Normal Platelet Count Group Research Articles

Thrombocytopenia and In-hospital outcomes in patients with acute ischemic stroke undergoing intravenous thrombolysis: Findings from a nationwide registry study in China

Background and ObjectiveOur study aimed to evaluate the associations between platelet count (PC) and in-hospital outcomes for patients with stroke after rt-PA intravenous thrombolysis. MethodsWe identified patients who had been hospitalized with a primary diagnosis of stroke and had received rt-PA intravenous thrombolysis from June 2015 to July 2019 at participating hospitals in the Chinese Stroke Center Alliance. PC measured before intravenous thrombolysis was categorized into the following four groups: severe thrombocytopenia (PC < 100 × 109/L), mild thrombocytopenia (100 ≤ PC < 150 × 109/L), normal PC (150 ≤ PC ≤ 450 × 109/L), and thrombocythemia (PC > 450 × 109/L). Outcomes were determined from clinical data collected during hospitalization. The primary clinical outcome was symptomatic intracranial hemorrhage (sICH). Secondary outcomes were mortality, bleeding events, gastrointestinal (GI) hemorrhage, and in-hospital stroke recurrence. We used multivariate logistic regression models to evaluate the associations between PC and outcomes. ResultsWe included 44,882 individuals with a median age of 66 years, of whom 34.7 % were female, 951 (2.1 %) had severe thrombocytopenia, 7218 (16.1 %) had mild thrombocytopenia, 36,522 (81.4 %) had a normal PC, and 191 (0.4 %) had thrombocythemia. Both severe and mild thrombocytopenia groups had higher risks of bleeding events (adjusted OR 1.30; 95 % CI,1.01-1.67; p = 0.045; adjusted OR 1.32; 95 % CI,1.19-1.46; p < 0.001) and sICH (adjusted OR 1.48;95 % CI,1.13-1.94; p = 0.005; adjusted OR 1.43;95 % CI,1.27-1.60; p < 0.001) than the normal PC group. Patients with 100 ≤ PC < 150 × 109/L also had a higher risk of in-hospital stroke recurrence (adjusted OR 1.12; 95 % CI,1.02-1.22; p = 0.02). ConclusionsIntravenous thrombolysis brings a high risk of sICH given PC < 150 × 109/L, especially PC < 100 × 109/L. It indicated that PC < 100 × 109/L is a reasonable contraindication to thrombolysis.

Effect of Baseline Thrombocytopenia on Long-Term Outcomes in Patients With Acute ST-Segment Elevated Myocardial Infarction - A Large Propensity Score-Matching Analysis From the China Acute Myocardial Infarction (CAMI) Registry.

Data on the association of baseline thrombocytopenia (TP) with long-term outcomes of patients with acute ST-segment elevated myocardial infarction (STEMI) are still limited. A total of 16,957 consecutive cases of patients with STEMI from multiple centers that participated in the China Acute Myocardial Infarction (CAMI) registry were included in this study. Two-year clinical outcomes were evaluated between patients with TP and those with a normal platelet count (PLT). Cases coexisting with baseline TP accounted for 2.1%. The rates of 2-year all-cause death (21.4% and 11.4%, P<0.001) and major adverse cardiovascular and cerebrovascular events (MACCE) (23.6% and 13.9%, P<0.001) were significantly higher in cases with TP, compared with the normal PLT group. After multivariate adjustment, compared with the control, cases with TP were not independently associated with 2-year all-cause death (HR: 1.21; 95% CI: 0.96-1.52; P=0.110) and MACCE (HR: 1.18; 95% CI: 0.95-1.47; P=0.132). After propensity score matching (PSM), the rates of 2-year all-cause death and MACCE were similar between the 2 groups (20.7% and 17.9%, P=0.317; 23.0% and 19.9%, P=0.288). Multivariable adjustment after PSM showed baseline TP was not independently associated with all-cause death (HR: 1.21; 95% CI: 0.88-1.67; P=0.240) and MACCE (HR: 1.21; 95% CI: 0.89-1.63; P=0.226). Patients with STEMI and baseline TP had higher rates of all-cause death and MACCE; however, baseline TP was not independently associated with 2-year adverse outcomes in patients with STEMI after multivariate adjustment and controlling for baseline differences.

Clinical features and prognosis of children with acute lymphoblastic leukemia and different platelet levels

To study the association of platelet level at diagnosis with prognosis in children with acute lymphoblastic leukemia (ALL). A total of 892 children with ALL who underwent chemotherapy with the CCLG-ALL 2008 regimen were enrolled. According to the platelet count at diagnosis, these children were divided into normal platelet count group (platelet count ≥100×109/L; n=263) and thrombocytopenia group (platelet count <100×109/L; n=629). The thrombocytopenia group was further divided into (50- <100)×109/L (n=243), (20- <50)×109/L (n=263), and <20×109/L (n=123) subgroups. The association of clinical features (sex, age, immunophenotype, and molecular biology) with event-free survival (EFS) and overall survival (OS) was analyzed. Compared with the thrombocytopenia group, the normal platelet count group had significantly lower positive rate of MLL gene rearrangement and recurrence rate (P<0.05), as well as a significantly higher 10-year EFS rate (P<0.05). There was no significant difference in 10-year OS between the two groups (P>0.05). The normal platelet count group still had a significantly higher 10-year EFS rate than the thrombocytopenia group after the children with MLL gene rearrangement were excluded (P<0.05), and there was still no significant difference in 10-year OS between the two groups (P>0.05). The <20×109/L subgroup had significantly lower 10-year EFS and OS rates than the normal platelet count group, the (50- <100)×109/L subgroup, and the (20- <50)×109/L subgroup (P<0.05). After the children with MLL gene rearrangement were excluded, the <20×109/L subgroup still had significantly lower 10-year EFS and OS rates than the normal platelet count group, the (50-<100)×109/L subgroup, and the (20- <50)×109/L subgroup (P<0.05). ALL children with MLL gene rearrangement often have the clinical manifestation of thrombocytopenia. Platelet level at diagnosis is associated with the prognosis of ALL children. The children with normal platelet count have a low recurrence rate and good prognosis, and those with a platelet count of <20×109/L have the worst prognosis.

Successful Management of Pregnancy with Severe Von Willebrand Disease in a Jehovah's Witness with Recombinant Von Willebrand Factor

Background: Von Willebrand disease (vWD) is the most common inherited bleeding disorder with a reported prevalence of 1% in epidemiological studies and symptomatic prevalence of 1 in 10,000.Pregnancy in vWD is associated with increased bleeding risk particularly postpartum hemorrhage. Treatment options include desmopressin acetate (DDAVP), plasma derived factor concentrates and antifibrinolytic agents. Human Recombinant von Willebrand factor (vWF) (Vonvendi®) has been approved in the United States for on demand treatment and perioperative management of adults with vWD. It has been shown to maintain sustained levels of VWF activity but requires co-administration with FVIII to achieve adequate FVIII levels. Recombinant VWF is an option for patients who refuse blood for religious reasons.Case: Here we describe a 39 year old patient in her third pregnancy who is a Jehovah's Witness. Consent was obtained from the patient for this report. She was initially diagnosed with von Willebrand's disease at the age of six, when she had hematuria. At the age of 11, with menarche, she had significant menorrhagia resulting in symptomatic anemia, a reduction in her hemoglobin concentration to 44 g/L, requiring uterine artery embolization. She was placed on an oral contraceptive pill for menorrhagia. She used DDAVP for trauma induced injury. Her first pregnancy resulted in spontaneous abortion. She required a D&C and DDAVP was used. Prior to delivery of the second pregnancy DDAVP was used but she had postpartum hemorrhage, requiring additional dosing of DDAVP and uterine artery embolization.In the current pregnancy, aPTT was 36.4 seconds with normal PT and platelet count and blood group O. At 15 weeks' gestational age, VWF antigen (ACL TOP 700 -IL HemosIL) was 0.11 units/ml (normal range for blood group O 0.45-1.5 unit/ml), ristocetin cofactor (ACL TOP 700 -IL HemosIL), 0.09 units/ml (normal range 0.48-2.0 units/ml for blood group O), and FVIII level (Sysmex CS5100 -Dade Actin FS) 0.09 units/ml (normal range 0.58-1.9 units/ml). Factor levels at 23 weeks' gestation 1 hour following DDAVP were FVIII 1.05 units/ml, VWF antigen 0.5 units/ mL, and ristocetin cofactor 0.52 units/ml. She was willing to accept recombinant factor concentrates only.Results: She had an elective admission for induction of labor at 37 weeks but proceeded to Cesarean Section due to non-progression of labor. Her PTT on admission was 40 seconds with VWF antigen of 0.11 units/ml, VWF activity < 0.07 units/ml and FVIII 0.13 units/ml. The Table describes her levels following the administration of recombinant vWF. She was administered Vonvendi® on a planned dose of 40 IU/kg Xynta® and rFVIII 30 IU/kg to increase factor levels to more than 50%; 60-min following infusions vWF : RCo was 0.64 U/ml with FVIII 0.79 U/ml. The Cesarean section was performed under spinal anesthesia without complications. Tranexamic acid was used intravenously before the delivery of the neonate and continued for first two days and then changed to oral dose.Target levels were achieved over the 5 days after delivery with the current regimen. She experienced a transient hypersensitivity reaction with urticaria and dyspepsia after the third dose of Vonvendi®. She did not have significant bleeding. Her hemoglobin concentration remained stable at 120 g/L throughout her inpatient stay.The neonate did not have bleeding with delivery but was found to have VWF antigen of 0.11 U /ml, VWF activity of 0.07 U/ml and FVIII of 0.16 U/ml. Genetic analysis of the mutation associated with her vWD is in progress.Conclusion: The use of rvWF and rVIII resulted in adequate hemostasis peripartum. Further prospective data are required to reaffirm the safety and dosing of rvWF for peripartum management of patients with vWD who require intervention. DisclosuresKazi:Shire: Other: Vonvendi was provided by Shire.

Prognostic efficacy of platelet count in patients with nonvalvular atrial fibrillation

The prognostic efficacy of quantitative platelet activity in atrial fibrillation (AF) remains unclear. The purpose of this study was to evaluate the platelet count (PLT) as a prognostic indicator in patients with nonvalvular AF. Data on 10,978 patients with nonvalvular AF were retrieved from a prospective registry of a single medical center in Korea. Cumulative risk for stroke and bleeding events were compared between patients with normal PLT (n = 8322), mild thrombocytopenia (n = 1791), and moderate to severe thrombocytopenia (n = 865) after propensity score matching. Prediction models for stroke were derived by conventional risk factors (model 1) and by combining PLT with model 1 (model 2), and model performance was assessed by area under the receiver operator characteristics curve (AUC). During the follow-up period, 7.3%, 7.0%, and 4.5% had stroke and 7.6%, 10.8%, and 17.2% had bleeding events in the normal PLT, mild, and moderate to severe thrombocytopenia groups, respectively. Compared to the normal PLT group, the moderate to severe thrombocytopenia group showed a lower risk of stroke (hazard ratio [HR] 0.57; 95% confidence interval [CI] 0.40-0.80; P = .002). A reverse relationship was found between PLT and bleeding risk (moderate to severe thrombocytopenia: HR 2.19; 95% CI 1.77-2.70; P <.001; mild thrombocytopenia: HR 1.43; 95% CI 1.18-1.73; P <.001). Compared to model 1, model 2 showed significant improvement in risk prediction (AUC 0.628 vs 0.644; P <.001). A lower PLT was associated with a lower risk of stroke and a higher risk of bleeding events. PLT combined with conventional risk factors showed significant improvement in prediction for stroke.

Thrombocytosis as a prognostic factor in patients with renal cell carcinoma: a meta-analysis of literature.

The aim of this study was to analyze the prognostic implications of perioperative thrombocytosis in patients with renal cell carcinoma (RCC). We conducted search on two medical databases, PubMed and EMBASE, to identify all studies. A meta-analysis was performed to clarify the prognostic role of thrombocytosis. Twelve studies (N = 8735) were included which evaluated the relation of thrombocytosis and 5-year overall survival (OS) or cancer-specific survival (CSS). One thousand and fifty-nine (12.1%) of the 8735 patients exhibited thrombocytosis, and for OS, their estimated risk of death in 5 years was 1.61-fold higher compared with the normal platelet count group [(RR = 1.61, 95% CI = (1.31-1.98), P < 0.001)]. While for CSS, the mortality was 2.56-fold higher [(RR = 2.56, 95% CI = (1.73-3.80), P < 0.00001). According to subgroup analyses, significant positive influence of thrombocytosis on 5-year OS and CSS was displayed only in patients with localized RCC and was also found in patients originated from different areas, such as Asian, Europe or North American. Thrombocytosis indicates worse OS and CSS for patients with RCC, and it showed stronger specificity or sensitivity for CSS. Thrombocytosis is more frequently in patients with metastatic RCC but only showed significant influence on survival of localized RCC patients.

Remarkable efficacy of tocilizumab for treating rheumatoid arthritis in patients with high platelet counts

Objectives. To optimize the efficacy of treatment with tocilizumab for rheumatoid arthritis (RA), we comparatively analyzed the outcome of tocilizumab treatment in patients with normal background changes associated closely with IL-6.Patients and Methods. The study involved 87 patients with RA satisfying the diagnostic criteria of the American College of Rheumatology (ACR) and receiving continuous tocilizumab treatment for 24 weeks or longer. The outcome of tocilizumab treatment in these patients was comparatively analyzed in relation to the baseline platelet count (the high platelet count group and the normal group), pretreatment hemoglobin levels (the low group and the normal platelet count group), and speed of bone destruction (the rapid progression group and slow progression group).Results. Treatment with tocilizumab significantly improved the 28-joint disease activity score using the erythrocyte sedimentation rate (DAS28-ESR) and Clinical Disease Activity Index (CDAI), regardless of baseline platelet count, hemoglobin level, or annual speed of bone destruction (ΔTSS). The margins of improvement in DAS28-ESR and CDAI did not differ depending on baseline hemoglobin level or ΔTSS, but the improvement was significantly greater in the high platelet count group than in the normal platelet count group.Conclusions. These results suggest that in patients with high platelet count, IL-6 is a more important factor involved in RA pathogenesis and that tocilizumab is suitable as a first-line biologic for the treatment of RA patients with high platelet count.

Estimating platelet production in patients with HIV‐related thrombocytopenia using the immature platelet fraction

Thrombocytopenia is common in patients with HIV infection. However, given the number of potential etiologies of low-platelet counts in this patient population, it is often difficult to determine the underlying cause. The immature platelet fraction (IPF) measures the number of reticulated platelets in peripheral blood and can be used to help determine if thrombocytopenia is secondary to low-platelet production or increased platelet turnover. We studied the performance characteristics of the IPF% in 50 inpatients with HIV-related thrombocytopenia and compared the results with 34 inpatients with HIV and normal platelet counts. The mean IPF% in the HIV thrombocytopenic group was 10.2% as compared with 6.8% in the HIV normal platelet count group (P = 0.001) and 3.1% in historical non-HIV controls (P < 0.001). In multivariate analyses, the presence of ITP, active infection, log CD4 count, platelet count, and diabetes mellitus were significantly associated with a higher IPF%. These findings suggest that increased platelet turnover plays an important role in the pathogenesis of HIV thrombocytopenia. Platelet turnover is also increased in patients with HIV in general, even when overt thrombocytopenia is absent.

Clinical Significance of Platelet Count in Patients with Renal Cell Carcinoma

Introduction: During the last decades numerous prognostic factors have been studied for predicting survival of renal cell carcinoma (RCC). Platelet count has previously been reported to correlate with prognosis in RCC. The aim of the this study was to evaluate the significance of thrombocytosis in determining prognosis in patients with localized RCC who underwent radical nephrectomy. Patients and Methods: The study included 118 consecutive patients. Patients were divided into a normal platelet count group (group 1) and a thrombocytosis group (group 2) according to the preoperative platelet count. Thrombocytosis was defined as a platelet count greater than 400,000/µl. The data about stage distribution, grade, tumor size, histological subtype, hemoglobin level, Body Mass Index (BMI), age, ECOG score, gender, and survival rate of tumors between these two groups were compared. Survival estimates were compared with the Kaplan-Meier method and multivariate analysis was performed using a Cox model. Results: The mean age of the patients was 61.4 years (range 30–78), and the mean follow-up period was 52.7 ± 19.6 months (range 9–96). Thrombocytosis was present in 23 patients (19.49%). Fourteen (60.86%) of 23 patients with thrombocytosis died of disease progression. Patients with thrombocytosis had a worse prognosis than patients without thrombocytosis (p = 0.001). Thrombocytosis was noted in 8 (10.81%) of 74 patients with stage pT1-pT2 disease and in 15 (34.09%) of 44 patients with stage pT3-pT4 disease (p = 0.004). In univariate analysis, platelet count was correlated with T stage, hemoglobin level, lymph node positivity, ECOG score, and tumor size. Controlling for established prognostic indicators of pathologic stage, tumor size, platelet count, and lymph positivity using Cox’s regression test, the difference in survival between the groups remained significant (p < 0.05). Conclusion: The platelet count can be considered a useful prognostic factor in patients with RCC who undergo radical nephrectomy.

Prognosis Associated with Thrombocytosis in Renal Cell Carcinoma

Purpose: Thrombocytosis has been reported in many types of malignancies and it has been studied as a prognostic factor. To better define the relationship between the platelet count and survival, we performed a retrospective analysis of patients with thrombocytosis and renal cell carcinoma, and some of whom had a lower survival rate than those with a normal platelet count. Materials and Methods: We reviewed the medical records of patients with renal cell carcinoma and who had undergone radical nephrectomy between January, 1995 and December, 2004. A total of 112 patients were treated by radical nephrectomy for renal cell carcinoma. Among them, 67 patients without primary thrombocytosis, no familial history of renal cell carcinoma and no history of adjuvant therapy were enrolled in this study. The patients were divided into a normal platelet count group and a thrombocytosis group (greater than 400,000/μl) according to the perioperative platelet count. The two groups were compared pathologically and clinically, including comparing the prognosis. Results: The mean follow-up was 55.8 months (range: 21 to 80). Thrombocytosis was present in 19 patients. The mean survival for the normal platelet count group was 67.8±39.36 months, compared with 41.4±30.65 months for the thrombocytosis group (p＜0.05). The difference of survival between the 2 groups remained significant when controlling for the established prognostic indicators like the pathological stage, nuclear grade and cell types. Conclusions: This study documents the association of thrombocytosis with decreased survival in patients with renal cell carcinoma. The peri-operative platelet count appears to be a significant independent predictor for determining the prognosis for patients with renal cell carcinoma. (Korean J Urol

Prognostic significance of thrombocytosis in renal cell carcinoma patients.

Thrombocytosis has been reported in many types of malignancies and has been studied as a prognostic factor. In the present study, we examined the incidence of thrombocytosis in patients with renal cell carcinoma (RCC) in order to evaluate the prognostic value of thrombocytosis. One hundred and ninety-six patients treated by radical nephrectomy for RCC were enrolled in this study. We divided the patients into a normal platelet count group and a thrombocytosis group according to the presurgical platelet count. The two groups were compared pathologically and clinically, including prognosis. Thrombocytosis was present in 16 patients (8.2%). Platelet counts had normalized after nephrectomy in all patients with thrombocytosis. There was no correlation between histological type or grade and thrombocytosis. However, there were correlations between thrombocytosis and tumor size and tumor stage. Patients with thrombocytosis had a worse prognosis than patients without thrombocytosis (P = 0.0028). When adjusted for stage or tumor size, the correlation was limited to low stage (stage 1 + 2: P = 0.0041, stage 3 + 4: P = 0.2983) or small tumors (tumor size: </=4 cm, P = 0.0021; 4-7 cm, P = 0.0142; >7 cm, P = 0.8158). Thrombocytosis is an inexpensive and easy tool with which to evaluate the prognosis of RCC patients in daily medical practice.

Effects of biological variations on platelet count in healthy subjects in China.

The effects of biological variations on platelet counts were investigated in 694 healthy subjects aged 18 to 60 years living in three cities including Chengdu (Sichuan Province), Suzhou (Jiangsu Province) and Harbin (Heilongjang Province) in China. Platelet counts in healthy subjects were significantly lower in Chengdu (52-202 x 10(9)/L) and Suzhou (60-259 x 10(9)/L) than in Harbin (154-348 x 10(9)/L) (p <0.0001), but the mean platelet volume (MPV) determined concurrently was negatively correlated with platelet count, the MPV values were significantly higher in Chengdu (11.8-15.6 fl) and Suzhou (10.9-15.8 fl) than in Harbin (9.5 approximately 12.9 fl) (p < 0.0001). Platelet counts were significantly higher in summer (73-289 x 10(9)/L) than in winter (52-202 x 10(9)/L) (p <0.0001), but the MPV values were lower in summer (11.2-14.7 fl) than in winter (11.8-15.6 fl) (p <0.05) in Chengdu. Platelet associated immunoglobulin (PA-IgG) in Chengdu was revealed to be significantly higher in the low platelet count group (<150 x 10(9)/L, 13.5 +/- 7.1 ng/10(7) PLT) than in the normal platelet count group (> or =150 x 10(9)/L, 8.3 +/- 2.7 ng/10(7) PLT) (p <0.0001). Similar results were observed in Suzhou for the reticulated platelet ratio, which was significantly higher in the low platelet count group (19.5 +/- 7.1%) than in the normal platelet count group (11.6 +/- 2.7%) (p <0.01). The bleeding time in Chengdu showed a significantly longer time in the low platelet count group (8.6 +/- 2.3 min) than in the normal platelet count group (6.0 +/- 1.2 min)(p <0.01). With regard to the effects of lipids on platelet counts, the HDL values were significantly higher in the normal platelet count group (1.60 +/- 0.76 mmol/L) than the low platelet count group (1.23 +/- 0.31 mmol/L) (p <0.01); but no significant differences in cholesterol and triglycerides values between the normal and low platelet count groups (p >0.05) were recorded. These findings suggest that the platelet counts could be greatly influenced in healthy subjects by biological variations such as geographical, seasonal, and lipid variations.

Thrombopoietin concentrations are low in patients with cirrhosis and thrombocytopenia and are restored after orthotopic liver transplantation

BACKGROUNDThrombocytopenia in cirrhotic patients may be due to deficient production of thrombopoietin.AIMSTo determine the relation between thrombopoietin and thrombocytopenia in cirrhotic patients before and after orthotopic liver transplantation.METHODSThrombopoietin concentrations and...