity of Pre-Test Probability Score

IntroductionExtracorporeal membrane oxygenation (ECMO) is a life saving measure for severe respiratory (veno-venous ECMO [VV-ECMO]) or cardiac (veno-arterial ECMO [VA-ECMO]) failure. Heparin induced thrombocytopenia (HIT) is a special concern in these patients because ECMO uses a modified cardiopulmonary bypass (CPB) resulting in continuous exposure to artificial surfaces and unfractionated heparin (UFH) over several days to weeks, compared to CPB in which these exposures are for only a few hours. In addition, most of the patients undergoing CPB do not have underlying systemic inflammation and have a normal platelet count at the time of first exposure to UFH. It is possible that patients receiving ECMO are at higher risk of developing HIT compared to patients having CPB. The prevalence of HIT in adult patients receiving VV-ECMO is unknown.We determined to ascertain the incidence of thrombocytopenia and the reliability of pre-test probability score (PTPS) in predicting HIT, in patients receiving VV-ECMO or VA-ECMO compared to CPB. Differences in the PTPS of patients on ECMO compared to patients who received CPB and the effect of HIT on 30-day mortality in ECMO patients compared to patients who did not have HIT were also assessed.MethodsThis was a single centre retrospective study of patients undergoing CPB (median 4.6 [2-16.5] hrs. or receiving ECMO for ≥ 48hrs (median 7.1 [3-42] days. HIT screening was performed in all patients who showed a typical pattern of platelet drop in first 5 to 12 days after exposure to UFH with or without thrombosis. A citrated blood sample and a completed PTPS (4Ts) were collected from all patients prior to a screening test for HIT antibody performed on an ACL TOP500 analyser using Hemosil HIT-Ab (PF4-H) kit (Werfen UK). Those with positive HIT screening had confirmatory testing by ELISA (HYPHEN BioMed, France). Clinical data were collected from electronic records. From January 2016 to April 2018, 296 ECMO patients (142 VA-ECMO, 156 VV-ECMO) and 2998 CPB patients were studied.ResultsCPB patients were older than the patients who received ECMO; mean age (standard deviation) for EMCO and CPB were 45.4 (±15.6) and 64.9 (±13), p< 0.00001. A significantly higher proportion of men had CPB (71.3%) and ECMO (58.5%) than women, P<0.0001.Thrombocytopenia was divided into mild (platelet count 100-150x109/L), moderate (50-99x109/L) and severe (<50x109/L)). Table 1 demonstrates the percentages of patients in ECMO and CPB with different degrees of thrombocytopenia on day 1, 2, 5 and 10. The incidences of severe thrombocytopenia and moderate thrombocytopenia were 4.4% and 40% already on the first day of ECMO which were significantly higher than in patients having CPB (p<0.0001) and this difference remained significant in day 2, 5 and 10. The proportion of CPB patients with moderate thrombocytopenia rose to 32.4% on day 2 from 14.5% on day 1 but by day 10 platelet count was normal in 83% compared to 42.3 % patients receiving ECMO.A total of 96 patients had HIT screening tests (64/296 ECMO and 32/2988 CPB). Twenty patients (20/296, 6.8%) on ECMO (11/142, 7.7% VA-ECMO and 9/156, 5.8% VV-ECMO) had a positive screening test compared to 18 patients (18/2998, 0.6%) on CPB (p<0.001). All positive screening tests were confirmed by ELISA (100% positive predictive value). The median PTPS for patients on ECMO was 4 (3-7) whilst for patients who received CPB it was 5 (4-7). Four ECMO patients had PTPS of 3 and would not normally been screened according current guidelines. All patients with confirmed HIT were treated with argatroban. There was no difference in mortality between ECMO patients who did or did not developed HIT; overall mortality: 95/296, 32.1%, mortality in patients without HIT: 89/276, 32.2% and patients with HIT 6/20, 30%)In conclusion, severe and moderate thrombocytopenia is already common in patients receiving ECMO on the day of the ECMO initiation. Patients who had CPB dropped their platelet count to mild to moderate levels on day 2 and 5 and then recovered by day 10. HIT is more frequent in patients receiving ECMO (both VV and VA-ECMO) compared to patients who had CPB. Although the PTPS was good at predicting HIT in patients who had CPB, it failed to detect HIT in 4/20 (20%) ECMO patients. [Display omitted] DisclosuresJayakody Arachchillage:Bayer: Other: Sponsored to attend educational meetings; Octapharma: Other: Sponsored to attend an educational meeting; Mitsubishi Phama: Other: Sponsored to attend an educational meeting. Laffan:Roche: Consultancy, Speakers Bureau; Pfizer: Honoraria.

Thrombocytopenia, Platelet Transfusion, and Outcome Following Liver Transplantation.

Thrombocytopenia affects patients undergoing liver transplantation. Intraoperative platelet transfusion has been shown to independently influence survival after liver transplantation at 1 and 5 years. We examined the impact of thrombocytopenia and intraoperative platelet transfusion on short-term graft and overall survival after orthotopic liver transplantation (OLT). A total of 399 patients undergoing first OLT were studied. Graft and overall survival in patients with different degrees of thrombocytopenia and with or without intraoperative platelet transfusion were described. The degree of thrombocytopenia prior to OLT did not affect graft or overall survival after transplant. However, graft survival in patients receiving platelets was significantly reduced at 1 year (P= .023) but not at 90 days (P= .093). Overall survival was significantly reduced at both 90 days (P= .040) and 1 year (P= .037) in patients receiving platelets. We conclude that a consistently lower graft and overall survival were observed in patients receiving intraoperative platelet transfusion.

The effects of single l-amino acid substitutions on the lethal potencies of the microcystins

R. D. Stoner, W. H. Adams, D. N. Slatkin and H. W. Siegelman. The effects of single l-amino acid substitutions on the lethal potencies of the microcystins. Toxicon 27, 825–828, 1989.—Microcystin-LR and -LA are more toxic than microcystin-LY and -RR in adult mice. They induce different degrees of thrombocytopenia and leukopenia, and the lethalities of their binary and ternary mixtures are additive. Postnatal mice are resistant to doses of microcystin-LR that are lethal to adults but they are susceptible to higher doses. Substitution of a single l-amino acid for another in a microcystin markedly affects the dosimetric potency, but not the pathophysiology of its toxicity.

Abnormal coagulation and fibrinolysis in eclampsia: A clinical and laboratory correlation study

This study evaluated the existence of abnormally increased coagulation and fibrinolysis in 33 severely toxemic and eclamptic women by means of a combined hemotologic profile with clinical and morphologic correlations. The dominant findings were: different degrees of thrombocytopenia, abnormal levels of blood fibrinogen, prolonged thrombin time, and positive protamine sulfate test. Altered activated partial thromboplastin time and positive ethanol gelation test were slightly less frequent, and only few cases showed prolonged prothrombin time or early lysis of euglobulins. These abnormalities seemed to be more numerous and more pronounced in the worst cases of the series and their severity seemed to be associated with the age of the patient and the presence of previous underlying disease. These variously handicapped pregnant women exhibited worse hematologic hematologic abnormalities, and provided most of the fatal cases in the series. Finally, the main findings were discussed and commented upon.