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Seminars in Thrombosis and Hemostasis Apr 2020Extracorporeal membrane oxygenation (ECMO) is a form of life support used to treat neonates, children, and adults with cardiorespiratory failure refractory to... (Review)
Review
Extracorporeal membrane oxygenation (ECMO) is a form of life support used to treat neonates, children, and adults with cardiorespiratory failure refractory to conventional therapy. This therapy requires the use of anticoagulation to prevent clotting in the extracorporeal circuit, but anticoagulation also increases the risk of bleeding on ECMO. Both bleeding and thrombosis remain significant complications on ECMO and balancing these risks is challenging. Acquired platelet dysfunction is common during ECMO and quantitative and qualitative platelet dysfunction contributes to bleeding risk. Optimal platelet count, function, and transfusion thresholds are not well established during pediatric ECMO. In this review, we provide an overview of hemostatic alterations during ECMO, changes in platelet count and function, platelet monitoring techniques, bleeding risk, and future needs to best optimize patient management and care.
Topics: Blood Coagulation; Extracorporeal Membrane Oxygenation; Humans; Platelet Count
PubMed: 32232826
DOI: 10.1055/s-0040-1708542 -
International Journal of Hematology Jun 2023The purpose of this study was to classify patients with severe COVID-19 into more detailed risk groups using coagulation/fibrinolysis, inflammation/immune response, and...
The purpose of this study was to classify patients with severe COVID-19 into more detailed risk groups using coagulation/fibrinolysis, inflammation/immune response, and alveolar/myocardial damage biomarkers, as well as to identify prognostic markers for these patients. These biomarkers were measured every day for eight intensive care unit days in 54 adult patients with severe COVID-19. The patients were classified into survivor (n = 40) and non-survivor (n = 14) groups. Univariate and multivariate analyses showed that the combined measurement of platelet count and presepsin concentrations may be the most valuable for predicting in-hospital death, and receiver operating characteristic curve analysis further confirmed this result (area under the curve = 0.832). Patients were consequently classified into three groups (high-, medium-, and low-risk) on the basis of their cutoff values (platelet count 53 × 10/µL, presepsin 714 pg/mL). The Kaplan-Meier curve for 90-day survival by each group showed that the 90-day mortality rate significantly increased as risk level increased (P < 0.01 by the log-rank test). Daily combined measurement of platelet count and presepsin concentration may be useful for predicting in-hospital death and classifying patients with severe COVID-19 into more detailed risk groups.
Topics: Adult; Humans; COVID-19; Prognosis; Hospital Mortality; Platelet Count; Biomarkers; ROC Curve; Peptide Fragments; Lipopolysaccharide Receptors
PubMed: 36920687
DOI: 10.1007/s12185-023-03555-5 -
The Australasian Journal of Dermatology Aug 2022The pathogenesis of livedoid vasculopathy (LV) remains unknown. Although platelet activation occurs in LV, little research has been conducted on LV platelet morphology...
BACKGROUND
The pathogenesis of livedoid vasculopathy (LV) remains unknown. Although platelet activation occurs in LV, little research has been conducted on LV platelet morphology parameters. The purpose of this study was to investigate whether platelet morphology changes in LV and its clinical significance.
METHODS
Twenty-seven LV patients and 21 cutaneous small vessel vasculitis (CSVV) patients, all at the active stage, were included. Platelet parameters in active- and stable-stage LV and CSVV patients were compared. Correlations between these platelet parameters and LV composite clinical scores were analysed.
RESULTS
LV patients' mean age was 25.48 years (range: 9-62 years), and 81.48% (22/27) were women and 18.52% (5/27) were men. The platelet counts and plateletcrit (PCT) levels were significantly elevated in LV patients compared with CSVV patients and in active-stage LV patients compared with stable-stage LV patients after treatment. LV patient composite clinical scores that reflected disease severity and activity were positively correlated with the platelet count and PCT levels.
CONCLUSION
Altered platelet morphology was detected in LV patients. Platelet count and PCT might be haematological biomarkers for early prediction of LV activity and relapses and for differential identification between LV and CSVV.
Topics: Adult; Biomarkers; Female; Humans; Livedoid Vasculopathy; Male; Platelet Count; Skin Diseases, Vascular
PubMed: 35635484
DOI: 10.1111/ajd.13884 -
Transfusion Medicine Reviews Oct 2023The optimal use of prophylactic platelet transfusion remains uncertain in a number of clinical scenarios. Platelet count thresholds have been established in patients... (Review)
Review
The optimal use of prophylactic platelet transfusion remains uncertain in a number of clinical scenarios. Platelet count thresholds have been established in patients with hematologic malignancies, yet thresholds backed by scientific data are limited or do not exist for many patient populations. Clinical scenarios involving transfusion thresholds for thrombocytopenic patients with critical illness, need for surgery or invasive procedures, or those involving specials populations like children and neonates, lack clear evidence for discerning favorable outcomes without undue risk related to platelet transfusion. In addition, while prophylactic platelet transfusions are administered with the goal of enhancing hemostasis, increasing evidence supports critical nonhemostatic roles for platelets related to innate and adaptive immunity, inflammation, and angiogenesis, which may impact patient responses and outcomes. Here we review several recent studies conducted in adult or pediatric patients that highlight the limitations in our current understanding of prophylactic platelet transfusion. Together, these studies underscore the need for additional research, especially in the form of robust randomized clinical trials and integrating additional parameters beyond the platelet count. Future research at the basic, translational, and clinical levels will best define the optimal role for prophylactic transfusion across the lifespan and its broader impact on health and disease.
Topics: Infant, Newborn; Adult; Humans; Child; Platelet Transfusion; Hemorrhage; Thrombocytopenia; Platelet Count; Blood Transfusion
PubMed: 37599188
DOI: 10.1016/j.tmrv.2023.150751 -
The New England Journal of Medicine Mar 2020
Topics: Humans; Platelet Count; Purpura, Thrombocytopenic, Idiopathic; Thrombocytopenia
PubMed: 32160680
DOI: 10.1056/NEJMc1913324 -
Frontiers in Immunology 2023Thrombocytopenia, characterized by a decrease in platelet count, is commonly observed in sepsis and COVID-19. In sepsis, thrombocytopenia can result from various... (Review)
Review
Thrombocytopenia, characterized by a decrease in platelet count, is commonly observed in sepsis and COVID-19. In sepsis, thrombocytopenia can result from various mechanisms, including impaired platelet production in the bone marrow, accelerated platelet destruction due to increased inflammation, sequestration of platelets in the spleen, immune-mediated platelet destruction, or dysregulated host responses. Similarly, thrombocytopenia has been reported in COVID-19 patients, but the immune-related mechanisms underlying this association remain unclear. Notably, interventions targeting thrombocytopenia have shown potential for improving outcomes in both sepsis and COVID-19 patients. Understanding these mechanisms is crucial for developing effective treatments.
Topics: Humans; COVID-19; Thrombocytopenia; Blood Platelets; Platelet Count; Sepsis; Anemia
PubMed: 37841241
DOI: 10.3389/fimmu.2023.1213510 -
Andrologia Mar 2021The updated systematic review and meta-analysis was conducted to assess the platelet indices between patients with varicocele and healthy subject. The main purpose of... (Meta-Analysis)
Meta-Analysis Review
The updated systematic review and meta-analysis was conducted to assess the platelet indices between patients with varicocele and healthy subject. The main purpose of our study was to explore the relationship between platelet and the pathogenesis of varicocele. Databases including Cochrane Library, PubMed, and MEDLINE were retrieved to identify studies. Two independent investigators extracted the related information of the included original passages. In order to estimate the difference of varicocele patients and healthy subjects, we applied the standardised mean difference (SMD) and the corresponding 95% confidence intervals (95% CIs). 1,156 patients and 797 healthy subjects of nine studies met the pre-set inclusion criteria. The estimated SMD in MPV between varicocele patients and healthy subjects was 0.61 (95% CI: 0.29-0.93, p < 0.001). The estimated SMD in MPV between preoperative varicocele patients and post-operative varicocele patients was 0.22 (95% CI: 0.03-0.41, p = 0.02). The estimated SMD in PLT between varicocele patients and healthy subjects was -0.19 (95% CI: -0.28, -0.08, p = 0.001). The available data suggest that a higher MPV level in varicocele patients, and the varicocele operation can normalise the preoperatively elevated mean platelet volume levels. Further researches are needed to investigate the potential role of platelet with varicocele.
Topics: Blood Platelets; Humans; Male; Mean Platelet Volume; Platelet Count; Postoperative Period; Varicocele
PubMed: 33369777
DOI: 10.1111/and.13939 -
Frontiers in Immunology 2023
Topics: Humans; Megakaryocytes; Blood Platelets; Platelet Count; Communicable Diseases
PubMed: 37056755
DOI: 10.3389/fimmu.2023.1175200 -
Platelets May 2021The relationship between platelet count and risk of major bleeding in patients with venous thromboembolism (VTE) during anticoagulation remains unclear. We therefore...
The relationship between platelet count and risk of major bleeding in patients with venous thromboembolism (VTE) during anticoagulation remains unclear. We therefore investigated the association between platelet count, measured at VTE diagnosis and before the thrombotic event, and risk of major bleeding. Participants comprised 744 patients with incident VTE derived from the Tromsø Study. Major bleedings were recorded during the first year after VTE. Cox-regression was used to calculate hazard ratios (HRs) for major bleeding across platelet count quartiles.There were 55 major bleedings (incidence rate 9.1/100 person-years, 95% confidence interval [CI] 7.0-11.8). The major bleeding risk increased across quartiles of platelet count measured at VTE diagnosis ( for trend<0.02). In the age- and sex-adjusted model, subjects with platelet count in the highest quartile (≥300x10/L) had a 4.3-fold (95% CI 1.7-10.9) higher risk of major bleeding compared to those with platelet count in the lowest quartile (≤192x10/L), and exclusion of patients with cancer yielded similar results. When platelet count was measured on average 7 years before a VTE, the corresponding HR was 2.5 (95% CI 0.9-6.7). Our results suggest that increasing platelet count, assessed several years before and at VTE diagnosis, is associated with a higher risk of major bleeding, and could be a stable individual marker of major bleeding risk in VTE-patients.
Topics: Adult; Aged; Aged, 80 and over; Female; Hemorrhage; Humans; Male; Middle Aged; Platelet Count; Risk Factors; Venous Thromboembolism
PubMed: 32498591
DOI: 10.1080/09537104.2020.1769052 -
JAMA Network Open Jan 2022Individuals with cancer often have an elevated platelet count at the time of diagnosis. The extent to which an elevated platelet count is an indicator of cancer is...
IMPORTANCE
Individuals with cancer often have an elevated platelet count at the time of diagnosis. The extent to which an elevated platelet count is an indicator of cancer is unclear.
OBJECTIVE
To evaluate the association of an elevated platelet count with a cancer diagnosis.
DESIGN, SETTING, AND PARTICIPANTS
This nested case-control study included Ontario residents enrolled in the provincial health insurance plan who had 1 or more routine complete blood count (CBC) tests performed between January 1, 2007, and December 31, 2017, with follow-up through December 31, 2018. Case patients were individuals with a new cancer diagnosis during the observation period. Eligible control individuals were cancer free before the date of diagnosis for a case patient to whom they were matched. One case patient was matched to 3 controls based on sex, age, and health care use patterns. Data were analyzed from September 24, 2020, to July 13, 2021.
EXPOSURES
Case patients and controls were assigned to 1 of 5 exposure groups based on age- and sex-specific platelet count distributions in the control population: very low (≤10th percentile), low (>10th to 25th percentile), medium (>25th to <75th percentile), high (75th to <90th percentile), and very high (≥90th percentile).
MAIN OUTCOMES AND MEASURES
Odds ratios (ORs) were estimated for specific cancer sites for each category of platelet count at intervals up to 10 years after a blood test.
RESULTS
Of the 8 917 187 eligible Ontario residents with a routine CBC record available, 4 971 578 (55.8%) were women; the median age at the first CBC was 46.4 years (IQR, 32.5-59.5 years). Among individuals with a routine CBC record available, 495 341 (5.6%) received a diagnosis of first primary cancer during the 10-year observation period. The OR for a solid tumor diagnosis associated with a very high platelet count vs a medium platelet count in the 6-month period before the diagnosis was 2.32 (95% CI, 2.28-2.35). A very high platelet count was associated with colon (OR, 4.38; 95% CI, 4.22-4.54), lung (OR, 4.37; 95% CI, 4.22-4.53), ovarian (OR, 4.62; 95% CI, 4.19-5.09), and stomach (OR, 4.27; 95% CI, 3.91-4.66) cancers. Odds ratios attenuated with increasing time from CBC test to cancer diagnosis.
CONCLUSIONS AND RELEVANCE
In this nested case-control study, an elevated platelet count was associated with increased risk of cancer at several sites. Our findings suggest that an elevated platelet count could potentially serve as a marker for the presence of some cancer types.
Topics: Adult; Biomarkers; Case-Control Studies; Female; Humans; Male; Middle Aged; Neoplasms; Ontario; Platelet Count
PubMed: 35015064
DOI: 10.1001/jamanetworkopen.2021.41633