Increase In Platelet Count Research Articles

Acute phase reactants in non-COVID-19 community-acquired pneumonia

BackgroundAcute phase reactants (APR) are markers of inflammation that could be applied for the assessment of community-acquired pneumonia (CAP) severity in association with various pneumonia severity scores. So, the aim of the study was to assess levels of APR such as total leucocytic count (TLC), platelets, neutrophils, neutrophils-to-lymphocyte ratio (NLR), CRP, D-dimer, ferritin, and ESR in patients with CAP and to correlate between their values and disease severity.MethodologyThe study included 51 patients diagnosed as non-COVID-19 (CAP). Patients were classified into two groups group A (pneumonia only) and group B (pneumonia complicated with empyema/complicated para-pneumonic effusion). All patients underwent clinical evaluation, CURB65, radiological assessment, and blood sampling to measure APR.ResultsThe mean age of patients was 47 ± 17 years. The main symptoms were productive cough (90.2%) and Fever (92.2%).TLC, platelets, neutrophils, CRP, D-dimer, ferritin, and ESR were elevated than normal values. Significant positive correlations were found between the duration of fever and CRP, D-dimer, and ferritin with p values = 0.024, 0.012, and 0.034 respectively. Significant positive correlations were found between CURB65 and both CRP and ferritin with p values = 0.007 and 0.020. A significant increase in platelet count and ESR values was found in group B than in group A.ConclusionAPR are important markers that can be used in the assessment of CAP in collaboration with clinical evaluation and severity scores. CRP, D-dimer, and ferritin were positively correlated with CURB65, while ESR and platelets could be considered predictors of the development of complications.Trial registrationRetrospectively registered, registration number NCT05926089, date of registration is 06/29/2023.

"Dietary Factors Influencing Platelet Counts: Knowledge to Improve Concentration for Platelet-Rich Plasma Injections"

The use of biologics, such as platelet-rich plasma (PRP) injections, has been widely used in the healing process surrounding injuries. Given the growth factor-rich property in nature, PRP injections induce neovascularization significantly. There has been research surrounding the role of diet and nutrition on platelet count and function. States of iron deficiency and dyslipidemia have supporting evidence of increasing platelet count. In contrast, ketogenic diets, cod liver, and vitamin D have been associated with decreased platelet counts. Considering that both diet and nutrients affect platelets, perhaps using this theory could be further researched in providing higher-quality PRP injections.

Giloy (Tinospora cordifolia) Extract Mediated Biochemical, Haematological and Histological Alterations in Mice

Tinospora cordifolia (TC), a medicinal plant deeply integrated into India's folklore and Ayurvedic medical tradition, has been a reliable remedy for addressing various health concerns. Despite its proven efficacy in managing diseases, it is essential to exercise prudence regarding its dosage, as excessive consumption may result in undesirable consequences. This present study seeks to ascertain if the methanolic extract of TC triggers any adverse effects on organ function, haematological parameters, or biochemical profiles. The extract was administered intra peritoneally (IP) into the Swiss albino mice at a concentration of 300mg/kg body weight and observations were taken on 7th and 14th day. In comparison to control groups, the levels of haemoglobin (Hb), packed cell volume (PVC), red blood corpuscles (RBC), red cell distribution width (RCW), and platelet count increase. However, significant decrease was also observed in the levels of erythrocyte sedimentation rate (ESR) and lymphocytes. Blood biochemical analysis reveals a significant increase in urea but a subsequent decrease in blood sugar levels. The findings unequivocally illustrate the disruption in the seminiferous tubules of the testis, accompanied by a decrease in spermatid count. Furthermore, observable damage to kidney tissues was noted. Based on these observations, it can be inferred that, despite its multifaceted therapeutic applications, TC extract may exert toxic effects in mice.

The operational impact of introducing cold stored platelets.

Cold stored platelets (CSP) undergo physical changes that make them better at initiating a clot. While cold stored platelets are superior for reducing bleeding in actively bleeding patients, room temperature platelets (RTP) are better for increasing platelet count in patients requiring a prophylactic transfusion. However, whether the overhead required to maintain a dual platelet inventory of both RTP and CSP could be compensated by reduced platelet wastage resulting from the longer shelf life of CSP has not been determined. A simulation model of a regional blood supply was built, with focus on the operations of a case hospital. Two scenarios were considered: "No-CSP," in which the hospital issues only RTP, and "CSP," in which the hospital issues both RTP and CSP Within the CSP scenario, conditions were tested under which the hospital receives only RTP and converts some to cold stored platelets and a second strategy where the hospital receives CSP from the regional supplier in addition to converting RTP. A centralized supply of CSP is necessary since on-site conversion is limited by platelet age. Product shortages decrease with increased CSP inventory, but CSP wastage increases. It was also determined that, because relatively few RTP units can be converted on-site, RTP wastage is not significantly decreased with the introduction of CSP. Given the clinical benefits for treatment of trauma, CSP is a desirable addition to a blood formulary. However, it is unlikely that significant reductions in RTP wastage will occur because of the introduction of CSP.

Thrombocytopenia Induced by Clopidogrel: A Rare Adverse Effect.

Immune thrombocytopenic purpura (ITP) can be induced by several drugs but there are few case reports of ITP induced by clopidogrel. Second-line treatment with thrombopoietin receptor agonists (TPO-RA) presents solid evidence and should be considered in patients in need of elective surgery who are poor responders to steroids. We report the case of a 79-year-old male who developed severe immune thrombocytopenic purpura after initiating treatment with clopidogrel. Because he needed elective orthopaedic surgery and he did not respond to corticotherapy and immunoglobulin, second-line treatment with romiplostim was initiated with a significant increase in platelet count. Clopidogrel can induce ITP and this diagnosis should be considered in patients who present with isolated thrombocytopenia. First-line therapy of ITP is not always successful; second-line treatment with TPO-RA has a high response rate and should be considered in patients in need of elective surgery who have failed to respond to first-line therapy. Clopidogrel can cause immune thrombocytopenic purpura (ITP); although there are some published cases in literature, it is a rare adverse effect.ITP induced by clopidogrel should be considered in the differential diagnosis of patients experiencing isolated thrombocytopenia.Second-line treatment of ITP with thrombopoietin receptor agonists (TPO-RA) presents solid evidence and should be considered in patients in need of elective surgery who are poor responders to steroids.

Examination stress: Effects on Quantitative Platelet count in medical students at Peoples University of medical and health sciences for women, Nawabshah.

Objective: To evaluate the examination stress on Quantitative Platelet count in medical students at Peoples University of medical and health sciences for women, Nawabshah. Study Design: Cross-sectional Comparative study. Setting: Department of Physiology, Peoples University of Medical & Health Sciences for Women, Shaheed Benazir Abad. Period: April to October 2019. Material & Method: A randomized selection of female students from Peoples University of medical and health sciences for women, Nawabshah was done. Blood samples were taken before and during the exams after a preliminary medical checkup, students with fever or with other infections at the start of the study were not allowed to participate. Finally 110 students were included and two groups were made each consists of 55 students each from first year and second year MBBS class. Estimation of platelets count was carried out thru complete blood count test. Results: Laboratory results of platelet count showed, mean Platelet Count ± SD before examination of all students including first year was 295961.81±68964.71%. become 311000.0±83017.84% during exam, which was higher as compared to before examination mean Platelet Count ±SD was There was highly significant increase of Platelet Count during examination as compared to before examination among the students of first year (n = 55, p value = <0.0001), whereas In this study, mean Platelet Count ± SD before examination of all students including second year was 297790.0± 72794.78%. increased during exam to 326641.81± 80963.01% which was higher as compared to before examination mean Platelet Count ±SD was There was highly significant increase of Platelet Count during examination as compared to before examination among the students of second year (n = 55, p value = <0.0001). Conclusion: This study concluded that examinations in medical schools are stressful enough to produce changes in blood cells parameters which include Platelet count and increased the levels.

Frequency of H-Pylori Infection in Immune Thrombocytopenic Purpura

Objective: To determine the frequency of Helicobacter pylori infection in patients with Immune Thrombocytopenia (ITP) and the impact of eradication therapy on platelet counts. Study design & Setting: It was a cross-sectional study conducted at National institute of blood disease and bone marrow transplant (NIBD) hospital, Karachi, Pakistan from January 2021 to September 2022. Methodology: Adults between 18 to 70 years of either gender with thrombocytopenia (platelet count less than 100x109/L) with or without bleeding manifestation from last six months were recruited. The immunoassay was used for stool sample to detect H. pylori antigen, eradication therapy was administered and platelet counts were evaluated at 3rd and 6th month of treatment. Results: Of 120 patients with ITP, the mean age was 36.67±15.32 years, and 76.7% were female. 35.83% had H. pylori positive. The eradication treatment on platelet counts was statistically significant (p=0.001). Median platelet counts at baseline, 3 months and 6 months were 43.50(23.00- 77.00), 136.50 (57.00- 237.00), and 192.00 (130.50-275.50) patients respectively. Platelet counts were statistically different between baseline with three and six months (p=0.007 and p=0.001, respectively). Conclusion: People with ITP frequently have H. pylori infections, and eradication treatment could contribute to the increase in platelet count.

Using immature platelet fraction as a factor in deciding on the need for platelet transfusions

Our study aimed to assess the prognostic significance of immature platelet fraction (IPF) and its role in deciding whether to transfuse platelets. The study was approved by the Independent Ethics Committee and the Scientific Council of the Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology. We monitored this hematologic parameter in 6 patients before and after hematopoietic stem cell transplantation (HSCT). For the study, we used whole blood collected in K EDTA tubes. IPF levels were measured by flow cytometry on the automated hematology analyzer SYSMEX XE-2100 (Sysmex, Kobe, Japan). The presence of platelet antibodies was detected using Capture-P Ready-Screen solid phase system for the detection of antibodies to platelets and the NEO Blood Bank Analyzer by Immucor, Inc. It was shown that the use of IPF enabled an early establishment of platelet engraftment and helped to make more a reasoned decision regarding the transfusion of platelets. It was established that if a rise in IPF > 6% was not accompanied by an increase in platelet count, serum platelet antibody testing was needed. IPF can help diagnose platelet engraftment failure following HSCT and thus eliminate the need for bone marrow aspiration. IPF is of great clinical importance; if adopted as a routine hematologic parameter, it can serve as an additional factor in deciding on the need for platelet transfusions and platelet antibody testing and subsequent personalized selection of platelets.

Investigating the interplay of hematological parameters, CD markers, genetic polymorphisms, and database mutations in the IL15 gene in acute myeloid leukemia patients.

Acute myeloid leukemia (AML) is a heterogeneous malignancy characterized by the clonal expansion of myeloid precursor cells in the bone marrow. In this study, we investigated the interplay of hematological parameters, CD markers, genetic polymorphisms, and database mutations in the interleukin 15 (IL15) gene in AML patients. We enrolled 59 newly diagnosed AML patients and analyzed their bone marrow specimens using flow cytometry and molecular techniques. The hematological parameters of the AML patients revealed a significant increase in platelet count and RBC, Hb, and HCT levels compared to healthy individuals. CD marker expression analysis revealed upregulation of CD33, CD45, CD13, CD117, CD38, HLA-DR, CD15, CD64, MPO, CD34, and CD11c in AML patients. Molecular analysis showed 15 mutations in different positions of exon 8 of the IL15 gene, with the most frequent mutation being a homozygous mutation resulting from a nucleotide substitution. Additionally, 10 novel heterozygous mutations were identified in different locations of chromosome 4, with a low variant rate. Finally, database analysis of gnomAD and Mutagene revealed a high number of potential driver mutations in the IL15 gene in leukemia patients. These results provide valuable insights into the genetic and immunophenotypic characteristics of AML patients and highlight the potential role of IL15 in AML pathogenesis.

Long-Term Evaluation of Biomarkers in the Czech Cohort of Gaucher Patients.

A personalized treatment decision for Gaucher disease (GD) patients should be based on relevant markers that are specific to GD, play a direct role in GD pathophysiology, exhibit low genetic variation, reflect the therapy, and can be used for all patients. Thirty-four GD patients treated with enzyme replacement therapy (ERT) or substrate reduction therapy (SRT) were analyzed for platelet count, chitotriosidase, and tartrate-resistant acid phosphatase activity in plasma samples, and quantitative measurement of Lyso-Gb1 was performed in dried blood spots. In our ERT and SRT study cohorts, plasma lyso-GL1 correlated significantly with chito-triosidase (ERT: r = 0.55, p < 0.001; SRT: r = 0.83, p < 0.001) and TRAP (ERT: r = 0.34, p < 0.001; SRT: r = 0.88, p < 0.001), irrespective of treatment method. A platelet count increase was associated with a Lyso-Gb1 decrease in both treatment groups (ERT: p = 0.021; SRT: p = 0.028). The association of Lyso-Gb1 with evaluated markers was stronger in the SRT cohort. Our results indicate that ERT and SRT in combination or in a switch manner could offer the potential of individual drug effectiveness for particular GD symptoms. Combination of the key biomarker of GD, Lyso-Gb1, with other biomarkers can offer improved response assessment to long-term therapy.

Immunomodulation with romiplostim as a second-line strategy in primary immune thrombocytopenia: The iROM study.

Thrombopoietin receptor agonists (TPO-RAs) stimulate platelet production, which might restore immunological tolerance in primary immune thrombocytopenia (ITP). The iROM study investigated romiplostim's immunomodulatory effects. Thirteen patients (median age, 31 years) who previously received first-line treatment received romiplostim for 22 weeks, followed by monitoring until week 52. In addition to immunological data, secondary end-points included the sustained remission off-treatment (SROT) rate at 1 year, romiplostim dose, platelet count and bleedings. Scheduled discontinuation of romiplostim and SROT were achieved in six patients with newly diagnosed ITP, whereas the remaining seven patients relapsed. Romiplostim dose titration was lower and platelet count response was stronger in patients with SROT than in relapsed patients. In all patients, regulatory T lymphocyte (Treg) counts increased until study completion and the counts were higher in patients with SROT. Interleukin (IL)-4, IL-9 and IL-17F levels decreased significantly in all patients. FOXP3 (Treg), GATA3 (Th2) mRNA expression and transforming growth factor-β levels increased in patients with SROT. Treatment with romiplostim modulates the immune system and possibly influences ITP prognosis. A rapid increase in platelet counts is likely important for inducing immune tolerance. Better outcomes might be achieved at an early stage of autoimmunity, but clinical studies are needed for confirmation.

The role of T cells and myeloid-derived suppressor cells in refractory immune thrombocytopenia.

Immune thrombocytopenia (ITP) is characterized by a dysregulated immune response against platelets, affecting both their destruction and production. A role for an abnormal T-cell compartment has been established in ITP pathogenesis and treatments that increase platelet counts in patients with ITP have shown improvements in T-cell profiles. On the other hand, patients who were refractory to treatment appear to retain the T-cell abnormalities as before. Myeloid-derived suppressive cells (MDSCs) are also emerging as key contributors to the immune pathology of ITP and response to treatment. In this review, we will discuss how various treatments affect the T-cell and MDSC compartments in ITP. The review will focus on studies that have examined the underlying mechanisms and/or genetic basis responsible for refractoriness to a given treatment and highlight remaining challenges in identifying factors and mechanisms to predict response to treatment.

Red blood cell - Platelet ratio (RPR) and Hemoglobin - Platelet ratio (HPR) in patients with rheumatoid arthritis: a study at Hue University of Medicine and Pharmacy Hospital

ABSTRACT Background: Rheumatoid arthritis (RA) is an autoimmune disease that causes chronic inflammation of the joints, resulting in destruction and deformation of bones and cartilage. In addition to causing joint damage, up to 30 - 70% of RA patients have chronic anemia that reduces quality of life. The inflammatory process affects some red blood cell and platelet indices such as increased platelet count, anemia and hypochromic microcytic cells. Red blood cell - platelet ratio (RPR) and hemoglobin - platelet ratio (HPR) are considered as indicators to help assess inflammation and activity level in patients with RA. This study describes hematological characteristics and the relationship of RPR and HPR indices with inflammation in patients with RA. Methods: The study was conducted on 30 patients with RA at the Department of General Internal Medicine - Endocrinology - Musculoskeletal and a control group of 30 healthy people who came to hospital of Hue University of Medicine and Pharmacy from April 2023 to August 2023. Results: Both RPR and HPR indices in the disease group were statistically significant lower than the control group (p &lt; 0.001). The predictive value of rheumatoid arthritis of RPR and HPR with cutoff points of 0.016 and 0.455 respectively (p &lt; 0.05). The RPR index was strongly positively correlated with HPR (p &lt; 0.001). PLT was strongly negatively correlated with RPR (p &lt; 0.001) and HPR (p &lt; 0.001). Conclusion: The RPR and HPR indices in RA patients were lower than those in controls, and could be one of the indicators to help assess inflammation in patients.

Experience of 2&lt;sup&gt;nd&lt;/sup&gt; line therapy with eltrombopag in patients with immune thrombocytopenia

Background. Immune thrombocytopenia (ITP), or idiopathic thrombocytopenic purpura, is a hematological autoimmune disease characterized by bleeding and an isolated decrease in platelet count &lt;100 × 109 / l. The decision to start treatment for ITP depends on several factors. The ITP treatment strategy is based on the clinical symptoms, with a focus on reducing the risk of severe bleeding and increasing platelet counts. Aim. To evaluate the efficacy of 2nd line therapy with the thrombopoietin receptor agonist eltrombopag in patients with ITP. Materials and methods. 490 patients with ITP are under observation at the center for orphan diseases of M. F. Vladimirskiy Moscow Regional Research Clinical Institute. The present study included 186 patients with primary ITP after 1st line glucocorticosteroid therapy. eltrombopag, a thrombopoietin receptor agonist, was prescribed as the 2nd line of therapy. Results. The median platelet count prior to eltrombopag therapy in all patients was 27.5 × 109 / l. after eltrombopag therapy, a significant (by 490 %) increase in platelet levels (median 135 × 109 / l) and a complete response according to clinical recommendations were noted. Conclusion. Glucocorticosteroids (prednisolone, dexamethasone) remain the drugs of choice for the 1st line of therapy. Treatment with drugs of this group in most cases allows achieving an optimal platelet level and preventing bleeding. In case of inefficiency, intolerance, occurrence of side effects, the appointment of thrombopoietin receptor agonists eltrombopag or romiplostim is recommended. therapy with eltrombopag at a dose of 50 mg daily for several weeks has been able to achieve an increase in platelet levels, correct hemorrhagic syndrome, reduce the number of side effects during first-line glucocorticosteroid therapy, and improve the patient’s quality of life.

Prevalence and pattern of iron deficiency and its correlation with different hematological parameters in a segment of patients coming to a tertiary care hospital in Lahore

Background: Iron is an essential micronutrient, abundantly present in nature. Very low quantities of iron are required in our daily diet to prevent its deficiency. But paradoxically, its deficiency is very common all around the world. In keeping with its wide and varied functions in the body, the deficiency of iron also has multiple manifestations. This study aimed to study the prevalence and pattern of iron deficiency in a segment of our population. The effect on various hematological parameters was also studied.&#x0D; Materials and Methods: Fifty cases including both genders and all ages were included in the study. The parameters analyzed were iron status and hematological indices. The status of serum iron levels was compared with total iron binding capacity (TIBC). Blood examination included total leukocyte count, differential leukocyte count, hemoglobin level, total RBC count, hematocrit, mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), and platelet count. The correlation of serum iron levels with the different hematological indices was analyzed.&#x0D; Results: Iron deficiency was even more prevalent than previously reported (70%). It was seen in both genders and all age groups. Only the elderly male group showed a mean that was in the normal range. Females were affected more severely than males in all age groups. Red cell indices showed expected correlation with serum iron levels. Platelet counts showed an increase with falling iron levels.&#x0D; Discussion: Iron deficiency continues to be rampant despite decades of public health measures to correct it. Iron deficiency anemia impacts multiple body functions with a myriad of health consequences. The ensuing symptoms are those classically related to anemia as well as some that are both unexpected and hard to explain. Increase in platelet count seen in iron deficiency carries the risk of creation of a thrombogenic state. The factors contributing to iron deficiency need to be identified and addressed.&#x0D; Key words: Serum iron levels, Complete Blood Count, iron deficiency, platelet count.

The effects of pathogenic and likely pathogenic variants for inherited hemostasis disorders in 140 214 UK Biobank participants

AbstractRare genetic diseases affect millions, and identifying causal DNA variants is essential for patient care. Therefore, it is imperative to estimate the effect of each independent variant and improve their pathogenicity classification. Our study of 140 214 unrelated UK Biobank (UKB) participants found that each of them carries a median of 7 variants previously reported as pathogenic or likely pathogenic. We focused on 967 diagnostic-grade gene (DGG) variants for rare bleeding, thrombotic, and platelet disorders (BTPDs) observed in 12 367 UKB participants. By association analysis, for a subset of these variants, we estimated effect sizes for platelet count and volume, and odds ratios for bleeding and thrombosis. Variants causal of some autosomal recessive platelet disorders revealed phenotypic consequences in carriers. Loss-of-function variants in MPL, which cause chronic amegakaryocytic thrombocytopenia if biallelic, were unexpectedly associated with increased platelet counts in carriers. We also demonstrated that common variants identified by genome-wide association studies (GWAS) for platelet count or thrombosis risk may influence the penetrance of rare variants in BTPD DGGs on their associated hemostasis disorders. Network-propagation analysis applied to an interactome of 18 410 nodes and 571 917 edges showed that GWAS variants with large effect sizes are enriched in DGGs and their first-order interactors. Finally, we illustrate the modifying effect of polygenic scores for platelet count and thrombosis risk on disease severity in participants carrying rare variants in TUBB1 or PROC and PROS1, respectively. Our findings demonstrate the power of association analyses using large population datasets in improving pathogenicity classifications of rare variants.

A Studying of The Effect of Oxidative Stress Among Patients with Atherosclerosis in Al-Najaf City

The current study sheds light on the effect of oxidative stress on the development of atherosclerosis. Thirty-eight males and twenty-two females with atherosclerosis were chosen as the patient group, whose samples were collected from the "Open-Heart Unit in Al-Sadr Teaching Hospital in Najaf City". Thirty healthy people who do not suffer from vascular disease, hypertension or diabetes, with similar ageing of patients, were selected as a control group. Total antioxidant capacity, Insulin, cholesterol, hemoglobin and platelets were measured in atherosclerosis patients and the control group. The results show a significant increase in full antioxidant capacity, Insulin, cholesterol, haemoglobin and platelets in patients with atherosclerosis compared with the control group; the results also showed a significant increase in hemoglobin and platelet count in males with atherosclerosis compared with females. There is a positive relation between T-AOC and Insulin in atherosclerosis patients, while there is no relationship between T-AOC and both (Hb &amp; PCV) in atherosclerosis patients.

Therapeutic Outcomes of High Dose-Dexamethasone versus Prednisolone + Azathioprine, Rituximab, Eltrombopag, and Romiplostim Strategies in Persistent, Chronic, Refractory, and Relapsed Immune Thrombocytopenia Patients.

Primary immune thrombocytopenia (ITP) is an inflammatory autoimmune disease that can be managed with several treatment options. However, there is a lack of comparative data on the efficacy of these options in different phases of the disease. This study aimed to evaluate the efficacy of high-dose Dexamethasone (HD-DXM), Prednisolone + Azathioprine, Rituximab, Eltrombopag, and Romiplostim schedules in persistent, chronic refractory or relapsed Egyptian ITP patients with a platelet count ≤30 × 109/L. The primary outcome measure was a sustained increase in platelet counts over 50 × 109/L for an additional 12 months without additional ITP regimens. The study also aimed to identify a suitable treatment regimen with a long remission duration for each phase of ITP. Prednisolone + Azathioprine was significantly more effective in achieving an overall response in persistent patients than Romiplostim, high-dose Dexamethasone, and Rituximab. (90.9% vs. 66.6, [Odds ratio, OR: 5; confidence interval, CI 95% (0.866-28.86)], 45%, [OR: 0.082, CI 95% (0.015-0.448)] and, 25%, [OR: 30, CI 95% (4.24-211.8)], respectively, p-value < 0.01). Eltrombopag was significantly more effective in achieving a durable response in refractory ITP than HD-DXM, Rituximab, and Prednisolone; (80% compared to 32.2% [OR: 0.119, CI 95% (0.035-0.410)], 22.2% [OR:0.071, CI 95% (0.011-0.455)], and 18.1% [OR: 0.056, CI 95% (0.009-0.342)], respectively, p-value < 0.01). Finally, Eltrombopag following HD-DXM showed the highest percentage of patients with complete treatment-free survival times of at least 330 days. These findings could help clinicians choose the most appropriate treatment for their patients with ITP based on the phase of the disease. This trial is registered in clinicaltrials.gov with registration number NCT05861297.

Transient increase in platelet counts associated with COVID-19 infection during TPO-RA as the second-line treatment in children with ITP.

The thrombopoietin receptor agonists (TPO-RA) were recommended for primary immune thrombocytopenia (ITP) during the pandemic of COVID-19. However, the incidence of thrombocytosis and thrombosis was sporadically reported in the chronic immune thrombocytopenia (CITP) patients receiving TPO-RA during the COVID-19 infection. With the local prevalence of COVID-19 in December 2022 in the Beijing area, we got more powerful evidence about the change in platelet (Plt) counts associated with COVID-19 infection. A single-centre observational cohort study was performed from the beginning of December 2022 to the end of February 2023 to enrol CITP children treated with TPO-RA alone as the second-line treatment and suffering from the COVID-19 infection in December 2022. The Plt counts before, during and after COVID-19 infection were collected. In total, 67 (34 males and 33 females) patients with 8.10 (2.15, 15.70) years of age were enrolled. Sixty-three patients who had responded to the TPO-RA showed a transient increase in Plt counts after the infection of COVID-19. The time of starting to increase was on Day 3 (2, 7), and to the peak level on Day 14 (7, 19) of infection with the peak Plt count was 289 (88, 1974) × 109 /L. With at least 2 months observation period from COVID-19 infection, the Plt counts of 100% (63/63) patients declined to the baseline on Day 25 (14, 41). The phenomenon of transient increase in Plt counts has been shown in the CITP children who responded to TPO-RA when suffering from COVID-19 infection.

Safety and effectiveness of lusutrombopag in patients who have chronic liver disease with thrombocytopenia and undergoing invasive procedures: Real-world post-marketing surveillance in Japan.

Lustrombopag has been approved for the treatment of thrombocytopenia in patients with chronic liver diseases (CLD) who are scheduled to undergo an invasive procedure. Here we report the final results of a post-marketing surveillance assessing the safety and effectiveness of lusutrombopag in Japan. This multicenter, prospective, real-world surveillance collected data from case report forms between October 2016 and May 2021. The observation period was 2 months after the first day of lusutrombopag treatment. Safety and effectiveness (proportion of patients avoiding preoperative platelet transfusion and responders who achieved platelet count increase from baseline) were assessed. The safety analysis set included 1033 (100.0%), 130 (12.6%), and 14 (1.4%) patients received ≥1, ≥2, and ≥3 treatment cycle(s), and 482 (48.9%), 457 (46.3%), and 43 (4.4%) patients were Child-Pugh (CP) class A, B, and C, respectively. The most common serious adverse drug reactions (ADRs) were portal vein thrombosis (PVT), pancytopenia, and white blood cell count decreased, reported in 14 (1.36%), 3 (0.29%), and 2 (0.19%) patients, respectively. The incidence of ADRs was not higher in patients with CP class C or those undergoing retreatment cycles compared with other CP classes or the first treatment cycle, respectively. During the observation period of the first treatment cycle, 94.7% (889/939) of patients avoided preoperative platelet transfusion and 82.8% (741/895) of the patients met the responder criteria. This surveillance further supports the safety and effectiveness of lusutrombopag in a broad range of patients with CLD undergoing planned invasive procedures. This article is protected by copyright. All rights reserved.