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Renee Eslick, Claire McLintock
Around 1 in 10 pregnant women will develop thrombocytopenia during an otherwise unremarkable pregnancy. While the most frequent cause is gestational thrombocytopenia, a benign clinical entity which typically induces a mild platelet fall in late pregnancy, a number of important pregnancy-specific causes must be excluded, particularly pre-eclampsia and its severe form hemolysis with elevated liver enzymes and low platelets (HELLP). For women who do not have an identifiable pregnancy-related cause of thrombocytopenia, an underlying medical condition should be considered...
July 11, 2019: Platelets
Lamya Garabet, Waleed Ghanima, Marit Hellum, Per Morten Sandset, James B Bussel, Hoa Tran, Carola E Henriksson
Immune thrombocytopenia (ITP) patients have thrombocytopenia and increased bleeding risk, but, conversely, they also have increased thrombotic risk which appears to be exacerbated by thrombopoietin-receptor agonist (TPO-RA)-treatment. Microvesicles (MVs) released from activated/apoptotic cells are prothrombotic due to exposure of phosphatidylserine (PS) and tissue factor (TF). MVs are increased in ITP patients, but their prothrombotic effect, before and during treatment with TPO-RAs, is unclear. We studied the effect of TPO-RAs on the procoagulant activity of MVs in 11 ITP patients, before, and two and six weeks after initiation of treatment, and in 15 healthy controls...
July 7, 2019: Platelets
Samuel Deshayes, Bertrand Godeau
Less than 40% of patients with newly diagnosed adult immune thrombocytopenia will show spontaneous recovery within 12 months. Therefore, second-line treatments are frequently used to maintain a hemostatic platelet count or at best to cure the disease, with as few adverse effects as possible. Nevertheless, we lack head-to-head comparison studies of the different available treatments. Moreover, physicians have no robust predictors of response to guide decision-making on an individual basis. Therefore, there is no consensus, and decisions when to treat and with which drug must be individualized and shared with the patient based on factors related to the patient and the available second-line treatments...
July 5, 2019: Platelets
Jaime Shaw, Karynsa Kilpatrick, Melissa Eisen, Michael Tarantino
Immune thrombocytopenia (ITP) is the most common bleeding disorder diagnosed in children. Characterized by low platelet counts, it leads to reduced clotting abilities and an increased tendency to bleed. The disorder in children is often self-limiting. However, approximately 25% of children develop persistent or chronic ITP, and bleeding associated with thrombocytopenia can be life-threatening. The current incidence of ITP in the US and the characterization of the illness among children being managed in routine clinical practice are sparsely reported...
July 4, 2019: Platelets
Fiona Swain, Robert Bird
Thrombocytopenia is a common reason for referral to hematologists in community and hospital practice. A broad differential diagnosis, combined with the potentially life-threatening nature of some presentations necessitates a rapid evaluation of the situation and potential need for emergency intervention; followed by further comprehensive investigation to confirm the diagnosis and institution of longer term management. This review offers an approach to the initial assessment, diagnosis, and referral. We then highlight aspects of the clinical history, examination and laboratory investigations which may provide critical insights into the most likely diagnosis...
July 3, 2019: Platelets
Ichiro Wakabayashi
Alcohol inhibits platelet function, and platelet count is often reduced in individuals with alcohol use disorder. However, the relation of habitual alcohol drinking with platelet count in a general population remains to be determined. The participants were 6508 men (30 ~ 69 years old) who had received annual health checkup examinations, and most of them (98.6%) were nondrinkers or drinkers with an average ethanol intake of less than 66 g per day. Relationships of platelet count with alcohol intake were investigated by using analysis of covariance and multivariate linear and logistic regression analyses...
July 3, 2019: Platelets
Jenny Q D Tran, Oliver H Pedersen, Mads L Larsen, Erik L Grove, Steen D Kristensen, Anne-Mette Hvas, Peter H Nissen
Essential thrombocythemia (ET) is characterized by persistently elevated platelet counts and an increased risk of thromboembolic events. Dysregulated expression of small noncoding microRNAs (miRNAs) have been shown in ET and may influence platelet maturity and function in ET patients. In this study, we included 22 ET patients and 19 healthy controls to investigate the expression of 12 platelet miRNAs previously reported to be dysregulated in ET. Further, we investigated the correlation between the expression of selected miRNAs and platelet maturity and platelet function...
June 26, 2019: Platelets
Anna Lecchi, Eti A Femia, Silvia La Marca, Francesco Onida, Andrea Artoni
The pathophysiology of impaired platelet function in acquired disorders is often poorly understood. We report two unrelated patients with hematologic malignancies associated with acquired severe bleeding diathesis, and complex platelet function abnormalities, including overproduction of the physiological inhibitor cyclic-AMP (cAMP). Patient 1, with mild macrocytic anemia and thrombocytopenia (100 x 109 /L), was diagnosed with chronic myelomonocytic leukemia a few months after the onset of her bleeding diathesis and our analysis of platelet function...
June 26, 2019: Platelets
Lore De Kock, Chantal Thys, Kate Downes, Daniel Duarte, Karyn Megy, Chris Van Geet, Kathleen Freson
A germline heterozygous gain-of-function p .E527K variant in tyrosine kinase SRC was previously found to cause thrombocytopenia, myelofibrosis, bleeding, bone pathologies, premature edentulism and mild facial dysmorphia in nine patients of a single pedigree. Because of this variant, SRC loses its self-inhibitory capacity, causing constitutively active SRC expression in platelets. These patients have fewer and heterogeneous-sized platelets that are hyporeactive to collagen. We now report a 5-year-old girl with syndromic thrombocytopenia due to the same SRC-E527K variant that occurs de novo ...
June 17, 2019: Platelets
Mie Shimizu, Tatsunori Natori, Keisuke Tsuda, Makiko Yoshida, Asami Kamada, Kiyotaka Oi, Yoko Ishigaku, Kazumasa Oura, Shinsuke Narumi, Masahiro Yamamoto, Yasuo Terayama
Dabigatran, a direct oral thrombin inhibitor, has two therapeutic effects: anticoagulation; and antiplatelet activity. In the clinical field, evaluation of the effect of dabigatran on thrombin-induced platelet aggregation is difficult because of fibrin clot formation and platelet aggregation. The aim of this study was to establish a new platelet aggregation method and to investigate the effects of dabigatran on thrombin-induced platelet aggregation. Platelet aggregation with thrombin was performed with automated light transmission aggregometry (CS2400; Sysmex, Kobe, Japan) in 40 healthy subjects...
June 4, 2019: Platelets
Yunjie Li, Yuye Shi, Zhengmei He, Qiuni Chen, Zhenyou Liu, Liang Yu, Chunling Wang
Rituximab has been frequently used as a second-line treatment for patients with immune thrombocytopenia (ITP). Recently, several studies have proposed low-dose (100 mg or 100mg/m2 per week for 4 weeks) rituximab instead of the standard dose of 375mg/m2 per week for 4 weeks to treat ITP patients. The aim of this review was to systematically evaluate the efficacy and safety of low-dose rituximab for patients with ITP. Pubmed, Web of Science, Cochrane Library and Embase were searched to identify the clinical studies published in full text or abstract that met the predefined inclusion criteria...
June 3, 2019: Platelets
Rick Kapur, Rukhsana Aslam, Edwin R Speck, Johan M Rebetz, John W Semple
Immune thrombocytopenia (ITP) is an autoimmune bleeding disorder in which autoantibodies and/or autoreactive T cells destroy platelets and megakaryocytes in the spleen and bone marrow, respectively. Thrombopoietin receptor agonists (TPO-RA e.g. Romiplostim and Eltrombopag) have made a substantial contribution to the treatment of patients with ITP, which are refractory to first-line treatments and approximately 30% demonstrate sustained elevated platelet counts after drug tapering. How TPO-RA induce these sustained responses is not known...
May 30, 2019: Platelets
Bjarne Østerud, Beth A Bouchard
Tissue factor (TF) is the most important trigger for the extrinsic coagulation pathway. TF, earlier denoted as thromboplastin, has always been a mystery since its discovery due to its abundant presence in most human tissues but not blood. The latter has been extensively studied in a vast quest for possible sources of blood-borne TF yielding many conflicting findings and confusing conclusions regarding the presence of TF mRNA, protein or functional procoagulant activity in virtually all blood cells. Platelets, in particular, have been heavily scrutinized by investigators eager to demonstrate expression of TF...
May 30, 2019: Platelets
Xareni Valle-Jiménez, Adriana Ramírez-Cosmes, Alba Soledad Aquino-Domínguez, Francisco Sánchez-Peña, José Bustos-Arriaga, María De Los Ángeles Romero-Tlalolini, Honorio Torres-Aguilar, Jeanet Serafín-López, Sergio Roberto Aguilar Ruíz
Platelets are anucleate cells that have a role in several innate immune functions, including the secretion of proteins with antimicrobial activity. Several studies have demonstrated the ability of platelets to secrete thrombin-induced platelet microbicidal proteins and antimicrobial peptides, like hBD-1. However, the expression and secretion of defensins of the alpha family by platelets have not been fully elucidated. The aim of this study was to characterize the expression of defensin alpha 1 (DEFA1) in human platelets and megakaryocytes...
May 22, 2019: Platelets
Rodriguez Nuñez Rosa María, Rubio Lacambra Laura, Palomo Bravo Ángeles, Langenhorst Baniandres Laura
Thrombocytopenia could appear during pregnancy, in up to 8-10% of the cases, where 3-5% is related to an autoimmune process so-called immune thrombocytopenia (ITP). We present a 34-year-old woman debuted at 13 weeks gestation, with a platelet count of 19 × 109 /L and petechiae. She did not respond to initial treatment with corticosteroids and intravenous immunoglobulin. At this point, considering the limited treatment options due to toxicity and/or teratogenesis of other drugs proven to be effective against ITP like azathioprine, rituximab, cyclophosphamide, etc...
May 22, 2019: Platelets
Zhengjing Lu, Lauriane Nikuze, Zhoulin Zhong, Fang Li, Fuyong Zhang, Kairong Liang, Manlv Wei, Hongying Wei
Glanzmann thrombasthenia (GT) is an inherited disorder of platelet aggregation resulting from quantitative and/or qualitative abnormalities of the glycoprotein IIb/IIIa complex. We analyzed the expression of GPIIb/IIIa and the gene sequencing in two pedigrees with GT, so as to determine the type and the relationship between genotype and clinical phenotype. Platelet aggregation tests and flow cytometric studies were performed, along with gene sequencing. Both probands were classified as grade III of bleeding...
May 14, 2019: Platelets
Annabella Braschi
Following acute exercise, normotensive and hypertensive subjects both undergo changes in hemostatic and fibrinolytic properties, but the hypertensive patient's response to exercise is exaggerated and prolonged, exposing them to increased cardiovascular risk during or immediately after unusual and strenuous exercise. Thrombotic complications are triggered by the activation of the autonomic sympathetic nervous system in a pathological milieu characterized by platelet α2 -adrenergic receptors with increased responsiveness to circulating catecholamine, altered platelet profile and function, abnormal hemostatic parameters, impaired fibrinolytic potential, and endothelial dysfunction...
May 12, 2019: Platelets
Ana C Antunes Naime, Pedro H L Bonfitto, Carolina Solon, Maria Elisa Lopes-Pires, Gabriel F Anhê, Edson Antunes, Sisi Marcondes
Increased reactive oxygen species (ROS) production leads to tissue damage observed in sepsis and lipopolysaccharide (LPS)-exposed animals. LPS stimulates cytokines releasing, including tumor necrosis factor alpha (TNF-α), that is important to ROS production. Platelets, considered inflammatory cells, generate ROS when exposed to LPS in vivo, but not when they are incubated in vitro with this compound. Therefore, we investigated the role of TNF-α on the increased intraplatelet ROS levels after LPS treatment...
May 10, 2019: Platelets
Martine Jandrot-Perrus, Cedric Hermans, Diego Mezzano
Platelet membrane glycoprotein VI (GPVI) is increasingly recognized as an important receptor for thrombus formation and growth. Numerous arguments have been published indicating that GPVI plays a major role in thrombosis without being essential for physiological hemostasis. In humans, GPVI deficiencies are rarely reported. These are most often deficiencies occurring in the context of autoimmunity and, more rarely, genetic deficits. The purpose of this review is to compile data on the quantitative and qualitative genetic abnormalities of GPVI...
May 8, 2019: Platelets
Takeshi Hagino, Nelson Hirokazu Tsuno, Fumihiro Azuma, Hideo Ohtani, Reina Matsui, Chie Someya, Yutaka Kato, Satoko Osanai, Hiroko Hidai, Hisashi Tsutsumi, Hideki Akiyama, Sayuri Motomura, Tetsunori Tasaki
The efficacy of 30 platelet concentrate (PC) products transfused to a patient with myelodysplastic syndrome (MDS) was evaluated by calculating the 1-hour post-transfusion corrected count increment (1h-CCI). Of the 30 transfusions, all HLA-A/B-matched, the cross-match (CM) test was negative in 23 (CM(-)-PC) and weakly positive (CM(+)-PC) in 2, and the CM test was not conducted in 5 (non-CM-PC). The effective rate was higher with CM(-)-PC compared to non-CM-PC (82.6% vs 60%), but statistical significance was not achieved, which suggested that the CM test of PC may still be a not satisfactorily effective predictor of PC refractoriness...
May 8, 2019: Platelets
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