Significant Increase In Platelet Count Research Articles

Final Results from the First European Real-World Experience on Lusutrombopag Treatment in Cirrhotic Patients with Severe Thrombocytopenia: Insights from the REAl-World Lusutrombopag Treatment in ITalY Study.

Background and aims: Management of severe thrombocytopenia poses significant challenges in patients with chronic liver disease. Here, we aimed to evaluate the first real-world European post-marketing cohort of cirrhotic patients treated with lusutrombopag, a thrombopoietin receptor agonist, verifying the efficacy and safety of the drug. Methods: In the REAl-world Lusutrombopag treatment in ITalY (REALITY) study, we collected data from consecutive cirrhotic patients treated with lusutrombopag in 19 Italian hepatology centers, mostly joined to the "Club Epatologi Ospedalieri" (CLEO). Primary and secondary efficacy endpoints were the ability of lusutrombopag to avoid platelet transfusions and to raise the platelet count to ≥50,000/μL, respectively. Treatment-associated adverse events were also collected. Results: A total of 66 patients and 73 cycles of treatment were included in the study, since 5 patients received multiple doses of lusutrombopag over time for different invasive procedures. Fourteen patients (19%) had a history of portal vein thrombosis (PVT). Lusutrombopag determined a significant increase in platelet count [from 37,000 (33,000-44,000/μL) to 58,000 (49,000-82,000), p < 0.001]. The primary endpoint was met in 84% of patients and the secondary endpoint in 74% of patients. Baseline platelet count was the only independent factor associated with response in multivariate logistic regression analysis (OR for any 1000 uL of 1.13, CI95% 1.04-1.26, p 0.01), with a good discrimination power (AUROC: 0.78). Notably, a baseline platelet count ≤ 29,000/μL was identified as the threshold for identifying patients unlikely to respond to the drug (sensitivity of 91%). Finally, de novo PVT was observed in four patients (5%), none of whom had undergone repeated treatment, and no other safety or hemorrhagic events were recorded in the entire population analyzed. Conclusions: In this first European real-world series, lusutrombopag demonstrated efficacy and safety consistent with the results of registrational studies. According to our results, patients with baseline platelet counts ≤29,000/μL are unlikely to respond to the drug.

The Clinical Significance of the Platelet Membrane Glycoproteins in Children with Primary Immune Thrombocytopenia

Abstract Background Primary immune thrombocytopenia (ITP) is an acquired immune-mediated disorder characterized by isolated thrombocytopenia. Although decreased platelet count is believed to be the main cause of hemorrhage in ITP, it is a poor predictor of bleeding risk by itself. Aim of the Work to measure CD62p and CD42b level in the pediatric ITP patients by using flow cytometer, measurement of platelet parameters in the pediatric ITP patients and to study its correlations to bleeding score. Patients and Methods sixty children with ITP were recruited and assessed for eligibility at the out-patients Hematology clinic – Pediatric Hospital at Ain Shams University, and compared with age and sex matched thirty healthy subjects. Results Pediatric ITP patients had a significant increase in the mean platelet volume, platelet distribution width and a significant decrease in plateletcrit among the ITP patient group in comparison with the control group (P value&amp;lt;0.001). The chronic ITP subgroup had significant increase of platelet count and plateletcrit in comparison with the acute ITP subgroup (P value&amp;lt;0.001). Pediatric ITP patients had significant increase in CD42b and a significant decrease in CD62p among the ITP patient group in comparison with the control group (P value&amp;lt;0.001). No statistically significant difference found between the acute, persistent and chronic ITP subgroups regarding CD42b and CD62p (P value&amp;gt;0.05). Conclusion Platelet function, platelet parameters and platelet glycoprotein CD62p, CD42b expression can be used as a clinical biomarkers in pediatric ITP.

Antioxidant Effects of Vitamin C on Some Hematological Parameters of Male Wistar Rats Exposed to Lead Acetate

The study investigated the effects of vitamin C on platelet parameters, white blood cell count and white blood cells differentials in Wistar rats exposed to lead acetate. A total of twenty-four male Wistar rats weighing between 160g and 200g were utilized. The experimental animals were divided into four groups of six rats each (n=6). Group 1 served as the control group (received normal feed and water), group II received 10mg/kg body weight of lead acetate, group III received 100mg/kg body weight of Vitamin C, and group IV received 10mg/kg body weight of lead acetate followed by 100mg/kg body weight of Vitamin C. Lead and Vitamin C, along with normal feed, were administered for four weeks. Blood samples were collected via jugular puncture and stored in EDTA bottles for analysis to determine the blood profile of the rats. The results showed significant increase in Platelet Count (PLT) in group III and a significant decrease in Mean Platelet Volume (MPV) in group IV (Pb + vitamin C). The Mean Platelet Width (MPW) showed decrease in groups 2, 3, and 4 compared to the control group, although this decrease was not statistically significant. The study also noted an elevated level of white blood cells (WBC) in response to the antioxidant treatment, indicating a potential positive impact on immune function. In conclusion, this study demonstrates the therapeutic effect of Vitamin C against the toxic effects of lead on platelet parameters and white blood cell count and differentials.

Effects of quercetin and extracts from Phyllanthus emblica, Morus alba, and Ginkgo biloba on platelet recovery in a rat model of chemotherapy-induced thrombocytopenia

BackgroundChemotherapy-induced thrombocytopenia (CIT) is a major reason for chemotherapy delays, dose reduction, or even treatment discontinuation, which may impact oncologic outcomes. We investigated the effects of quercetin and extracts of Phyllanthus emblica fruit (PEE), Morus alba leaf (MAE), and Ginkgo biloba leaf (GBE) on platelet recovery in a rat model of chemotherapy-induced thrombocytopenia. MethodsThe total phenolic content (TPC), total flavonoid content (TFC), quercetin content, and antioxidant activities of all the extracts were determined. Sixty male Sprague Dawley rats were categorized into healthy controls and CIT groups. The CIT groups was administered a cyclophosphamide solution, while the control group received a saline solution. Each group was then subdivided into five subgroups of six animals which were administered with PEE, MAE, GBE, quercetin, or a vehicle for 15 days. ResultsThe highest quercetin content was found in PEE, followed by MAE and GBE, which correlated with their antioxidant properties. Administration of these extracts and quercetin did not significantly change the platelet counts in healthy rats. Thrombocytopenic rats treated with PEE, MAE, and GBE also were not associated with significant changes in platelet counts. However, more rapid platelet count recovery was observed in all groups receiving extracts. On day 11, platelet counts in the PEE, MAE, and GBE groups returned to near baseline levels with a mean of 4.29 %, −40.77 %, and −14.24 %, respectively, compared to −71 % in the CIT group. In thrombocytopenic rats treated with quercetin, there was a significant increase in platelet counts on days 9 and 11, with a mean decrease of 5.41 % from baseline on day 11. ConclusionQuercetin improved platelet recovery in the animal model of CIT. This finding merits for further investigation to better elucidate the health benefits of quercetin and quercetin-rich plants and potential pharmacokinetics underpinning their activity in thrombocytopenia.

Platelet Count Response to Obstetrical Use of IVIG for Maternal Thrombocytopenia: A 14-Year Retrospective Study

Introduction: Thrombocytopenia affects approximately 10% of pregnant individuals with Gestational Thrombocytopenia (GT) accounting for 80% of cases and Immune Thrombocytopenia (ITP) representing 3% of cases. Distinguishing between GT and ITP is challenging, leading to many pregnant individuals with moderate thrombocytopenia receiving treatment for ‘possible ITP’ with Intravenous Immunoglobulin (IVIG) in attempt to raise platelet counts (PLT) for safe labor and delivery and to potentially allow for neuraxial anesthesia. However, evidence on the impact of IVIG on PLT during pregnancy remains limited, and predictive factors for IVIG response are lacking. We aim to investigate the effect of IVIG on PLT in pregnant individuals with moderate thrombocytopenia (PLT &amp;lt; 100 x 10 9/L). The specific objectives are to assess the incremental response in maternal PLT following IVIG administration, the proportion of PLT exceeding 80 x 10 9/L after IVIG administration, the proportion of incremental increase in PLT by more than 20 x 10 9/L following IVIG administration, and to identify factors associated with these outcomes. Methods: We conducted a retrospective cohort study using administrative and chart review data between 2007-2020. We included all pregnant individuals who received IVIG for moderate thrombocytopenia. Data collected encompassed parameters such as age, gestational age at delivery, platelet counts at various timepoints, highest immature platelet fraction (IPF) during pregnancy, IVIG dose and frequency, hemoglobin levels, transfusions, and corticosteroid use. Data were analyzed using descriptive statistics. Paired t-test was used to compare means of PLT pre- and post-IVIG administration. Simple logistic regression was used to assess predictors of PLT ≥ 80 x10 9/L and PLT increment ≥ 20 x10 9/L post-IVIG. Results: Out of 651 deliveries with moderate thrombocytopenia, 79 (12.1%) received IVIG for a total of 4,527.50 grams and a median dose of 60 g (IQR: 30 - 77.5). Excluding 22 pregnancies due to other interventions such as platelet transfusions (n=12), corticosteroids (n=7), or both (n=3), 57 remained for analysis. The median incremental response in PLT following IVIG administration was 27 x10 9/L (IQR: 3-94). Pre-IVIG PLT median was 65 x10 9/L (IQR: 48-73), and post-IVIG PLT median was 98 x10 9/L (IQR: 69-142). PLT increment ≥ 20 x 10 9/L following IVIG was observed in 54.4% (31/57) of deliveries, and 57.9% (33/57) of deliveries achieved PLT ≥ 80 x 10 9/L following IVIG administration. Mean PLT post-IVIG (M = 112.51 x10 9/L, SD 55.88) were significantly greater than pre-IVIG PLT (M = 59 x10 9/L, SD = 19.71) by 53.51 points, p = &amp;lt; .001. Nadir PLT &amp;lt; 30 in pregnancy was associated with a statistically significant increase in PLT ≥ 80 x10 9/L following IVIG (odds ratio (OR) = 6.29, 95% confidence interval (CI) = 1.25-31.51, p &amp;lt; 0.05) and PLT increment ≥ 20 x10 9/L (OR = 7.58, 95% CI = 1.51-38.05, p &amp;lt; 0.05). An IPF &amp;lt; 16% was also associated with a statistically significant increase in PLT ≥ 80 x10 9/L (OR = 4.85, 95% CI = 1.08-21.76, p &amp;lt; 0.05) and PLT increment ≥ 20 x10 9/L (OR = 4.85, 95% CI = 1.08 - 21.76, p &amp;lt; 0.05). Moreover, a post-IVIG PLT increment ≥ 20 x10 9/L was positively associated with pre-IVIG PLT below 50 x10 9/L (OR = 8.67, 95% CI = 1.73 - 43.33, p &amp;lt; 0.05), but negatively associated with PLT 70-100 x10 9/L (OR = 0.18, 95% CI = 0.05 - 0.57, p &amp;lt; 0.05). For post-IVIG PLT ≥ 80 x10 9/L, there were no statistically significant relationships with gestational age, maternal age, pre-pregnant PLT or pre-IVIG PLT. Similarly, for post-IVIG PLT increment ≥ 20 x10 9/L, there were no statistically significant relationships with GA, maternal age, pre-pregnant PLT, or a pre-IVIG PLT between 50-69 x10 9/L. Conclusions: IVIG administration shows promising results for pregnant individuals with moderate thrombocytopenia. The study highlights the importance of nadir PLT in pregnancy, IPF levels, and pre-IVIG PLT as potential factors influencing the response to IVIG treatment. Our study is limited by its retrospective and single-centered design, and small sample size. Nevertheless, these findings generate hypotheses and could inform future prospective multicenter studies to optimize IVIG administration in this setting, considering its effectiveness and potential risks while minimizing costs.

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.

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 &amp; Health Sciences for Women, Shaheed Benazir Abad. Period: April to October 2019. Material &amp; 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 = &lt;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 = &lt;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.

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.

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.

White Blood Cell and Platelet Counts as Simple and Inexpensive Markers for Determination the Metabolic Syndrome among patients with Type 2 Diabetes Mellitus

Metabolic Syndrome (MetS) is a rapidly growing public health problem worldwide and is significantly associated with poor cardiovascular outcomes. Increased visceral adiposity activates a low-grade chronic inflammatory state, oxidative stress, and blood coagulation. This study aimed to investigate the association of both white blood cell (WBC) and platelet counts, as inflammatory markers, with the presence and severity of MetS among T2DM patients.. The study was conducted on 117 adult patients with type 2 diabetes mellitus (T2DM) seen at Tishreen University Hospital (TUH) and Diabetes Center of Lattakia city in Syria. MetS was diagnosed according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III). The results showed a statistically significant increase in platelet counts in MetS patients compared to patients without MetS, and a statistically significant increase in WBC counts with increasing MetS components. There was a significant association between platelet counts and body mass index (BMI) (P=0.013), triglycerides levels (P=0.02), and glycated hemoglobin (HbA1C) (P=0.041). In conclusion, this study has demonstrated that high counts of WBCs and Platelets are associated with the prevalence and severity of Metabolic Syndrome (MetS).

Defective binding of ETS1 and STAT4 due to a mutation in the promoter region of THPO as a novel mechanism of congenital amegakaryocytic thrombocytopenia.

Congenital amegakaryocytic thrombocytopenia (CAMT) is a recessive disorder characterized by severe reduction of megakaryocytes and platelets at birth, which evolves toward bone marrow aplasia in childhood. CAMT is mostly caused by mutations in MPL (CAMT-MPL), the gene encoding the receptor of thrombopoietin (THPO), a crucial cytokine regulating hematopoiesis. CAMT can be also due to mutations affecting the THPO coding region (CAMT-THPO). In a child with the clinical picture of CAMT, we identified the homozygous c.-323C>T substitution, affecting a potential regulatory region of THPO. Although mechanisms controlling THPO transcription are not characterized, bioinformatics and in vitro analysis showed that c.-323C>T prevents the binding of transcription factors ETS1 and STAT4 to the putative THPO promoter, impairing THPO expression. Accordingly, in the proband the serum THPO concentration indicates defective THPO production. Based on these findings, the patient was treated with the THPO-mimetic agent eltrombopag, which induced a significant increase in platelet count and stable remission of bleeding symptoms. Herein, we report a novel pathogenic variant responsible for CAMT and provide new insights into the mechanisms regulating transcription of the THPO gene.

A new (q*, S) policy to manage inventory for low shelf life products facing deterioration in quality and age differentiated requirements

Inventory management of products with short shelf life is a critical problem for managers due to its unique characteristics. The efficient and economical planning to manage inventory of such products is important and the complexity multiplies when such products face a deterioration in quality/effectiveness during its shelf life. This paper proposes a new (q*, S) policy with its mathematical model which will help to establish an efficient and economical system which could handle the above situation. The efficiency of this policy is evaluated by considering blood platelets as an example. Platelet transfusions are vital in patients undergoing chemotherapy and those suffering massive bleeding. Shortage of platelets can lead to cancellation or postponement of major operations and excessive storage can lead to wastage due to its low shelf life. For those patients undergoing chemotherapy and bone marrow transplantations (critical illness patients), young platelets (3 to 4 days’ shelf life) are highly preferred, as it can give significant increase in platelet count and increase the interval between transfusions. However, for general surgery and traumatology patients (less critical cases), platelets of any age will serve the purpose as the deficiency is temporary and bone marrow will be able to produce the required quantity. A new (q*, S) policy is proposed through this study to ensure the supply of young platelets for the treatment of critical illness patients and to strike a balance between the shortage in supply of platelets of any age (less critical illness patients) and the expiration of platelets. From the computational studies conducted, this policy is observed to outperform several existing policies discussed in the literature. Other considerations in this paper are fluctuations in demand in certain months and classification of central blood bank on the basis of the type of hospital it caters to. Another major contribution of this paper is the optimization of facility required to store platelets. Optimizing the order-up-to-level without considering the capacity could lead to wastage of resources as there could be lack of space for storing. Instead of predetermining the capacity of the blood bank to store platelets, the number of machines and its type is optimized in this study. So given a demand and cost profile, facility requirements and order-up-to-level to be maintained that could reduce the overall cost to minimum with reduced shortage and expiry can be determined.

Self-nanoemulsifying drug delivery system of aqueous leaf extracts of Justicia adhatoda and Psidium guajava to enhance platelet count.

Self-nanoemulsifying drug delivery system (SNEDDS) containing aqueous leaf extracts of Justicia adhatoda (JA) and Psidium guajava (PG), was designed to evaluate their ability to enhance platelet count. The ternary phase diagram was constructed to identify the self-emulsifying regions and nanoemulsion prepared using clove oil, tween 80 and transcutol. The globule size of the prepared SNEDDS formulation at different folds of dilution in buffers of various pH was evaluated. The average globule size of the optimized JA2- and PG2-loaded SNEDDS at different folds of dilutions was in the range of 103.4 ± 7.1 to 238.3 ± 5.4nm and 240.2 ± 7.9 to161.7 ± 3.7nm, respectively. The viscosity of JA2 and PG2 loaded SNEDDS formulations were found to be 621 and 642 centipoise, respectively with no observed signs of phase separation, turbidity or precipitation during the freeze-thaw process. Oral administration of combined JA2 and PG2 loaded SNEDDS formulation to Wistar rats depleted with platelets showed a significant increase in platelet count when compared to a marketed tablet Caripill. Pharmacodynamic studies in platelet-depleted Wistar rats enhanced the platelet count after administration of SNEDDS containing lyophilized aqueous extracts JA2 and PG2.

Biochemical and reproductive biomarker analysis to study the consequences of heavy metal burden on health profile of male brick kiln workers

The present study aims to assess the effect of a heavy metal burden on general health, biochemical parameters, an antioxidant enzyme, and reproductive hormone parameters in adult male brick kiln workers from Pakistan. The study participants (n = 546) provided demographic data including general health as well as body mass index. Blood was collected to quantitatively assess hematological, biochemical, and reproductive hormone parameters as well as heavy metal concentrations using both atomic absorption spectroscopy (AAS) and particle-induced X-ray emission (PIXE). The data showed that 10% of the brick kiln workers were underweight and 10% obese (P = 0.059), with workers also reporting multiple health issues. Heavy metal concentrations utilizing AAS revealed significantly (p = 0.000) higher levels of cadmium, chromium, and nickel, while PIXE detected more than permissible levels of Si, P, S, Cl, K, Ca, Zn, Ti (p = 0.052), Mn (p = 0.017), Fe (p = 0.055), Co (p = 0.011), Ni (p = 0.045), and Cu (p = 0.003), in the blood of kiln workers. Moreover, a significant increase in platelet count (P = 0.010), a decrease in sodium dismutase levels (p = 0.006), a major increase in reactive oxygen species (p = 0.001), and a reduction in protein content (p = 0.013) were evident. A significant increase in cortisol levels (p = 0.000) among the workers group was also observed. The concentration of LH and FSH increased significantly (p = 0.000), while that of testosterone decreased (p = 0.000) in the worker group compared with controls. A significant inverse relationship was found between cortisol, LH (r = − 0.380), and FSH (r = − 0.946), while a positive correlation between cortisol and testosterone was also evident (r = 0.164). The study concludes that increased heavy metal burden in the blood of brick kiln workers exposes them to the development of general and reproductive health problems due to compromised antioxidant enzyme levels, increased oxidative stress conditions, and a disturbing reproductive axis.

Factors Associated with Significant Platelet Count Improvement in Thrombocytopenic Chronic Hepatitis C Patients Receiving Direct-Acting Antivirals.

To clarify the predictive factors of significant platelet count improvement in thrombocytopenic chronic hepatitis C (CHC) patients. CHC patients with baseline platelet counts of <150 × 103/μL receiving direct-acting antiviral (DAA) therapy with at least 12-weeks post-treatment follow-up (PTW12) were enrolled. Significant platelet count improvement was defined as a ≥10% increase in platelet counts at PTW12 from baseline. Platelet count evolution at treatment week 4, end-of-treatment, PTW12, and PTW48 was evaluated. This study included 4922 patients. Sustained virologic response after 12 weeks post-treatment was achieved in 98.7% of patients. Platelet counts from baseline, treatment week 4, and end-of-treatment to PTW12 were 108.8 ± 30.2, 121.9 ± 41.1, 123.1 ± 43.0, and 121.1 ± 40.8 × 103/μL, respectively. Overall, 2230 patients (45.3%) showed significant platelet count improvement. Multivariable analysis revealed that age (odds ratio (OR) = 0.99, 95% confidence interval (CI): 0.99–1.00, p = 0.01), diabetes mellitus (DM) (OR = 1.20, 95% CI: 1.06–1.38, p = 0.007), cirrhosis (OR = 0.66, 95% CI: 0.58–0.75, p < 0.0001), baseline platelet counts (OR = 0.99, 95% CI: 0.98–0.99, p < 0.0001), and baseline total bilirubin level (OR = 0.80, 95% CI: 0.71–0.91, p = 0.0003) were independent predictive factors of significant platelet count improvement. Subgroup analyses showed that patients with significant platelet count improvement and sustained virologic responses, regardless of advanced fibrosis, had a significant increase in platelet counts from baseline to treatment week 4, end-of-treatment, PTW12, and PTW48. Young age, presence of DM, absence of cirrhosis, reduced baseline platelet counts, and reduced baseline total bilirubin levels were associated with significant platelet count improvement after DAA therapy in thrombocytopenic CHC patients.

The effect of hyperbaric oxygenation on the state of blood cells in children with inflammatory bowel diseases

The aim of this work is to determine changes in erythrocyte and platelet indices during standard therapy for inflammatory bowel diseases (IBD) in children and combination with hyperbaric oxygenation (HBO). Materials and methods. We used the blood of 147 children of both genders aged 6-17 years with IBD: 76 - with Crohn’s disease (CD), 71 - with ulcerative colitis (UC). The complex of treatment for patients (16 with CD, 11 with UC) included HBO therapy, which was carried out in a single air-oxygen pressure chamber «BaroOx 1.0». The course consisted of 5-8 daily sessions in the 1.3-1.4 atm regime for 40 minutes. The number of platelets and blood cell indices in all patients were determined: MCV, RDW, MCH, MCHC, MPV, PDW. Results. IBD in children is characterized by a significant increase in platelet count, a decrease in MCV and MPV, and an increase in RDW and PDW. The use of HBO in IBD treatment promotes an increase in MCV, MCHS and a tendency to decrease the number of platelets. Conclusion. The patterns of changes in the qualitative and quantitative characteristics of blood cells that we have established indicate that the use of HBO to the standard treatment protocol for IBD in children contributes to the correction of the identified disorders.

Different platelet-rich plasma preparation protocols in Female pattern hair loss: Does it affect the outcome? A pilot study.

Platelet-rich plasma (PRP) injection is a promising modality for hair regeneration in female pattern hair loss (FPHL). A standard protocol on best methods for PRP preparation has not been established. To optimize standard PRP preparation protocols and evaluate its clinical efficacy in FPHL. Comparative study enrolled 40 female patients with FPHL divided randomly into 4 equal groups. Each group received 3 sessions of monthly intradermal injection of PRP prepared by different methods regarding number of spins, centrifugation speeds, type of the centrifuge, and the size of PRP tube. Patients were evaluated by trichoscan before and 1month after the 3rd session for number of terminal, vellus hair, and average hair width. A statistically significant increase in platelet count in PRP prepared by combination of digital centrifuge, large-sized sodium citrate tube, and low centrifugation speed (900rpm). All patients showed statistically significant increase in percentage of terminal hair and average width of hair after treatment as assessed by trichoscan, without statistically significant difference between studied groups. Digital centrifuge, large-sized sodium citrate tubes, and a single spin with low centrifugation speed (900rpm) were ideal for PRP preparation. PRP is an effective and safe modality in FPHL therapy.

Therapeutic plasma exchange in HELLP syndrome: A life savior.

BACKGROUND:HELLP (hemolysis, elevated liver enzymes, low platelet count) syndrome occurs in about 0.5%–0.9% of all pregnancies, but its prevalence is higher in patients with severe preeclampsia, accounting for a substantial maternal and perinatal morbidity and mortality. According to the latest American Society for Apheresis guidelines, Therapeutic plasma exchange (TPE) performed for postpartum cases and antepartum HELLP syndrome cases fall in Categories III and IV, respectively.MATERIALS AND METHODS:Retrospective analysis was done at our tertiary care center from January 2014 to June 2019 for patients diagnosed with HELLP syndrome. Clinical data for age, gestational age at the time of diagnosis, type of delivery, outcome of pregnancy, history of preeclampsia /eclampsia, hemoglobin levels, AST, ALT, LDH, platelet counts, prothrombin time, activated partial thromboplastin time, international normalised ratio, complete blood count, was obtained from patients' electronic medical records. The TPE was initiated within 24 hrs of diagnosis. All TPE was done on Spectra Optia apheresis system (Terumo BCT, Inc, USA). Statistical testing was conducted with the statistical package for the social science system version SPSS 20.0 and R-3.2.0. Continuous variables were expressed as mean±SD and were compared between Pre and Post TPE records of patients by using the paired T test.RESULTS:Nine patients fulfilled the criteria of HELLP syndrome. Seven (77.8%) were diagnosed in the postpartum period and 2 (22.2%) during the second trimester. Out of the total nine patients, two patients (22.2%) recovered completely and were discharged on day 15 ± 7 days, whereas 4 (44.4%) patients were discharged on day 21 ± 7 days with the advice of hemodialysis. Two (22.2%) patients had an intrauterine death and were discharged 3–4 days after the demise. In all these patients (except one), the TPE was initiated within 24 h of the diagnosis. A significant increase in platelet count and decrease in the lactate dehydrogenase levels (P < 0.05) was observed post TPE.CONCLUSION:Our data showed that TPE improved the treatment outcome in patients with HELLP syndrome despite being a Category III and IV indication among postpartum and antenatal females, respectively. However, a timely diagnosis and management are of paramount importance for a favorable outcome. TPE needs to be performed within 24 h of the diagnosis postdelivery when the patient is not responsive to the usual therapies, especially in class I HELLP syndrome.

Determination of Coagulation Profile among Children with Sickle Cell: Anemia in Steady-State and Crisis

Background: Patients with Sickle Cell Disease (SCD) have been found to have an aberrant coagulation profile. One of the primary elements hypothesized to contribute to the vaso-occlusive crisis that characterizes sickle cell disease is coagulopathy (SCD)&#x0D; Material and Methods: A total of 150 children were enrolled as follows, 50 children with Sickle Cell Anemia (SCA) in steady-state, 50 in crisis, and 50 with Hb AA genotype as control. 5 ml of Venous blood was collected. The platelets count was performed using Sysmex KX21N, the electrical impedance principle. The Mean Platelet Volume (MPV) is derived from the impedance platelet size distribution curve. STAGO PT31039352) semi-automated machine was used for estimation of PT, and APTT.&#x0D; Result: children with SCA have significantly a prolonged PT, and APTT compared with children with normal hemoglobin genotype (P. value &lt; 0.001) the mean of PT was (16.64, and 12.6) respectively, and APTT (41.45 and 37.94) consequently. A significant increase in platelet count between patients with SCA when compared with control (p. value 0.02), however a significant prolonged in APTT when compared to steady-state (P. value 0.005). MPV among children with crises when compared with steady-state revealed a significant result (p. value 0.006) the mean of MPV in steady-state = 6.79 while the mean of MPV in crisis = 7.09.&#x0D; Conclusion: children with sickle cell anemia had a longer coagulation profile and marked variation in platelet count, which may increase the risk of thrombosis or bleeding.

Role of Corticosteroids In Dengue Fever in Pakistan

Aim: To compare and evaluate clinical efficacy of corticosteroids in thrombocytopenia in patients suffering from moderate to severe Dengue. Methods: This randomized single blinded study was conducted at Furqan Clinic Gulbahar Peshawar from August 2021 to October 2021. 100 individuals of ages between 20 to 60 years irrespective of gender, with positive NS1 antigen test and no co-morbidities were included in study by convenient sampling technique. Patients with dengue and Covid-19 were excluded from the study. Randomization was done in four treatment groups. Consent was taken from all patients prior treatment with Cefixime, artemether/lumefantrine, IV Dexamethasone in adjunct to oral papaya leaf extracts. Duration of study was 3 months. Statistical analysis done using SPSS software version 24. Results: Group C and D showed the significant increase in platelet count as compared to group A and B. Pronounced effect was observed in group D. Conclusion: Intravenous Dexamethasone produced more beneficial effects in adjunct to oral carica papaya leaf extracts on thrombocytopenia with reduced risk of bleeding. Keywords: Artemether, carica papaya leaf , Dexamethasone, Lumefantrine, platelet count