Abnormal Platelet Research Articles

Roles of ROCK/Myosin Pathway in Macrothrombocytopenia in Bernard-Soulier Syndrome.

Megakaryocytes (MK) from Bernard-Soulier syndrome (BSS) induced pluripotent stem cells (iPSCs) yielded reduced numbers but increased sizes of platelets. The molecular mechanisms remain unclear. This study aims to determine roles of signaling molecules involved in this process. Wild-type (WT) iPSCs and iPSCs from BSS patients with GP1BA (BSS-A) or GP1BB (BSS-B) mutations were differentiated into MKs and platelets with or without myosin II inhibitor (blebbistatin), ROCK inhibitor (Y27632), and procaspase-3 activator (PAC-1). Proplatelet and platelet numbers and sizes were characterized. The iPSC lines containing tubulin-green fluorescent protein (GFP) reporters were constructed to observe proplatelet formation under time-lapse microscopy. BSS-derived MKs (BSS-MKs) yielded fewer but larger platelets compared with the WT. In the presence of blebbistatin, ROCK inhibitor, or PAC-1, WT, BSS-A, and BSS-B MKs could generate more platelets with decreased sizes, but PAC-1 caused CD42 loss on WT platelets. The proportions of proplatelet formation from MKs carrying tubulin-GFP were not different between WT and BSS-MKs, as well as among inhibitors. Notably, initially thick cytoplasmic processes were transformed into thin branching proplatelets over the observation time. The proplatelet shafts of BSS-MK became thinner in the presence of blebbistatin or ROCK inhibitor, but not of PAC-1, which displayed uneven F-actin distribution. Inhibition of the ROCK/myosin pathway, downstream of GpIb, could restore normal morphology of proplatelets in BSS-MKs. Procaspase-3 activation could increase platelet yields, but with abnormal proplatelet and platelet structures. Our model can be used for therapeutic drug screening and a disease model for platelet production in the future.

Biphasic Effect of Thyroid Hormone on Megakaryopoiesis and Platelet Production.

Background: Abnormal platelet counts are frequently observed in patients with thyroid dysfunction; however, the direct impact of thyroid hormones on thrombopoiesis remains largely undefined. Methods: This study elucidates the dose-response effect of the thyroid hormone triiodothyronine (T3) on megakaryocyte (MK) development and thrombopoiesis using both a murine model of hyperthyroidism/hypothyroidism and in vitro cultures of human cord blood CD34+ cell-derived MKs. After the application of inhibitors to MKs, the examination of total and phosphorylated protein levels of the phosphoinositide 3-kinase (PI3K)/AKT pathway was utilized to assess the specific mechanisms of T3 action. The use of autophagy dual-staining lentivirus and transmission electron microscopy was employed to evaluate the impact of T3 on the autophagy flux in MKs. Mouse whole-body irradiation and bone marrow transplantation models are applied to assess the influence of T3 on the recovery of MKs/platelets invivo. Results: We found that physiological or slightly elevated thyroid hormone levels are essential for sustaining MK development and thrombopoiesis, primarily through the TRα-PI3K/AKT signaling pathway. In contrast, supraphysiological thyroid hormone concentrations induce MK apoptosis via excessive autophagy, thereby reducing platelet production. Conclusions: Here, we present evidence that the thyroid hormone influences MK development and platelet production in a concentration-dependent manner, exhibiting a dualistic role. Our discoveries shed new light on the intricate relationship between thyroid hormones and platelet formation, offering novel perspectives on the pathophysiological consequences of thyroid disorders.

Comparing the coagulation and platelet parameters of womenwith premature ovarian insufficiency with those of age-matched controls: A case-control study.

This study aimed to compare the coagulation and platelet parameters in women with spontaneous premature ovarian insufficiency (POI) with those in age-matched controls. This case-control study recruited 202 women with POI and 202 age-matched women with benign gynecological diseases as controls. Coagulation parameters, including prothrombin time (PT), international normalized ratio (INR), activated partial thromboplastin time (APTT), and thrombin time (TT), fibrinogen, and platelet parameters, including platelet count (PLT), mean platelet volume (MPV), plateletcrit (PCT), and platelet distribution width (PDW), were compared between women with POI and controls. Factors associated with coagulation and platelet parameters were also analyzed in women with POI. In women with POI, higher fibrinogen levels and PDW, lower PLT, MPV, and PCT levels, and shorter TT were observed (p < 0.001). Linear regression analysis further revealed that women with POI were more likely to exhibit increased serum fibrinogen levels (β = 0.465, 95% confidence interval [CI] 0.366-0.564) and PDW (β = 0.340, 95% CI 0.300-0.379), decreased TT (β = -1.101, 95% CI -1.233--0.969), PLT (β = -50.985, 95% CI -65.087--36.882), MPV (β = -1.498, 95% CI -1.875 to -1.120), PCT levels (β = -0.084, 95% CI -0.095--0.973). Additionally, follicle-stimulating hormone levels were positively associated with fibrinogen levels in women with POI. There were no statistically significant differences in PT, INR, and APTT between women with POI and controls. Women with POI exhibited decreased platelet numbers, abnormal platelet morphology, and elevated fibrinogen concentrations, potentially implicating POI's etiopathogenesis or contributing to an increased risk of cardiovascular disease in women with POI. No coagulation abnormalities were observed in women with POI.

Severity prediction markers in dengue: a prospective cohort study using machine learning approach

Background Dengue virus causes illnesses with or without warning indicators for severe complications. There are no clear prognostic signs linked to the disease outcomes. Methods Clinical and laboratory parameters among 102 adult including 17 severe dengue (SD), 33 with warning and 52 without warning signs during early and critical phases were analysed by statistical and machine learning (ML) models. Results In classical statistics, abnormal ultrasound findings, platelet count and low lymphocytes were significantly linked with SD during the febrile phase, while low creatinine, high sodium and elevated AST/ALT during the critical phase. ML models highlighted AST/ALT and lymphocytes as key markers for distinguishing SD from non-severe dengue, aiding clinical decisions. Conclusion Parameters like liver enzymes, platelet counts and USG findings were linked with SD.USG testing at an earlier phase of dengue and a point-of-care system for the quantification of AST/ALT levels may lead to an early prediction of SD.

Ginsenoside Rg1 Prevents and Treats Acute Pulmonary Injury Induced by High-Altitude Hypoxia.

This study aimed to investigate the protective effects of ginsenoside Rg1 on high-altitude hypoxia-induced acute lung injury (ALI) and elucidated its molecular targets and related pathways, specifically its association with the fluid shear stress pathway. Using a combination of bioinformatics analysis and both in vivo and in vitro experiments, we assessed the role of ginsenoside Rg1 in mitigating physiological and biochemical disturbances induced by hypoxia. In the in vivo experiments, we measured arterial blood gas parameters, levels of inflammatory cells and cytokines, erythrocyte and platelet parameters, and conducted histological analysis in rats. The in vitro experiments utilized human pulmonary microvascular endothelial cells (HPMECs) and A549 cells to examine cell viability, intracellular reactive oxygen species (ROS) and Ca2⁺ levels, and mitochondrial function. The results of the in vivo experiments demonstrate that ginsenoside Rg1 significantly increased arterial blood oxygen partial pressure and saturation, elevated arterial blood glucose levels, and stabilized respiratory and metabolic functions in rats. It also reduced inflammatory cells and cytokines, such as tumor necrosis factor-α and interleukin-6, and improved erythrocyte and platelet abnormalities, supporting its protective role through the regulation of the fluid shear stress pathway. Histological and ultrastructural analyses revealed that Rg1 significantly protected lung tissue structure and organelles. In vitro experiments further confirmed that Rg1 improved cell viability in HPMEC and A549 cells under hypoxic conditions, decreased intracellular ROS and Ca2⁺ levels, and enhanced mitochondrial function. These findings collectively demonstrate that ginsenoside Rg1 exerts significant protective effects against high-altitude hypoxia-induced ALI by enhancing oxygen delivery and utilization, reducing inflammatory responses, and maintaining cellular metabolism and vascular function. Notably, the protective effects of Rg1 are closely associated with the regulation of the fluid shear stress pathway, suggesting its potential for treating high-altitude hypoxia-related diseases.

Efficacy of Uterine Artery Doppler Changes, Platelet Indices and Combination of Both in Prediction of Preeclampsia in Pregnant Women: A Prospective Observational Study

Introduction: Preeclampsia is a pregnancy-specific medical disorder characterised by an abnormal vascular response to placentation. Uterine artery Doppler ultrasound has emerged as a predictive tool in preeclampsia. Abnormal Doppler waveforms have been associated with impaired placental perfusion and an increased risk of developing preeclampsia. Preeclampsia is associated with alterations in platelet function and activation. The estimation of platelet indices is an easy and economical method for screening preeclampsia. Abnormal uterine artery Doppler findings and abnormal platelet indices are both related to the etiological pathways of preeclampsia. Aim: To compare the efficacy of uterine artery Doppler changes, platelet indices alone and their combination in predicting preeclampsia among pregnant women. Materials and Methods: This was a prospective observational study conducted Department of Obstetrics and Gynaecology, Gandhi Hospital in Secunderabad, Telangana, India, over 18 months, including 160 pregnant women aged 18-35 years with singleton pregnancies between 20-24 weeks of gestational age. Doppler ultrasound and platelet indices were measured and patients were followed-up until delivery for the development of preeclampsia. Receiver Operating Characteristic (ROC) curves were constructed and sensitivity, specificity and accuracy were determined to predict preeclampsia. Results: The mean age of the study population was 25.9±4.04 years. The sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV) and accuracy of platelet indices in predicting preeclampsia alone were 67.71%, 59.38%, 71.43%, 55.07% and 64.38%, respectively. The sensitivity, specificity, PPV, NPV and accuracy of the uterine artery Doppler indices in predicting preeclampsia alone were 77.08%, 68.75%, 78.72%, 66.67% and 73.75%. The combined assessment of uterine artery Doppler study and platelet indices in the prognostication of preeclampsia had a sensitivity of 85.42%, specificity of 82.81%, PPV of 88.17% and NPV of 79.10%, with improved accuracy of 84.38%. Conclusion: A combination of uterine artery Doppler ultrasound with platelet indices is easy to use, affordable, readily available in clinical settings and more effective in predicting preeclampsia than when used individually.

The Effect of Ketogenic Diet on Platelet Function in Children with Drug-Resistant Epilepsy

Abstract Background The ketogenic diet (KD) is a high-fat, adequate-protein, low-carbohydrate diet. As a special diet, the KD provides daily nutritional needs for children while controlling seizure and thus decreases the use of antiepileptic drugs. Several studies have reported pathological coagulation parameters and platelet abnormalities in patients treated with various antiseizure drugs (ASDs), especially for Valproic acid (VPA). The KD is frequently used in combination with antiepileptic drugs (AEDs), which may increase the risk of bleeding tendency, particularly with concomitant use of VPA or Topiramate. Objective To assess platelet count and function at baseline and six months after starting the KD in children with drug resistant epilepsy (DRE). Methods This prospective cohort study was conducted on 25 DRE children treated with KD for 6 months with age range of 4 months -14 years in the Children ‘s Hospital, Ain Shams University, Cairo, Egypt. They were assessed for anthropometric measurements, detailed medical history, history of bleeding symptoms, complete physical examination, neurological examination, and laboratory assessments as Complete Blood Count (CBC) and platelet function by ADP level at start and after 6 months of ketogenic diet treatment. Results There is no statistically significant change between platelet count and function initially and after 6 months of KD treatment, most of the patients (44%) were maintained on combination of Valproic acid and Levetiracetam and (40%) were maintained on triple therapy Valproic acid, Levetiracetam and Topiramate. Conclusion KD is an effective, safe, and tolerable therapy for children with DRE. No excessive bruising or other bleeding events were observed in any studied patient on KD.

Therapeutic Efficacy of Wet Cupping on Uterine Inflammation in Primary Dysmenorrhea: An In Vivo Investigation Targeting Bilateral L4/L5 Vertebrae

Primary dysmenorrhea (PD) is a prevalent problem in gynecology affecting the quality of life for young women. This medical condition is often responsible for the absence of young women from school or work, increasing the risk of developing hyperemesis gravidarum in the future. Furthermore, PD causes pain due to the activation of the local PGF2α pathway in the endometrium, which triggers oxidative stress processes, uterine ischemia and spasmodic uterine contractions. The first-line therapies for PD, Nonsteroid anti-inflammatory drugs (NSAIDs) and oral contraceptives, can cause side effects such as headache, nausea, intestinal ulcers and platelet abnormalities. To overcome the impact of PD, cupping has been proven effective as an alternative pain therapy with minimal side effects. Therefore, this study aimed to evaluate the effects of cupping on writing latency threshold time, PGF2α levels and FP receptor expression in PD model rats. The experiment was conducted using female Sprague Dawley rats to analyze the effects of wet cupping therapy (WCT) on inflammatory repair in the uterus. The method used was a pre- and post-test control group design, with 35 female rats randomly divided into 5 groups. These consisted of normal control (NC), negative control (C−), positive control (C+) + ibuprofen 7.2 mg, as well as treatment groups, comprising dry cupping (DC) and WCT. The results showed that writhing time threshold of WCT was the same as C+ (p = 0.368), while PGF2α decreased in DC (43.43 pg/mL, p = 0.008) and WCT (189.25 pg/mL, p = 0.0154). Similar to C+, WCT significantly decreased serum PGF2α levels compared to C−. WCT also influenced the expression of PTGFR subunit similarly to NC, showing the capacity to control the inflammatory pathway. The study suggested that WCT was a promising therapeutic strategy for PD by decreasing PGF2α and PTGFR expression. HIGHLIGHTS Previous investigations conducted on experimental animals using wet cupping therapy (WCT) have shown histopathological results associated with primary dysmenorrhea (PD) caused by estradiol benzoate and oxytocin. Moreover, this study shows the potential of WCT in reducing inflammation-induced PD pain by inhibiting the expression of PGF2α and PTGFR in the cyclooxygenase pathway, potentially increasing the pain threshold. The results show that WCT offers a potential alternative therapy for PD caused by estradiol benzoate and oxytocin. GRAPHICAL ABSTRACT

Impact of 6-hydroxydopamine on agonist-induced human platelet functional parameters: An explanation for platelet impairment in Parkinson’s disease

Parkinson’s disease (PD) is the second-most prevalent neurodegenerative disease worldwide, which worsens with advancing age. It is a common movement disorder and is often associated with several vascular diseases with decreased stroke frequency. Circulating platelets substantially regulate vascular complications, including stroke, and share striking similarities with PD neurons. Although structural alterations in platelets are well-documented in PD, their functional parameters remain unclear. This study aimed to investigate the functional abnormalities in platelets associated with PD by evaluating key functional aspects such as adhesion, activation, secretion, aggregation, and clot retraction. To achieve this, we treated human blood platelets with 6-hydroxydopamine or 6-OHDA, that selectively destroys dopaminergic neurons, thereby creating an in vitro experimental model that closely resembles the pathogenic environment in PD, and examine its impact on platelet functions. In our study, platelet adhesion was assessed and further evaluated by a microplate reader, activation and secretion by a flow cytometer, aggregation by aggregometer, and clot retraction by Sonoclot. Phase-contrast and confocal microscopic studies further verified the results from the above experiments. Our findings showed that 6-OHDA treatment significantly inhibited thrombin (a platelet agonist)-induced functions, including adhesion, activation, aggregation, secretion, and clot retraction in human-washed platelets. In summary, this research provides pioneering evidence that 6-OHDA induces abnormal platelet functions, shedding light on the previously unexplored processes by which 6-OHDA affects platelet activity.

Platelet Aggregation Alterations in Patients with Severe Viral Infection Treated at the Intensive Care Unit: Implications for Mortality Risk.

Severe viral infections often result in abnormal platelet function, affecting various stages of hemostasis. Activated platelets are often considered prothrombotic and more susceptible to further stimulation. However, emerging evidence suggests that initial hyperactivation is followed by platelet exhaustion and hypo-responsiveness, affecting platelet degranulation, activation, and aggregation. We examined early alterations in platelet aggregation among patients (N = 28) with acute respiratory distress syndrome and SARS-CoV-2 infection who were receiving mechanical ventilation and venovenous extracorporeal membrane oxygenation support. Blood samples were stimulated with four different activators: arachidonic acid, adenosine diphosphate, thrombin receptor-activating protein 6, and ristocetin. Our observations revealed that platelet aggregation was reduced in most patients upon admission (ranging from 61 to 89%, depending on the agonist used), and this trend intensified during the 5-day observation period. Concurrently, other coagulation parameters remained within normal ranges, except for elevated d-dimer and fibrinogen levels. Importantly, we found a significant association between platelet aggregation and patient mortality. Impaired platelet aggregation was more severe in patients who ultimately died, and reduced aggregation was associated with a significantly lower probability of survival, as confirmed by Kaplan-Meier analysis (p = 0.028). These findings underscore the potential of aggregometry as an early detection tool for identifying patients at higher risk of mortality within this specific cohort.

Baseline platelet count and long-term clinical outcomes in patients with acute venous thromboembolism: a prospective cohort study.

An abnormal platelet count (PC) is common in acute venous thromboembolism (VTE) but its relationship with clinical outcomes remains ill-defined. We aimed to explore the association between baseline PC and the long-term risk of clinically relevant outcomes in a prospective cohort of 991 patients with acute VTE. We classified patients into four PC groups: very low (< 100 G/l), low (≥ 100 to < 150 G/l), normal (≥ 150 G/l to ≤ 450 G/l), and high (> 450 G/l). The primary outcome was major bleeding (MB), secondary outcomes were recurrent VTE and overall mortality. We examined the association between PC and clinical outcomes, adjusting for confounders, competing risk for mortality, and periods of anticoagulation. After a median follow-up of 30 months, 132 (13%) of patients experienced MB, 122 (12%) had recurrent VTE, and 206 (21%) died. Compared to patients with a normal PC, patients with a very low PC had a sub-distribution hazard ratio (SHR) for MB of 1.23 (95% confidence interval [CI] 0.52-2.91) and those with a high PC a SHR of 1.87 (95%CI 0.82-4.29). Patients with a low PC had a twofold increased VTE recurrence risk (SHR 2.05, 95%CI 1.28-3.28). Patients with low and very low PC had a hazard ratio for mortality of 1.43 (95%CI 0.99-2.08) and of 1.55 (95%CI 0.80-2.99), respectively. Our findings do not suggest a consistent relationship between baseline PC and long-term clinical outcomes in patients with VTE.

Prediction of Adverse Maternal Outcomes in Preeclampsia Using the FullPIERS (Preeclampsia Integrated Estimate of Risk) Model in a Tertiary Care Hospital of Eastern India.

Preeclampsia, characterized by hypertensive disorders and systemic inflammatory response, remains a leading cause of maternal morbidity and mortality globally. Effective risk assessment tools are crucial for predicting adverse maternal outcomes. This study evaluates the performance of the fullPIERS (Preeclampsia Integrated Estimate of Risk) model in predicting adverse maternal outcomes within 24 hours of admission for preeclampsia. A cross-sectional study was conducted over one year, involving 100 preeclamptic patients admitted to Nil Ratan Sircar Medical College & Hospital (NRSMCH). Predictor variables were collected within 24 hours of admission and analyzed using the fullPIERS model. The fullPIERS model effectively stratified maternal risk. Adverse outcomes were significantly associated with systolic blood pressure (BP) ≥ 140 mmHg, diastolic BP ≥ 90 mmHg, oxygen saturation ≤ 95%, frontal headache, visual disturbances, chest pain/dyspnea, and abnormal random blood sugar, albumin, alanine aminotransferase, platelet count, and creatinine levels. A fullPIERS score ≥ 30 was strongly predictive of adverse maternal outcomes. The fullPIERS model is a valuable tool for predicting adverse maternal outcomes in preeclampsia, aiding in timely and effective clinical decision-making.

Platelet traits and sepsis risk and prognosis: a bidirectional two-sample Mendelian randomization study.

Sepsis is a critical medical condition characterized by a dysregulated host response to infection. Platelet abnormalities frequently manifest in sepsis patients, but the causal role of platelets in sepsis remains unclear. This study employed a bidirectional two-sample Mendelian randomization (MR) approach to investigate the causal direction between platelets and sepsis. MR analysis was used to investigate the causal effect of four platelet traits - platelet count (PLT), platelet crit (PCT), mean platelet volume (MPV), and platelet distribution width (PDW)- on sepsis risk and prognosis. Additionally, the study explored the reverse causality, assessing the impact of sepsis on these platelet traits. Genetic variants from large-scale genome-wide association studies (GWAS) served as instrumental variables to infer causality. Sensitivity analyses and heterogeneity tests were conducted to ensure the validity and robustness of the results. Genetically predicted decreased PCT (OR = 0.938, p = 0.044) and MPV (OR = 0.410, p = 0.006) were associated with an increased risk of sepsis. In the reverse direction, 28-day sepsis mortality was significantly associated with decreased PLT (OR = 0.986, p = 0.034). No significant causal relationships were observed between sepsis and other platelet traits. This study suggests a causal association between low PCT and MPV levels and increased risk of sepsis. Additionally, sepsis with a poor prognosis was causally linked to decreased PLT. These findings provide novel evidence for the causal relationship between platelet traits and sepsis.

Real-time platelet P2Y12 receptor occupancy as a promising pharmacodynamics biomarker for bridging the gap between PK/PD of clopidogrel therapy

Clopidogrel effectively inhibits platelet aggregation in response to ADP by irreversibly binding to the platelet P2Y12 receptor through its active metabolite. However, the observed discrepancies between the pharmacokinetics (PK) and pharmacodynamics (PD) of clopidogrel present substantial challenges in individualizing of antiplatelet therapy. To address these challenges, a robust liquid chromatography–tandem mass spectrometry method has been developed to facilitate the real-time assessment of platelet P2Y12 receptor occupancy. This method has been validated in animal models, providing a reliable link between individual PK profiles and PD effects. Target receptor occupancy offers a comprehensive overview of interindividual variations in clopidogrel metabolism, regulation of P2Y12 receptor expression, and platelet turnover. Moreover, it directly correlates with the inhibitory effect on platelet aggregation. The levels of platelet P2Y12 occupancy accurately reflect the extent of clinical factors influencing the PD of clopidogrel, including dosage, drug–drug interactions (DDI), and type 2 diabetes mellitus (T2DM). As a normalized metric, platelet P2Y12 occupancy not only serves potential as a diagnostic tool for personalized clopidogrel therapy but also aids in elucidating the role of the P2Y12 signaling pathway in cases of abnormal on-treatment platelet reactivity.

Frequency of clinico-hematological features and JAK 2 status of young adults presenting with polycythemia in RMI hospital, Peshawar.

Objective: To determine the frequency of clinico-hematological features and JAK 2 status of young adults presenting with Polycythemia Vera at the department of hematology. Study Design: Cross-sectional study. Setting: Department of Hematology, RMI Hospital, Peshawar. Period: 25th November 2023 to 25th May 2024. Methods: A total of 190 patients aging between 18-45 years and presented as suffering from Polycythemia Vera as per diagnosis of consultant hematopathologists, were included in this study. Samples with clear evidence of hemolysis, coagulation, or clots were excluded. Patient’s demographics, details of physical appearance, clinical findings and history of adverse events were recorded. Hematological and pathological investigations were done and analysis of JAK2 V617F mutation was conducted using polymerase chain reaction from the diagnostic lab of the institute. The primary outcome of the study was to determine the frequency of clinico-hematological features and JAK 2 status. Results: The Mean±SD of age in our study was 36.81±6.11 years with an age range of 21-45 years. Out of total patients, 49 (25.79%) patients were asymptomatic. The major symptoms affecting the daily life activities were headache 65 (34.21), abdominal discomfort 41 (21.58%), blurred vision 27 (14.21%) and fatigue 27 (14.21%). These patients had plethoric face 61 (32.11%), splenomegaly 64 (33.68%) and budd-chiari syndrome 8 (4.21%). The results of hematopathological findings showed abnormal hemoglobin (17±3.92 gm/dL), hematocrit (52.94±4.8 g %), platelet (579.63±227.68 103/μL) and leukocyte (10.32±2.6, 103/μL) levels while 177 (93.16 %) patients had mutated JAK2 levels. Conclusion: Plethoric face and splenomegaly are the commonly found clinical findings in patients with Polycythemia Vera while these patients also have abnormal levels of hemoglobin, hematocrit, platelet and leukocyte. JAK 2 status serves conclusive role in the diagnosis of Polycythemia Vera.

A 72-year-old Woman with Dyspnea and Thrombocytosis

&lt;p&gt;原發性血小板增多症的臨床表徵並不典型且早期診斷不易，往往多數病人於診斷前已發生動靜脈血栓形成及出血併發症。本個案一位72歲女性，有高血壓及胃食道逆流病史並按時門診追蹤服藥，五天前注射新冠疫苗後，呼吸喘、乾咳併胸悶至診所就醫未改善，於急診初步診斷急性支氣管炎。入院後感心悸且胸悶，藉由病史詢問、檢驗及理學檢查，顯示心肌酵素正常但心電圖呈現陣發性心室上心搏過速，安排冠狀動脈血管攝影攝影後排除急性心肌梗塞，但呼吸急促未見好轉呈現低血氧，經胸腔電腦斷層為肺栓塞。疑似新冠疫苗後引起的免疫併發症，直到右手食指及中指末梢腫、痛且發紺症狀出現，筆者再次重新檢視病史資料，發現血小板異常，透過骨髓穿刺切片是發現巨核細胞（megakaryocyte）增生，病理報告判斷為骨髓增生性腫瘤，基因檢測結果為JAK2V617F 突變，最後確診是原發性血小板增多症併發肺栓塞，接受Hydroxyurea合併口服抗凝血劑治療，症狀改善且血小板數值趨於穩定。藉此案例分享提醒當發現病人有不明血栓產生時須考慮將相關血液疾病列入鑑別診斷，期能及早發現疾病，掌握治療時機。&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;&lt;p&gt;The clinical symptoms of essential thrombocythemia are not typical and early diagnosis is difficult.Most patients have arteriovenous thrombosis and bleeding complications before diagnosis. In this case, a 72-year-old woman had a history of hypertension and gastroesophageal reflux and was taking medication regularly at the outpatient clinic. After being injected with the COVID-19 vaccine five days ago, her breathing, dry cough, and chest tightness did not improve when she went to the clinic. She was initially diagnosed with acute bronchitis in the emergency department. After being admitted to the hospital, she felt palpitations and chest tightness. The medical history, examination and physical examination showed that myocardial enzymes were normal, but the electrocardiogram showed Parox-ysmal supraventricular tachycardia. Coronary angiography was arranged to rule out acute myocardial infarction, but the shortness of breath persisted with hypoxemia, and the computed tomography of the chest showed pulmonary embolism. Immune complications caused by the COVID-19 vaccine were suspected, symptoms of swelling, pain and cyanosis appeared in the distal part of the right index fin-ger and middle finger appeared. The author re-examined the medical history data and found abnormal platelets. Through bone marrow aspiration and sectioning, megakaryocyte hyperplasia was found. Pa-thology report determined that the patient suffered from myeloproliferative neoplasm, and the genetic test result was the JAK2V617F mutation. The patient was finally diagnosed with essential thrombocythe-mia complicated by pulmonary embolism. She was treated with Hydroxyurea combined with oral an-ticoagulants. The symptoms improved and the platelet level stabilized. This case serves as a reminder that when a patient is found to have unknown thrombosis, related blood diseases must be considered in the differential diagnosis, so that the disease can be detected early and proper treatments can be pro-vided.&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;

Exploring the relationship between blood platelet and other components utilizing count regression: A cross-sectional study in Bangladesh.

Blood, vital for transporting nutrients and maintaining balance, comprises red blood cells, white blood cells, and platelets, each pivotal. Imbalances lead to issues-low red cells cause fatigue (anemia), high white cells hint at infection, low counts raise infection risks. Using trendy statistical approaches, investigating the complex link between platelet counts and numerous blood components. Our investigation, leveraging count regression approaches, revealed deep insights into the interaction between platelet counts and other important hematological markers. A cross-sectional study utilized data from 3120 individuals, including both male and female participants, who visited these hospitals between June 16, 2022 and December 17, 2022, to assess their blood samples through testing by using convenience non-parametric sampling framework. Platelet count was taken into account as a measure of outcome in this research. This specific study region was chosen for its easy accessibility, which helped the seamless execution of the data-gathering technique. Count regression, negative binomial regression, and quasi-Poisson regression techniques have been employed for examining relationship of the data sets. Three different count regression models were utilized to assess the proper association between the response and the relevant covariates and we found negative binomial count regression model (Akaike information criterion = 76.55, Bayesian information criterion = 76.59, and deviance = 3.14) was providing comparatively better performance than others. Based on the chosen model we found white blood cell, erythrocyte sedimentation rate, and eosinophils are significant but neutrophil, monocyte, and lymphocyte are not significant. We have also gone through proper model adequacy checking for our selected model and we found enough evidence to justify our model. From the result, we found insightful remarks into the mechanisms involved in platelet production and regulation, which can aid in developing increased effective treatments and interventions to maintain optimal platelet levels and prevent health problems related to abnormal platelet counts.

Neuropathologic Features and Underlying Medical Disease States of Spontaneous Subdural Hematomas in Adults: A Hospital Autopsy Case Series From a Single Tertiary Center.

Spontaneous (nontraumatic) subdural hematomas have been reported yet have not been well studied. To identify the neuropathologic features of acute spontaneous SDHs (ASSDHs) and their associated medical conditions. A retrospective study of 235 autopsy cases of SDH was conducted. Review of demographics, underlying medical conditions, and coagulation profile as well as gross and histopathologic examination of the brain and other organs were performed. Among the 32 cases of ASSDH, 5 cases (15.6%) had severe hemorrhage and 4 (12.5%) demonstrated brain herniation. Twenty-two cases (68.8%) had concurrent but nonconnecting subarachnoid hemorrhage or intraparenchymal hemorrhage. The most common underlying medical condition was thrombocytopenia (n = 21; 65.6%), followed by immunosuppression (n = 15; 46.9), bloodstream infections or sepsis (n = 12; 37.5%), hypertension (n = 13; 40.6%), and coronary artery disease (n = 12; 37.5%). Many patients with thrombocytopenia or immunosuppression had underlying malignancies, with leukemia being the most common type (n = 11; 34.4%). The use of circulatory devices or hemodialysis was noted in a significant portion of ASSDH cases. In terms of coagulation factors, most of our ASSDH patients had normal prothrombin time and activated partial thromboplastin time, but abnormal platelet count and D-dimer levels. ASSDHs can be severe and are often associated with subarachnoid hemorrhage and/or intraparenchymal hemorrhage. The causes of ASSDH are limited to certain underlying medical conditions that ultimately lead to bleeding tendency. Autopsies are helpful in determining the etiology. Given their association with abnormal platelet count, correcting platelet deficiencies is a potential preventive measure for ASSDHs.

Adverse Associations of Long-Term Exposure to PM2.5 and Its Components with Platelet Traits among Subway Shift-Workers without Air Purifier Use.

Air purifier use, shift work, and long-term exposure to fine particulate matter (PM2.5) are linked to platelet abnormality. However, the role of air purifier use and shift work in the individual or joint associations of PM2.5 and its components with platelet indices are largely unknown. A total of 8772 participants were recruited from a population of subway workers in China. PM2.5 and its component data were obtained from the Tracking Air Pollution in China dataset. The role of air purifier use and shift work in the association between PM2.5 and its components and platelet indices were analyzed. Among shift workers without air purifier use, positive associations of PM2.5 and each component in PM2.5 with the mean platelet volume (MPV) or platelet counts (PLT) were observed, whereas negative associations of PM2.5 and each component in PM2.5 with the platelet distribution width (PDW) were observed. Furthermore, estimated changes (95%CIs) in PLT, MPV, and PDW in response to each 10th percentile increment in the mixture of PM2.5 and its components were 0.8657 (0.2496, 1.4819), 0.0192 (0.0054, 0.0329), and -0.0648 (-0.0945, -0.0351), respectively, and sulfate in PM2.5 was the major contributor to those associations. Long-term exposure to PM2.5 and its components was related to increased platelet disorders among shift workers without air purifier use, and those associations were mainly attributed to sulfate in PM2.5.

Correlation Of Neutrophil Lymphocyte Ratio And Platelet Lymphocyte Ratio With Severity Of COVID-19

The neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) tests are simple tests can be done before a COVID-19 patient hospitalized. This examination is useful for determining the diagnosis and prognostic of the patient. The aim of the study was to determine the correlation between NLR and PLR with the severity of COVID-19. This research was an analytical study with a cross-sectional approach using secondary data from 289 medical records of patients with confirmed COVID-19 for the period June-August 2021. The total sampling technique was used and processed with the chi-square test. Most of the research subjects were in the range of 26-45 years (28.4%). More than half of the subjects were female (61.6%). There were 99 patients (34.3%) with severe conditions. Less than half of the patients had abnormal leukocyte and platelet examination results, namely 64 (22.1%) and 56 (19.4%). Patients with abnormal NLR and PLR examinations were 135 (46.7%) and 123 (42.6%). There was a significant correlation between NLR and the severity of COVID-19 inpatients (p&lt;0.001, OR=9.452). There is a significant correlation between PLR and the severity of COVID-19 inpatients (p&lt;0.001, OR=7.268). This study concludes a significant correlation between NLR and PLR with the severity of COVID-19.