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Li X, Wang S, Ma J, Bai SG, Fu SZ. Predictive value of thrombocytopenia for bloodstream infection in patients with sepsis and septic shock. World J Crit Care Med 2024; 13:88540. [PMID: 38633475 PMCID: PMC11019628 DOI: 10.5492/wjccm.v13.i1.88540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 12/04/2023] [Accepted: 01/02/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND Thrombocytopenia is common in patients with sepsis and septic shock. AIM To analyse the decrease in the number of platelets for predicting bloodstream infection in patients with sepsis and septic shock in the intensive care unit. METHODS A retrospective analysis of patients admitted with sepsis and septic shock in Xingtai People Hospital was revisited. Patient population characteristics and laboratory data were collected for analysis. RESULTS The study group consisted of 85 (39%) inpatients with bloodstream infection, and the control group consisted of 133 (61%) with negative results or contamination. The percentage decline in platelet counts (PPCs) in patients positive for pathogens [57.1 (41.3-74.6)] was distinctly higher than that in the control group [18.2 (5.1-43.1)] (P < 0.001), whereas the PPCs were not significantly different among those with gram-positive bacteraemia, gram-negative bacteraemia, and fungal infection. Using receiver operating characteristic curves, the area under the curve of the platelet drop rate was 0.839 (95%CI: 0.783-0.895). CONCLUSION The percentage decline in platelet counts is sensitive in predicting bloodstream infection in patients with sepsis and septic shock. However, it cannot identify gram-positive bacteraemia, gram-negative bacteraemia, and fungal infection.
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Affiliation(s)
- Xia Li
- Department of Critical Care Medicine, Xingtai People Hospital, Xingtai 054001, Hebei Province, China
| | - Sheng Wang
- Department of Physiology, Hebei Collaborative Innovation Center for Cardio-cerebrovascular Disease, Hebei Medical University, Shijiazhuang 050000, Hebei Province, China
| | - Jun Ma
- Department of Critical Care Medicine, Xingtai People Hospital, Xingtai 054001, Hebei Province, China
| | - Su-Ge Bai
- Department of Critical Care Medicine, Xingtai People Hospital, Xingtai 054001, Hebei Province, China
| | - Su-Zhen Fu
- Department of Critical Care Medicine, Xingtai People Hospital, Xingtai 054001, Hebei Province, China
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Zheng J, Zhang J, Jin Y, Wang Y, Xu L, Zheng H, Jiang H, Yuan C. Characteristics of primary Sjögren's syndrome-associated peripheral nervous system lesions. J Neurol 2023; 270:5527-5535. [PMID: 37523064 DOI: 10.1007/s00415-023-11883-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 06/24/2023] [Accepted: 07/18/2023] [Indexed: 08/01/2023]
Abstract
OBJECTIVE The aim of this study is to investigate potential risk factors associated with peripheral nervous system lesions in primary Sjögren's syndrome (pSS) through a retrospective analysis of clinical manifestations, examination characteristics, and clinical electrophysiological features. MATERIALS AND METHODS A retrospective case-control study was conducted at Nanfang Hospital, including 108 patients diagnosed with pSS following the criteria revised by the American College of Rheumatology in 2016. The study spanned from January 2015 to October 2020. The patient cohort was divided into two groups, an experimental group (N = 27) consisting of patients with primary Sjögren's syndrome-peripheral nervous system lesions (pSS-PNS), and a control group (N = 81) comprising patients without peripheral neurological impairment, i.e., primary Sjögren's syndrome-non peripheral nervous system lesions (pSS-nPNS). RESULTS The results showed a significant correlation between immunoglobulin G (IgG), α-Fodrin immunoglobulin G (α-FIgG), platelet counts (PLT), dry mouth and peripheral neuropathy of Sjogren's syndrome (p < 0.01). The research also revealed that α-FIgG (OR 2.03; 95% CI 1.14-3.64), IgG (OR 1.23; 95% CI 1.06-1.42), and PLT (OR 1.01; 95% CI 1.00-1.01) were identified as risk factors for the onset of peripheral neuropathy of Sjogren's syndrome, while dry mouth had a negative correlation (OR 0.08; 95% CI 0.02-0.40). Remarkably, the total risk assessment of the independent variables demonstrated a high AUC (95%CI) of 0.923 (0.861-0.986; p < 0.001), indicating an excellent prediction of pSS-PNS occurrence through the ROC analysis. Additionally, high platelet counts and strong positive anti-SSB antibody titer were found to be risk factors for dual motor and sensory nerve damages among pSS-PNS patients. CONCLUSION IgG, α-FIgG, and PLT were identified as independent risk factors for patients with pSS-PNS. The likelihood of peripheral neuropathy appeared to increase in tandem with the elevated levels of above three factors. Interestingly, we found that dry mouth might play a protective role in this context. Our study further noted that both high platelet counts and strong positive anti-SSB antibody titer may be associated with increased risk of both motor and sensory nerve involvement in pSS-PNS patients. These findings have significant implications for both the etiologies and therapeutics of pSS-PNS.
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Affiliation(s)
- Jiaman Zheng
- Department of Neurology, Nanfang Hospital, Southern Medical University, 1838# North Guangzhou Avenue, Guangzhou, 510515, China
| | - Jiayu Zhang
- Department of Neurology, Nanfang Hospital, Southern Medical University, 1838# North Guangzhou Avenue, Guangzhou, 510515, China
| | - Ying Jin
- Second Clinical Medical College, Southern Medical University, Guangzhou, 510515, China
| | - Yang Wang
- School of Rehabilitation Sciences, Southern Medical University, Guangzhou, 510515, China
| | - Liying Xu
- Department of Neurology, Nanfang Hospital, Southern Medical University, 1838# North Guangzhou Avenue, Guangzhou, 510515, China
| | - Hui Zheng
- Department of Neurology, Nanfang Hospital, Southern Medical University, 1838# North Guangzhou Avenue, Guangzhou, 510515, China
| | - Haishan Jiang
- Department of Neurology, Nanfang Hospital, Southern Medical University, 1838# North Guangzhou Avenue, Guangzhou, 510515, China.
| | - Chao Yuan
- Department of Neurology, Nanfang Hospital, Southern Medical University, 1838# North Guangzhou Avenue, Guangzhou, 510515, China.
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Fujiwara S, Sakai N, Imamura H, Ohara N, Tanaka K, Yamagami H, Matsumoto Y, Takeuchi M, Uchida K, Yoshimura S, Morimoto T. Impact of thrombocytopenia on hemorrhagic complications after endovascular therapy for acute large vessel occlusion: Sub-analysis of RESCUE-Japan registry 2. J Neurol Sci 2023; 449:120659. [PMID: 37079972 DOI: 10.1016/j.jns.2023.120659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 03/14/2023] [Accepted: 04/10/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND Endovascular treatment (EVT) for patients with large vessel occlusion (LVO) and concurrent thrombocytopenia raises concerns about hemorrhagic complications. We examined the association between thrombocytopenia and clinical outcomes after EVT. METHODS This is a sub-analysis of the RESCUE-Japan Registry 2, a nationwide registry that enrolled 2420 consecutive acute LVO patients. We evaluated the clinical outcomes in patients who underwent EVT according to their platelet count on admission (Moderate/Severe, < 100 × 109 /L; Mild, 100 to ≤150 × 109/L; Normal, ≥ 150 × 109/L). The outcomes included any and symptomatic intracranial hemorrhage (ICH) after EVT, and modified Rankin Scale (mRS) at 90 days. RESULTS Of 1268 patients who underwent EVT, the Moderate/Severe and Mild groups consisted of 41 (3.2%), and 193 (15.2%) patients. Any ICH occurred in 37%, 35%, and 24% of Moderate/Severe, Mild, and Normal group patients, respectively, and the adjusted ORs (95% CIs) were 1.50 (0.71-3.18) for Moderate/Severe and 1.87 (1.28-2.73) for Mild, compared to the Normal group (p for trend = 0.004). Symptomatic ICH increased with the severity of thrombocytopenia (9.8% vs 3.6% vs 2.1%), and adjusted ORs were 4.43 (1.16-17.0) in Moderate/Severe and 1.85 (0.71-4.86) in Mild (p for trend = 0.10). Mortality was significantly associated with the severity of thrombocytopenia (p for trend = 0.005), and adjusted ORs were 3.26 (1.29-8.26) in the Moderate/Severe and 2.76 (1.58-4.84) in the Mild groups. CONCLUSIONS Thrombocytopenia in LVO patients was not rare and associated with the incidence and manifestation of ICH after EVT.
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Affiliation(s)
- Satoru Fujiwara
- Department of Neurology, Kobe City Medical Center General Hospital, Kobe, Japan; Department of Clinical Epidemiology, Hyogo Medical University, Nishinomiya, Japan
| | - Nobuyuki Sakai
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Hirotoshi Imamura
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan; Division of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Nobuyuki Ohara
- Department of Neurology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Kanta Tanaka
- Division of Stroke Care Unit, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Hiroshi Yamagami
- Department of Stroke Neurology, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Yasushi Matsumoto
- Department of Neuroendovascular Therapy, Kohnan Hospital, Sendai, Japan
| | | | - Kazutaka Uchida
- Department of Clinical Epidemiology, Hyogo Medical University, Nishinomiya, Japan; Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan
| | - Shinichi Yoshimura
- Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo Medical University, Nishinomiya, Japan.
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Zhu J, Luo L, Guo W, Wang B, Pan B. A Vortex Method to Disaggregate Platelets for Correct Counting in Pseudothrombocytopenia. Indian J Hematol Blood Transfus 2023; 39:330-334. [PMID: 37006969 PMCID: PMC10064346 DOI: 10.1007/s12288-022-01582-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 09/13/2022] [Indexed: 04/04/2023] Open
Abstract
Pseudothrombocytopenia (PTCP) refers to the aggregation of platelets in anticoagulant blood in vitro and causes a false lower platelet count (PLT). For the purpose to achieve an accurate PLT, we presented an alternative vortex method to disaggregate platelet clumps and consequently generate a reliable PLT without a second venous puncture for patients. PLT, mean-platelet-volume (MPV), red blood cells (RBCs), hematoglobin (Hb), hematocrit (Hct) and white blood cells (WBCs) were evaluated before and after vortex in 221 specimens with PTCP using vortex method, and the PLT was also compared with 85 specimens disaggregated by citrate method. Twenty control samples were used to investigate mixing effect on complete blood counts in normal samples. One thrombocytopenia specimen was used to evaluate reproducibility of vortex. The mean PLT, MPV, RBCs, Hb, Hct and WBCs of 20 control specimens pre-vortex were 260.7 ± 53.4 × 109/L, 11.65 ± 0.85, 4.87 ± 0.46 × 1012/L, 147.6 ± 13.8 g/L, 45.31 ± 4.04, 6.46 ± 1.41 × 109/L, and results of post-vortex were 252.9 ± 50.2 × 109/L, 11.66 ± 0.92, 4.95 ± 0.48 × 1012/L, 149.1 ± 13.8 g/L, 45.19 ± 4.03, 6.35 ± 1.36 × 109/L respectively. Specimens with platelet clumps using vortex mixer had higher PLT after mixing, the mean pre-vortex PLT was 54.3 ± 35.2 × 109/L, and after vortexing PLT increased to 157.5 ± 58.8 × 109/L (p < 0.05). MPV, RBCs, Hb, Hct and WBCs in 221 specimens were comparable before and after vortex mixing (all p > 0.05). Vortex method might disaggregate platelet clumps sufficiently in most PTCP specimens, and obtain a relatively reliable PLT without the need of a second venous puncture.
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Affiliation(s)
- Jianfeng Zhu
- Department of Laboratory Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Lei Luo
- Department of Laboratory Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wei Guo
- Department of Laboratory Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Beili Wang
- Department of Laboratory Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Baishen Pan
- Department of Laboratory Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
- Department of Laboratory Medicine, Xiamen Branch, Zhongshan Hospital, Fudan University, Xiamen, China
- Department of Laboratory Medicine, Wusong Branch, Zhongshan Hospital, Fudan University, Shanghai, China
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Su X, Zhao W. Platelet aggregation in normal pregnancy. Clin Chim Acta 2022; 536:94-97. [PMID: 36169058 DOI: 10.1016/j.cca.2022.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 09/04/2022] [Accepted: 09/14/2022] [Indexed: 11/29/2022]
Abstract
It was recently shown that abnormal platelet aggregation (PA) had played a critical role in some adverse pregnancies. Till now reference range for PA in normal pregnancy has not been determined. Furthermore, few study has been conducted to explore the factors related to PA. Our study was performed to assess the reference range of PA in normal pregnancy (150 participants in the second trimester), and to determine whether it differs from that of the controls (38 nonpregnant participants). In addition, this study explored the factors related to PA. The results showed that PA was significantly higher in normal pregnancy than that in the controls (84.40% vs. 80.7%, respectively, P = 0.013). The reference interval for PA in normal pregnancy was 74.75%-94.77%. Hemoglobin (Hb), platelet counts (PLT) and albumin (Alb) were significant lower in normal pregnancy than those in the control group. Moreover, it was found that PA was positively correlated with PLT (r = 0.263, P < 0.001), and negatively correlated with platelet distribution width (PDW) (r = -0.342, P < 0.001) and mean platelet volume (r = -0.296, P < 0.001). Linear correlations between PA and Alb, PDW were proved by linear regression model (LRM). In conclusion, PA was enhanced in normal pregnancy, and Alb and PDW might be the possible contributing factors to PA.
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Affiliation(s)
- Xiaoling Su
- Department of Obstetrics and Gynecology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Weixiu Zhao
- Department of Obstetrics and Gynecology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Bi Y, Wang Z, Feng S, Wang Y, Zhao Y, Li H, Yu J, Liu Q, Zhu C, Li M. Dynamic trajectory of platelet counts after the first cycle of induction chemotherapy in AML patients. BMC Cancer 2022; 22:477. [PMID: 35501722 PMCID: PMC9059911 DOI: 10.1186/s12885-022-09601-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 04/21/2022] [Indexed: 12/24/2022] Open
Abstract
Background Platelet counts varied over time after induction chemotherapy. We aimed to investigate the different trajectories of platelet counts after the first cycle of induction chemotherapy in patients newly diagnosed with acute myeloid leukemia. Methods and results In total, 149 individuals were included in this study. We identified four distinct trajectories using a group-based trajectory model: low- stability group (n = 27, 18.12%), low-level decrease–medium elevation group (n = 42, 28.19%), low-level decrease–high elevation group (n = 60, 40.27%), and high-level decrease–medium elevation group (n = 20, 13.42%). The baseline characteristics of the high-level decrease–medium elevation group included higher platelet count, lower white blood cell count, lower percentage of bone marrow blasts, and lower rates of complete remission after the first cycle of induction chemotherapy. Compared with the low-stability group, the hazard ratios were 0.32 (95% confidence interval, 0.15–0.68) for the low-level decrease–medium elevation group, 0.31 (95% confidence interval, 0.15–0.63) for the low-level decrease–high elevation group, and 0.35 (95% confidence interval, 0.13–0.89) for the high-level decrease–medium elevation group after adjustment for age and gender by Cox proportional hazard regression. Compared with the low-stability group, the hazard ratios were 0.33 (95% confidence interval, 0.14–0.77) for the low-level decrease–medium elevation group and 0.31 (95% confidence interval, 0.14–0.67) for the low-level decrease–high elevation group after adjustment for age, gender, white blood cell count, and bone marrow blasts. These associations persisted after adjusting for age, gender, white blood cell count, bone marrow blasts, and platelet count. Conclusion The dynamic trajectory of platelet counts after the first cycle of induction chemotherapy is a significant predictor of all-cause mortality in patients with acute myeloid leukemia. Timely intervention should be considered for the low-stability group. The low-level decrease–medium elevation and low-level decrease-high elevation groups were independent protective factors for all-cause mortality.
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Affiliation(s)
- Yazhen Bi
- Shandong Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.,Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, Shandong, China
| | - Zhaohui Wang
- Department of Hematology, Haici Medical Group Qingdao, Qingdao, Shandong, China
| | - Saran Feng
- Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, Shandong, China
| | - Yan Wang
- Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, Shandong, China
| | - Yang Zhao
- Department of Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Hong Li
- Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, Shandong, China
| | - Jingyi Yu
- Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, Shandong, China
| | - Qian Liu
- Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, Shandong, China
| | - Chuansheng Zhu
- Shandong Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China. .,Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, Shandong, China.
| | - Mingzhuo Li
- Center for Big Data Research in Health and Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, Shandong, China.
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Hehua Z, Qing C, Yuhong Z. Association between ambient particulate matter exposure and platelet counts in adults: a retrospective cohort study. Environ Sci Pollut Res Int 2021; 28:31268-31275. [PMID: 33599925 DOI: 10.1007/s11356-021-12865-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 02/04/2021] [Indexed: 06/12/2023]
Abstract
Associations between ambient particulate matter exposure and platelet counts are inconsistent in previous studies, and study on the effect of long-term exposure especially in Asian populations is limited. We explored the associations between long-term PM2.5 (particulate matter < 2.5 μm) exposure and platelet counts using a prospective cohort study in Northeast China. We used a logistic regression model to analyze the effects of different PM2.5 increments and platelet count elevation. Mixed linear models were used to analyze the association between PM2.5 concentration and platelet counts. Interaction and sub-group analyses were also conducted. Results showed that every 1 μg/m3 increment of PM2.5 exposure was associated with 0.29% (95%CI: 0.25-0.32%) increase in platelet counts and 10% (95%CI: 8-12%) higher risk of platelet elevation. Effects of long-term PM2.5 exposure on platelet elevation were stronger in male participants, of Han ethnicity, and without diabetes. Long-term PM2.5 exposure would increase platelet counts in adults in Northeast area of China, which might add more evidence to the potential biological mechanisms responsible for the effect of air pollution exposure on cardiovascular disease.
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Affiliation(s)
- Zhang Hehua
- Clinical Research Center, Shengjing Hospital of China Medical University, Huaxiang Road No. 39, Tiexi District, Shenyang, China
| | - Chang Qing
- Clinical Research Center, Shengjing Hospital of China Medical University, Huaxiang Road No. 39, Tiexi District, Shenyang, China
| | - Zhao Yuhong
- Clinical Research Center, Department of Clinical Epidemiology, Shenjing Hospital of China Medical University, Sanhao Street, No. 36, Heping District, Shenyang, China.
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Papila Kundaktepe B, Papila C. The clinical significance of preoperative plasma fibrinogen levels and platelet counts in resectable colon cancer. World J Surg Oncol 2021; 19:69. [PMID: 33706789 PMCID: PMC7953657 DOI: 10.1186/s12957-021-02180-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 03/02/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND AND AIM Several aspects of the correlation between colon cancer and hemostatic markers are still unknown to many researchers in the field. In this study, we evaluated the association, if any, of preoperative platelet (PLT) counts and plasma fibrinogen levels with postoperative lymph node involvement and venous invasion in colon cancer patients. METHODS This study retrospectively included eighty patients with colon cancer (mean age 58.09 years; 37% female 63% male). RESULTS Patients with negative lymph nodes and venous invasion showed a significantly lower PLT count and higher fibrinogen level than their counterparts, i.e., patients with positive lymph nodes (p<0.001, all of them) and venous invasion (p<0.001, all of them). The results also showed a positive association of PLT counts and fibrinogen levels with lymphatic invasion (r=0.670, p<0.001 and r=0.639, p<0.001, respectively) and a positive association of PLT counts and fibrinogen levels with venous invasion (r=0.3988, p<0.001 and r=0.5268, p<0.001, respectively). According to the results of the ROC curve analysis, when the PLT count cutoff was 290/mm3, the sensitivity and specificity were 82% and 86.67%, respectively (AUC = 0.8840, p<0.0001, 95% CI 0.8084-0.9596). When the fibrinogen level cutoff was 310.0 mg/dL, the sensitivity and specificity were 72% and 96.67%, respectively (AUC 0.8790, p <0.0001, 95% CI 0.8067-0.9513). CONCLUSION The preoperative PLT count and plasma fibrinogen level may be considered key markers to monitor postoperative lymph node involvement and venous invasion in colon cancer patients.
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Affiliation(s)
- Berrin Papila Kundaktepe
- Department of General Surgery, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey.
| | - Cigdem Papila
- Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
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Gotic M, Egyed M, Gercheva L, Warzocha K, Kvasnicka HM, Achenbach H, Wu J. Cardiovascular Safety of Anagrelide Hydrochloride versus Hydroxyurea in Essential Thrombocythaemia. Cardiovasc Toxicol 2020; 21:236-247. [PMID: 33123978 PMCID: PMC7847982 DOI: 10.1007/s12012-020-09615-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 10/16/2020] [Indexed: 11/30/2022]
Abstract
Essential thrombocythaemia (ET) is a rare myeloproliferative neoplasm. This multicentre, Phase 3b, randomised, open-label, non-inferiority study investigated the cardiac safety, efficacy and tolerability of first-line treatment with anagrelide or hydroxyurea in high-risk ET patients for up to 3 years. Eligible patients aged ≥ 18 years with a diagnosis of high-risk ET confirmed by bone marrow biopsy within 6 months of randomisation received anagrelide (n = 75) or hydroxyurea (n = 74), administered twice daily. Treatment dose for either compound was titrated to the lowest dose needed to achieve a response. Planned primary outcome measures were change in left ventricular ejection fraction from baseline over time and platelet count at Month 6. Planned secondary outcome measures were platelet count change from baseline at Months 3 and 36; percentage of patients with complete or partial response; time to complete or partial response; number of patients with thrombohaemorrhagic events; and changes in white blood cell count or red blood cell count over time. Neither treatment altered cardiac function. There were no significant differences in adverse events between treatment groups, and no reports of malignant transformation. The incidence of disease-related thrombotic or haemorrhagic events was numerically higher in anagrelide-treated patients. Both treatments controlled platelet counts at 6 months, with the majority of patients experiencing complete or partial responses. In conclusion, these results suggest that long-term treatment with anagrelide is not associated with adverse effects on cardiac function. This is one of the few studies using left ventricular ejection fraction assessment and central biopsy reading to confirm the diagnosis of ET. Trial registration number: Clinicaltrials.gov NCT00202644
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Affiliation(s)
- Mirjana Gotic
- Clinic for Hematology Clinical Centre of Serbia Belgrade, Medical Faculty, University of Belgrade, Koste Todorovica 2, 11000, Belgrade, Serbia.
| | - Miklos Egyed
- Somogy Megyei Kaposi Mór Oktató Kórház, Kaposvár, 7400, Hungary
| | - Liana Gercheva
- Clinic of Hematology, University Hospital St. Marina, 9010, Varna, Bulgaria
| | - Krzysztof Warzocha
- Institute of Hematology and Transfusion Medicine, Department of Haematology, 00-791, Warsaw, Poland
| | - Hans Michael Kvasnicka
- Institute of Pathology, University Clinic Wuppertal, University of Witten / Herdecke, Wuppertal, Germany
| | - Heinrich Achenbach
- Research & Development, Shire International GmbH (a Member of the Takeda Group of Companies), 6300, Zug, Switzerland
| | - Jingyang Wu
- Research & Development, Shire (a Member of the Takeda Group of Companies), Lexington, MA, 02421, USA
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Amygdalos I, Czigany Z, Bednarsch J, Boecker J, Santana DAM, Meister FA, von der Massen J, Liu WJ, Strnad P, Neumann UP, Lurje G. Low Postoperative Platelet Counts Are Associated with Major Morbidity and Inferior Survival in Adult Recipients of Orthotopic Liver Transplantation. J Gastrointest Surg 2020; 24:1996-2007. [PMID: 31388889 DOI: 10.1007/s11605-019-04337-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 07/19/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND Platelets (PLT) play an essential functional role in cellular injury and liver regeneration following partial hepatectomy and orthotopic liver transplantation (OLT). Here, we investigated the association of postoperative PLT counts with short- and long-term outcomes in adult OLT recipients. METHODS Three hundred consecutive patients from our prospective OLT database were analyzed retrospectively (May 2010-November 2017). Ninety-day post-OLT complications were graded using the Clavien-Dindo (CD) classification and quantified by the comprehensive complication index (CCI). To determine the prognostic accuracy of PLT counts, the area under the receiver operating characteristic curve (AUROC) was calculated for major complications (CD ≥ 3b). Parametric and non-parametric tests were applied for subgroup analyses. Uni- and multivariable logistic regression analyses were performed to identify risk factors for major complications. Graft and patient survival were analyzed using the Kaplan-Meier method as well as uni- and multivariable Cox regression analyses. RESULTS Postoperative day 6 PLT counts < 70 × 109/L (POD6-70) were identified as the best cutoff for predicting major complications (AUROC = 0.7; p < 0.001; Youden index 0.317). The stratification of patients into low- (n = 113) and high-PLT (n = 187) groups highlighted significant differences in major complications (CCI 68 ± 29 vs. 43 ± 28, p < 0.001); length of hospital and intensive care unit (ICU) stay (53 ± 43 vs. 31 ± 25, p < 0.001; 21 ± 29 vs. 7 ± 11, p < 0.001, respectively) and estimated procedural costs. POD6-70 was associated with inferior 5-year graft survival. Multivariable logistic regression analysis identified POD6-70 as an independent predictor of major complications (odds ratio 2.298, confidence intervals 1.179-4.478, p = 0.015). CONCLUSION In OLT patients, a PLT count on POD6 of less than 70 × 109/L bears a prognostic significance warranting further investigations.
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Affiliation(s)
- Iakovos Amygdalos
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Zoltan Czigany
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Jan Bednarsch
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Joerg Boecker
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
| | | | - Franziska Alexandra Meister
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Jelena von der Massen
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Wen-Jia Liu
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Pavel Strnad
- Department of Internal Medicine III, University Hospital RWTH Aachen, Aachen, Germany
| | - Ulf Peter Neumann
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
- Department of Surgery, Maastricht University Medical Centre (MUMC), Maastricht, Netherlands
| | - Georg Lurje
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany.
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Liu K, Xu J, Tao L, Yang K, Sun Y, Guo X. Platelet counts are associated with arterial stiffness in Chinese Han population: a longitudinal study. BMC Cardiovasc Disord 2020; 20:353. [PMID: 32731902 PMCID: PMC7393731 DOI: 10.1186/s12872-020-01634-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 07/20/2020] [Indexed: 11/13/2022] Open
Abstract
Background Determining the risk factors for brachial-ankle pulse wave velocity (baPWV) may help to identify people susceptible to diabetic atherosclerosis and could prevent diabetic macrovascular complications in the early stages. We aim to comprehensively investigate risk factors contributing to arterial stiffness in patients with and without diabetes. Methods BaPWV was measured in 5651 individuals who attended health check-ups at baseline and follow-up. Lasso regression was used to screen for risk factors. Mixed models and multiple linear regressions were subsequently established to evaluate the effect size of the potential risk factors on baPWV and PWV change rates. All analyses were stratified by diabetes. Mediation analysis was also conducted to demonstrate the mechanisms of arterial stiffness in patients with diabetes. Results In lasso regression, postprandial 2-h glucose (P2hG), systolic blood pressure (SBP) and age were associated with baPWV regardless of diabetes. Platelet counts (PLT), mean corpuscular volume (MCV) and coronary heart disease (CHD) were associated with baPWV in patients with diabetes. In the mixed models, PLT were positively associated with baPWV in patients with diabetes (βplatelet, perSD = 25.80; 18.26–33.33). Elevated PLTs could also significantly increase the PWV change rate in patients with diabetes (βplatelet, perSD = 54.05; 10.00–107.10). In mediation analysis, diabetes had a significant average direct effect on baPWV. The average causal mediation effect (ACME) of PLTs was 1.76, with a range of 0.17 to 3.70. Conclusions Elevated PLT counts can increase baPWV in diabetes and are a potential mediator between diabetes and atherosclerosis.
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Affiliation(s)
- Kuo Liu
- Department of Epidemiology and Health statistics, School of Public Health, Capital Medical University, No.10 Xitoutiao, Youanmenwai Avenue, Beijing, 100069, People's Republic of China.,Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Junfeng Xu
- Beijing Xiaotangshan Hospital, Xiaotangshan Town, Changping District, Beijing, 102211, China
| | - Lixin Tao
- Department of Epidemiology and Health statistics, School of Public Health, Capital Medical University, No.10 Xitoutiao, Youanmenwai Avenue, Beijing, 100069, People's Republic of China.,Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Kun Yang
- Department of Epidemiology and Health statistics, School of Public Health, Capital Medical University, No.10 Xitoutiao, Youanmenwai Avenue, Beijing, 100069, People's Republic of China.,Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Yang Sun
- Department of Epidemiology and Health statistics, School of Public Health, Capital Medical University, No.10 Xitoutiao, Youanmenwai Avenue, Beijing, 100069, People's Republic of China.,Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Xiuhua Guo
- Department of Epidemiology and Health statistics, School of Public Health, Capital Medical University, No.10 Xitoutiao, Youanmenwai Avenue, Beijing, 100069, People's Republic of China. .,Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China.
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12
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Bao S, Xia W, Xu S, Li Y, Lu B, Wu C, Liao J, Liu H, Sun X, Zhou A. Multiple metal exposure and platelet counts during pregnancy: A repeated measure study. Environ Int 2020; 136:105491. [PMID: 31991237 DOI: 10.1016/j.envint.2020.105491] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 12/27/2019] [Accepted: 01/13/2020] [Indexed: 05/15/2023]
Abstract
BACKGROUND Evidence from animal and in vitro studies suggest that some metals interfere with normal platelet counts (PLT). However, limited human studies have investigated the association of metals and PLT, a marker of hematologic and hemostatic, particularly in susceptible populations such as pregnant women. OBJECTIVES Our purpose was to investigate the associations of repeated measures of 13 urinary metals with PLT during pregnancy. METHODS The present study involved 3911 pregnant women participating in a prospective cohort study in Wuhan, China, from 2013 to 2016. We measured 13 metals in urine and PLT in blood samples collected in the first, second, and third trimester (median = 13, 24, and 35 weeks of gestation, respectively). Mixed linear models and general linear models were applied to analyze the associations between multiple metals and PLT during pregnancy. The odds ratio (OR) for gestational thrombocytopenia was examined using generalized estimating equations. RESULTS After adjusting for other metals and covariates, the repeated measure analyses showed that decreased levels of PLT were associated with a 10-fold increase in urinary concentration of cadmium (Cd) [percent difference (%Δ) = -5.02, 95%CI = -9.53, -0.29], manganese (Mn) [percent difference (%Δ) = -4.63, 95%CI = -7.50, -1.67], and arsenic (As) [percent difference (%Δ) = -4.56, 95%CI = -8.11, -0.86]. Cross-sectional analyses by trimesters revealed that Cd was inversely associated with PLT through the three trimesters. In addition, Cd was associated with an increased OR of 1.80 (95%CI: 1.26, 2.56), 1.65 (95%CI: 1.05, 2.59), 1.54 (95%CI: 1.02, 2.33) for gestational thrombocytopenia in the first, second, and third trimester, respectively. CONCLUSIONS Our study suggested an association of Cd, Mn, and As with decreased PLT during pregnancy. Particularly, Cd may increase the risk of gestational thrombocytopenia.
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Affiliation(s)
- Shuangshuang Bao
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubation), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Wei Xia
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubation), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China.
| | - Shunqing Xu
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubation), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Yuanyuan Li
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubation), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Bin Lu
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubation), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Chuansha Wu
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubation), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Jiaqiang Liao
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubation), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Hongxiu Liu
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubation), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Xiaojie Sun
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubation), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Aifen Zhou
- Wuhan Medical and Healthcare Center for Women and Children, Wuhan, Hubei, People's Republic of China
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Moradi Kelardeh B, Rahmati-Ahmadabad S, Farzanegi P, Helalizadeh M, Azarbayjani MA. Effects of non-linear resistance training and curcumin supplementation on the liver biochemical markers levels and structure in older women with non-alcoholic fatty liver disease. J Bodyw Mov Ther 2020; 24:154-160. [PMID: 32825982 DOI: 10.1016/j.jbmt.2020.02.021] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 01/30/2020] [Accepted: 02/17/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND With increasing age, non-alcoholic fatty liver disease is very common among women with low levels of physical activity. Nonlinear resistance training is one of the new methods to help patients who have low levels of physical activity. Curcumin is an herbal supplement that has anti-inflammatory effects. The present study aimed to examine the effects of nonlinear resistance training and curcumin supplementation on the liver structure and biochemical markers in obese older women with non-alcoholic fatty liver disease. METHODS Forty-five obese women with non-alcoholic fatty liver disease were randomly assigned into resistance training (RT), curcumin supplement (C), resistance training with curcumin supplement (RTC), and placebo (P) groups. The RT and RTC groups received 12-weeks of nonlinear resistance training while the C and P groups had a normal sedentary lifestyle. Daily, the C and RTC groups received a curcumin capsule while the P and RT groups were given a placebo capsule. Blood sampling and ultrasonography were taken before and after the protocol. RESULTS Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels significantly decreased in the RT and RTC groups (P ≤ 0.05) but not in the C and P groups (P > 0.05). Alkaline phosphatase (ALP), total bilirubin (TB) levels, platelet counts (PLT), and liver structure did not significantly change in all groups (P > 0.05). Resistance training alone and with curcumin supplementation could significantly improve liver function while taking curcumin alone did not have any significant effect on it. CONCLUSION 12-week non-linear resistance training has beneficial effects on non-alcoholic fatty liver disease in older obese women.
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Affiliation(s)
- Baharak Moradi Kelardeh
- Phd Exercise Physiology, Sama Technical and Vocational Training College, Islamic Azad University, Esfahan (Khorasgan) Branch, Esfahan, Iran
| | | | - Parvin Farzanegi
- Department of Exercise Physiology, Sari Branch, Islamic Azad University, Sari, Iran
| | - Masoumeh Helalizadeh
- Department of Exercise Physiology, Sport Medicine Research Center, Sport Sciences Research Institute, Tehran, Iran
| | - Mohammad-Ali Azarbayjani
- Department of Exercise Physiology, Central Tehran Branch, Islamic Azad University, Tehran, Iran.
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Abstract
Background Obesity is associated with chronic inflammation, liver steatosis and increased liver enzymes such as gamma-glutamyltransferase (GGT) and alanine aminotransferase (ALT), markers for non-alcoholic fatty liver disease (NAFLD) and liver fat content. Increased platelet counts (PCs) are a biomarker reflecting inflammation and the degree of fibrosis in NAFLD. We investigated alterations in PCs, GGT, ALT, C-reactive protein (CRP) and ferritin after Roux-en-Y gastric bypass (RYGBP). Methods One hundred twenty-four morbidly obese non-diabetic patients were evaluated before (baseline) and 12 months after (follow-up) RYGBP. Results Body mass index (BMI) was reduced from 43.5 kg/m2 (baseline) to 31.1 kg/m2 (follow-up), and p < 0.001 and weight declined from 126.2 to 89.0 kg. PCs decreased from 303 × 109 to 260 × 109/l, p < 0.001. GGT was reduced from 0.63 to 0.38 μkat/l, p < 0.001. ALT decreased from 0.69 to 0.59 μkat/l, p = 0.006. CRP was lowered from 7.3 to 5.4 mg/l p < 0.001 and ferritin from 106 to 84 μg/l p < 0.001. The alterations in PCs correlated with the changes in CRP (r = 0.38, p = 0.001), BMI (r = 0.25, p = 0.012), weight (r = 0.24, p = 0.015) and inversely correlated with ferritin (r = 21, p = 0.036). Conclusions PCs, GGT and ALT (markers for NAFLD), and CRP and ferritin (markers for inflammation) decreased in morbidly obese after RYGBP. The decrease in PCs correlated with alterations in CRP, BMI, weight and ferritin. The lowering of liver enzymes may reflect a lowered liver fat content and decreased general inflammation.
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Hans R, Sharma RR, Marwaha N. Effect of plateletpheresis on postdonation serum thrombopoietin levels and its correlation with platelet counts in healthy voluntary donors. Asian J Transfus Sci 2019; 13:10-16. [PMID: 31360004 PMCID: PMC6580838 DOI: 10.4103/ajts.ajts_86_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND: Thrombopoietin (TPO) is regulated by a feedback mechanism between megakaryocytes and platelets. This is important in plateletpheresis donors to compensate for donation-associated platelet loss. AIMS AND OBJECTIVES: The aim and objective of this study were to investigate changes in serum TPO levels in healthy plateletpheresis donors and its correlation with platelet recovery pattern. MATERIALS AND METHODS: Out of 50 plateletpheresis donors recruited in the study over 1 year, only 29 completed follow-up and were further analyzed. Plateletpheresis procedures were performed on two types of cell separators (TRIMA ACCEL®, Terumo BCT Lakewood Colorado and AMICUS®, Fresenius Kabi, Germany). Platelet parameters were estimated pre- and post-platelet donation, at 3rd- and 5th-day postdonation. Serum TPO levels were determined using quantitative sandwich enzyme-linked immunosorbent assay technique (Raybiotech, USA) as per the protocol of the manufacturer. RESULTS: The majority of donors (72%) in our study were first-time donors. The baseline platelet count was 226 ± 44 × 103/μl with a significant decline (30%; P < 0.001) in postdonation phase and remained below baseline on the 3rd and 5th day. The serum TPO levels increased significantly (P < 0.001) from a baseline of 227.81 (interquartile range [IQR]: 176.06) pg/ml to 269.94 (IQR: 110.68) pg/ml postdonation and remained elevated from baseline levels on the 3rd and 5th day. An inverse relation was observed between change in serum TPO levels and platelet count during postdonation phase which was not statistically significant (P > 0.05). CONCLUSION: Serum TPO levels increase significantly post plateletpheresis donation corresponding to decrease in platelet counts showing that TPO plays a vital role in compensatory mechanism after platelet loss.
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Affiliation(s)
- Rekha Hans
- Department of Transfusion Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ratti Ram Sharma
- Department of Transfusion Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Neelam Marwaha
- Department of Transfusion Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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16
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An HS, Kim GB, Song MK, Bang JS, Lee SY, Bae EJ, Noh CI. Eisenmenger Syndrome in Adults: Treatment Pattern and Prognostic Factors in the Advanced Pulmonary Vasodilator Era. Pediatr Cardiol 2019; 40:23-28. [PMID: 30121863 DOI: 10.1007/s00246-018-1956-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 08/09/2018] [Indexed: 11/28/2022]
Abstract
Patients with Eisenmenger syndrome (ES) have a higher mortality rate than patients with simple congenital heart disease (CHD). To determine factors associated with death in the era of advanced pulmonary vasodilator treatment, we analyzed the characteristics of adult ES patients depending on underlying CHD. Simple septal defects and patent ductus arteriosus were classified as simple CHD, and other conditions were classified as complex CHD. Sixty-seven adult ES patients (50.7% women) were reviewed retrospectively. CHD was diagnosed at a median of 10.0 years of age and ES was diagnosed at 18.6 years. Thirteen patients (19.4%) died; the median age was 38.6 years (IQR 32.2-47.8). In a multivariate analysis, patients with SpO2 < 85% had a higher mortality rate than others [hazard ratio (HR) 9.7; 95% confidence interval (CI) 1.002-95.2, p = 0.05]. In simple CHD patients, those with a low platelet count (< 100 × 109/L) or low SpO2 (< 85%) were at a higher risk of death than those without (HR 16.32, 95% CI 1.25-2266.31, p = 0.032; and HR 38.91, 95% CI 3.44-5219.41, p = 0.001, respectively). Advanced pulmonary vasodilators were used more in survivors than in non-survivors (48.1% vs. 15.4%, p = 0.032). Low SpO2 and platelet count were related to mortality in adult ES, especially in those with simple CHD. Therefore, careful attention should be paid to the care of adult ES patients with this tendency; active pulmonary vasodilator treatment should be considered.
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Affiliation(s)
- Hyo Soon An
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea.,Department of Pediatrics, Seoul Metropolitan Government - Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Gi Beom Kim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea.
| | - Mi Kyoung Song
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Ji Seok Bang
- Department of Pediatrics, Sejong General Hospital, Bucheon, South Korea
| | - Sang Yun Lee
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Eun Jung Bae
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Chung Il Noh
- Department of Pediatrics, Sejong General Hospital, Bucheon, South Korea
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Liu F, Zhou H, Cao L, Guo Z, Dong C, Yu L, Wang Y, Liu C, Qiu J, Xue Y, Liu X, Xu Y. Risk of reduced platelet counts in patients with nonalcoholic fatty liver disease (NAFLD): a prospective cohort study. Lipids Health Dis 2018; 17:221. [PMID: 30227874 PMCID: PMC6145189 DOI: 10.1186/s12944-018-0865-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 09/11/2018] [Indexed: 12/25/2022] Open
Abstract
Background The production of peripheral platelet is mainly regulated by thrombopoietin, which is a glycoprotein hormone predominantly synthesized in the liver. Previously, many studies have reported that there was an inverse correlation between the degree of chronic viral hepatitis and the peripheral platelet count. However, the effect of nonalcoholic fatty liver disease (NAFLD) on the peripheral platelet counts remains unclear. Methods With 1303 participants from “The prevention of MS and multi-metabolic disorders in Jiangsu province of China (PMMJS)” cohort study, we investigated the associations between NAFLD and the risk of platelet counts reduction in Chinese adults. The paired-samples T test was used to explore the platelet counts changes between baseline and follow-up. Multivariate logistic regression was used to examine the association between presence of NAFLD and the risk of platelet reduction by calculating the odds ratios (ORs) and 95% confidence interval (CI). Results After five years of follow-up, platelet counts were markedly reduced from 220.6 ± 42.22 (109/L) at baseline to 208.41 ± 40.70 (109/L) at follow-up in NAFLD group (P < 0.0001). However, platelet counts were slightly lowered from 213.2 ± 43.26(109/L) at baseline to 211.8 ± 41.65 (109/L) at follow-up in non-NAFLD people (P = 0.2349). Meanwhile, there was a significant association between NAFLD and the risks of platelet count reduction, even after adjustment for confounding variables (OR: 1.68, 95% CI: 1.06–2.67). Additionally, among the participants with BMI ≤ 23 kg/m2 and SUA ≤ 344.3 μmol/L, the NAFLD participants have an increased risk of platelet count reduction compared to the persons in non-NAFLD group. Conclusions Our present results suggested that NAFLD individuals have an increased risk of platelet counts reduction. Electronic supplementary material The online version of this article (10.1186/s12944-018-0865-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Fang Liu
- Suzhou Center for Disease Control and Prevention, Suzhou, China
| | - Hui Zhou
- Suzhou Industrial Park Centers for Disease Control and Prevention, Suzhou, China
| | - Lei Cao
- Xinghai Hospital of Suzhou Industrial Park, Suzhou, China.
| | - Zhirong Guo
- Department of Epidemiology and Statistics, School of Public Health, Jiangsu Key Laboratory and Translational Medicine for Geriatric Disease, Medical College of Soochow University, Suzhou, Jiangsu, China
| | - Chen Dong
- Department of Epidemiology and Statistics, School of Public Health, Jiangsu Key Laboratory and Translational Medicine for Geriatric Disease, Medical College of Soochow University, Suzhou, Jiangsu, China
| | - Lugang Yu
- Suzhou Industrial Park Centers for Disease Control and Prevention, Suzhou, China
| | - Yiying Wang
- Department of Epidemiology and Statistics, School of Public Health, Jiangsu Key Laboratory and Translational Medicine for Geriatric Disease, Medical College of Soochow University, Suzhou, Jiangsu, China
| | - Chunxing Liu
- Department of Epidemiology and Statistics, School of Public Health, Jiangsu Key Laboratory and Translational Medicine for Geriatric Disease, Medical College of Soochow University, Suzhou, Jiangsu, China
| | - Jing Qiu
- Department of Epidemiology and Statistics, School of Public Health, Jiangsu Key Laboratory and Translational Medicine for Geriatric Disease, Medical College of Soochow University, Suzhou, Jiangsu, China
| | - Yong Xue
- Huai'an Third Hospital, Huai'an, China
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Abstract
Though the American society of hematology Guidelines and British guidelines do not recommend screening of thyroid diseases in cases of immune thrombocytopenia (ITP), more than 160 cases of hyperthyroidism associated with ITP have been reported. Numerous case reports would suggest that patients with ITP and concurrent hyperthyroidism would respond to control of thyroid disease rather than the standard ITP treatment. Although this issue is still debatable, we report a case of a young female with a previous diagnosis of hyperthyroidism which was not well controlled, had presented with severe thrombocytopenia. Initially, all work-up had been done to find out the cause of thrombocytopenia. After all normal reports except deranged thyroid function tests, the patient was labeled as ITP and started on steroids. Even after a few months of steroid treatment, platelet counts had not improved. However, after starting antithyroid drugs, platelet counts had become normalized.
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Vázquez-Santiago M, Ziyatdinov A, Pujol-Moix N, Brunel H, Morera A, Soria JM, Souto JC. Age and gender effects on 15 platelet phenotypes in a Spanish population. Comput Biol Med 2016; 69:226-33. [PMID: 26773944 DOI: 10.1016/j.compbiomed.2015.12.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 12/22/2015] [Accepted: 12/26/2015] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Several studies have analysed the platelet parameters in human blood, nevertheless there are no extensive analyses on the less common platelet phenotypes. The main objective of our study is to evaluate the age and gender effects on 15 platelet phenotypes. METHODS We studied 804 individuals, ranging in age from 2 to 93 years, included in the Genetic Analysis of Idiopathic Thrombophilia 2 (GAIT 2) Project. The 15 platelet phenotypes analysed were the platelets counts, platelet volumes, plateletcrits, immature platelet fraction (IPF) and platelet function assay (PFA). A regression-based method was used to evaluate the age and gender effects on these phenotypes. RESULTS Our results were consistent with the previously reported results regarding platelet counts and plateletcrit (PCT). They showed a decrease with increasing age. The mean platelet volume (MPV), platelet distribution width (PDW) and platelet-large cell ratio (P-LCR) increased with age, but did not present any gender effect. All the IPF phenotypes increased with age, whereas the PFA phenotypes did not show any relation to age or gender. DISCUSSION To sum up, our study provides a comprehensive analysis of the age and gender effects on the platelet phenotypes in a family-base sample. Our results suggest more reasonable age stratification into two distinct groups: childhood, ranging from 2 to 12 years, and the mature group, from 13 to 93 years. Moreover, the PFA phenotypes were maintained constant while the platelet counts, the MPV and IPF levels vary with age.
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Affiliation(s)
- Miquel Vázquez-Santiago
- Unitat d'Hemostàsia i Trombosi, Hospital de la Santa Creu i Sant Pau, Sant Antoni Maria Claret, 167, Barcelona 08025, Spain.
| | - Andrey Ziyatdinov
- Unit of Genomics of Complex Diseases, Sant Pau Institute of Biomedical Research (IIB-Sant Pau), Sant Antoni Maria Claret, 167, Barcelona 08025, Spain.
| | - Núria Pujol-Moix
- Unitat d'Hemostàsia i Trombosi, Hospital de la Santa Creu i Sant Pau, Sant Antoni Maria Claret, 167, Barcelona 08025, Spain; Department of Medicine, Universitat Autònoma de Barcelona, Hospital de la Santa Creu i Sant Pau, Sant Antoni Maria Claret, 167, Barcelona 08025, Spain.
| | - Helena Brunel
- Unit of Genomics of Complex Diseases, Sant Pau Institute of Biomedical Research (IIB-Sant Pau), Sant Antoni Maria Claret, 167, Barcelona 08025, Spain.
| | - Agnès Morera
- Unitat d'Hemostàsia i Trombosi, Hospital de la Santa Creu i Sant Pau, Sant Antoni Maria Claret, 167, Barcelona 08025, Spain.
| | - José Manuel Soria
- Unit of Genomics of Complex Diseases, Sant Pau Institute of Biomedical Research (IIB-Sant Pau), Sant Antoni Maria Claret, 167, Barcelona 08025, Spain.
| | - Juan Carlos Souto
- Unitat d'Hemostàsia i Trombosi, Hospital de la Santa Creu i Sant Pau, Sant Antoni Maria Claret, 167, Barcelona 08025, Spain.
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Noonavath RN, Lakshmi CP, Dutta TK, Kate V. Helicobacter pylori eradication in patients with chronic immune thrombocytopenic purpura. World J Gastroenterol 2014; 20:6918-6923. [PMID: 24944483 PMCID: PMC4051932 DOI: 10.3748/wjg.v20.i22.6918] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2013] [Revised: 01/18/2014] [Accepted: 03/10/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess the effect of Helicobacter pylori (H. pylori) eradication on platelet counts in patients with chronic immune thrombocytopenic purpura (cITP).
METHODS: A total of 36 cITP patients were included in the study. The diagnosis of H. pylori was done by rapid urease test and Giemsa staining of the gastric biopsy specimen. All H. pylori positive patients received standard triple therapy for 14 d and were subjected for repeat endoscopy at 6 wk. Patients who continued to be positive for H. pylori on second endoscopy received second line salvage therapy. All the patients were assessed for platelet response at 6 wk, 3rd and 6th months.
RESULTS: Of the 36 patients, 17 were positive for H. pylori infection and eradication was achieved in 16 patients. The mean baseline platelet count in the eradicated patients was 88615.38 ± 30117.93/mm3 and platelet count after eradication at 6 wk, 3 mo and 6 mo was 143230.77 ± 52437.51/mm3 (P = 0.003), 152562.50 ± 52892.3/mm3 (P = 0.0001), 150187.50 ± 41796.68/mm3 (P = 0.0001) respectively and in the negative patients, the mean baseline count was 71000.00 ± 33216.46/mm3 and at 6 wk, 3rd and 6th month follow up was 137631.58 ± 74364.13/mm3 (P = 0.001), 125578.95 ± 71472.1/mm3 (P = 0.005), 77210.53 ± 56892.28/mm3 (P = 0.684) respectively.
CONCLUSION: Eradication of H. pylori leads to increase in platelet counts in patients with cITP and can be recommended as a complementary treatment with conventional therapy.
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Payandeh M, Raeisi D, Sohrabi N, Zare ME, Kansestani AN, Keshavarz N, Gholami S, Hashemian AH. Poor platelet Count Response to Helicobacter Pylori Eradication in Patients with Severe Idiopathic Thrombocytopenic Purpura. Int J Hematol Oncol Stem Cell Res 2013; 7:9-14. [PMID: 24505529 PMCID: PMC3913150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Accepted: 06/02/2013] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION ITP is an autoimmune blood disorder in which platelet destruction is mediated by anti-platelet antibodies. The mechanisms of anti-platelet antibodies development are still a little known. The rate of some bacterial or viral agents in cause of ITP is well known. Recently, some study proposed that H pylori infection may be associated with ITP and H pylori eradication can improves platelet counts in infected ITP patients. MATERIALS AND METHOD A baseline platelet count <50×10(3) µL for 4 weeks prior to study entry were required. These patients were tested for H. pylori infection by urea breath. All positive H pylori patients received triple therapy for 7 or 14 days to eradicate H pylori infection. These patients followed for six months. RESULTS Of 92 patients with ITP, H pylori infection was found in 59.7% (55/92). After excluding patients with confounding factors, 41 patients were remained. After H pylori eradication, CR wasn't obtained in any patients. Partial response were obtained only in 3 (7.3%) of the 41 patients and no response in 38 (92.6%) patients. There is a significant difference between the platelet counts of PR and NR groups (P < 0.001). CONCLUSION The results of this study and our previously study showed H pylori eradication therapy has beneficial effect for patients with mild thrombocytopenia but the chance of obtaining a response by H pylori treatment is lower in patients with severe thrombocytopenia.
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Affiliation(s)
- Mehrdad Payandeh
- Medical Biology Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Dariyush Raeisi
- Medical Biology Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Nasrollah Sohrabi
- Department of Medical Laboratory Sciences, Para medicine Faculty, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mohammad Erfan Zare
- Medical Biology Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran,Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Atefeh Nasir Kansestani
- Medical Biology Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran,Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Nazanin Keshavarz
- Student research committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Samira Gholami
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Amir Hossein Hashemian
- Department of Biostatistics, Faculty of Public Health, Kermanshah University of Medical Sciences, Kermanshah, Iran,Corresponding Author: Amir Hossein Hashemian, Assisstant professor of biostatistics, Department of Biostatistics, Faculty of Public Health, Kermanshah University of Medical Sciences, Kermanshah, Iran. Tel: +98 831 8281993, Fax: +98 831 8263048. E-mail:
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He XH, Gu JJ, Li WT, Peng WJ, Li GD, Wang SP, Xu LC, Ji J. Comparison of total splenic artery embolization and partial splenic embolization for hypersplenism. World J Gastroenterol 2012; 18:3138-44. [PMID: 22791950 PMCID: PMC3386328 DOI: 10.3748/wjg.v18.i24.3138] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2011] [Revised: 03/29/2012] [Accepted: 04/27/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate whether total splenic artery embolization (TSAE) for patients with hypersplenism delivers better long-term outcomes than partial splenic embolization (PSE).
METHODS: Sixty-one patients with hypersplenism eligible for TSAE (n = 27, group A) or PSE (n = 34, group B) were enrolled into the trial, which included clinical and computed tomography follow-up. Data on technical success, length of hospital stay, white blood cell (WBC) and platelet (PLT) counts, splenic volume and complications were collected at 2 wk, 6 mo, and 1, 2, 3, 4 years postoperatively.
RESULTS: Both TSAE and PSE were technically successful in all patients. Complications were significantly fewer (P = 0.001), and hospital stay significantly shorter (P = 0.007), in group A than in group B. Post-procedure WBC and PLT counts in group A were significantly higher than those in group B from 6 mo to 4 years (P = 0.001), and post-procedure residual splenic volume in group A was significantly less than that observed in group B at 1, 2, 3 and 4 years post-procedure (P = 0.001). No significant differences were observed in red blood cell counts and liver function parameters between the two groups following the procedure.
CONCLUSION: Our results indicate that TSAE for patients with hypersplenism not only delivers a better long-term outcome, but is also associated with lower complication rates and a shorter hospital stay than PSE.
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Tag HS, Lee HS, Jung SH, Kim BK, Kim SB, Lee A, Lee JS, Shin SH, Kim YS. Effects of Helicobacter pylori eradication in patients with immune thrombocytopenic purpura. Korean J Hematol 2010; 45:127-32. [PMID: 21120192 PMCID: PMC2983021 DOI: 10.5045/kjh.2010.45.2.127] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2010] [Revised: 05/19/2010] [Accepted: 05/24/2010] [Indexed: 12/14/2022]
Abstract
Background The relationship between Helicobacter pylori (H. pylori) infection and chronic idiopathic thrombocytopenic purpura (ITP) has been confirmed; however, no clear evidence for the effectiveness of H. pylori eradication on ITP exists thus far. The purpose of this study was to investigate platelet recovery in chronic ITP after H. pylori eradication. Methods A total of 25 patients (18 male, 7 female; the median age of 55 years) diagnosed with ITP, whose platelet counts were less than 100×103/µL, were enrolled. They were tested for H. pylori infection by the rapid urea test or urea breath test. All patients received triple therapy for 7 or 14 days to eradicate H. pylori infection. Results Of the 25 patients, 23 (92%) were diagnosed with H. pylori infection. Of all the ITP patients, 11 (44%) exhibited a complete response (CR) to H. pylori eradication therapy; 6 (24%), a partial response (PR); and 8 (32%) were nonresponsive (NR). Predictive factors of response after H. pylori eradication therapy were platelet counts at the initial response (27.3% responders among patients with platelet counts <100×103/µL vs 100% responders among patients with platelet counts ≥100×103/µL, P<0.001) and H. pylori infectivity (73.9% responders among the H. pylori positive patients vs 0% responders among the H. pylori negative patients, P=0.032). Conclusion This study confirmed the efficacy of H. pylori eradication in increasing the platelet count in ITP patients. Further studies with a larger number of patients are necessary to identify the crucial predictive factors responsible for platelet recovery in chronic ITP patients with the H. pylori infection.
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Affiliation(s)
- Hee Sang Tag
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
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