Immature Platelet Fraction As a Measure of Thrombocytopenia in Trauma Patients and Its Cut off Value with Severity of Thrombocytopenia

Abstract Abstract 4681 Thrombocytopenia is common finding in trauma patients. However, platelet count fluctuates widely. Therefore, Immature Platelet Fraction is being studied for whether it can complement the platelet count. Immature platelet fraction (IPF ) is a measure of reticulated platelets (RPs), which represents the state of thrombopoiesis. IPF is obtained from an automated haematology analyzer. It is proportional to reticulated platelets and expressed as percentage of Total optical count. Aim To establish cut off value of IPF (%) with increasing severity of thrombocytopenia in trauma patients which can be useful for diagnosis and monitoring of the cases. Material and methods Total 69 patients admitted in J.P.N Apex trauma centre (AIIMS) were studied within first 24 hrs after injury. Peripheral blood was collected in K2EDTA tube for measurement of platelet count using a fully automated analyzer Sysmex XE 2100 (Japan). RET channel was selected for the measurement of IPF%.The patients were categorized with platelet count between 150×103/μ l and 100×103/μ l, between 100×103/μ l and 50×103/μ l, and below 50×103/μ l. Immature platelet fraction was measured in all categories of thrombocytopenia and statistically compared. Each patient was ascribed New Injury Severity Score and SOFA (sequential organ failure assessment) score and their correlation with IPF value was assessed. ROC curve was used to establish cut off value of IPF between those with platelet count above150×103/μ l and below 150×103/μ l and between those with platelet count above 100×103/μ l and below 100×103/μ l. Results Using Mann Whitney test, the patients (n=41) with platelet count < 150×103/μ l showed mean IPF (%) (18.19 ± 9.43, range: 4.0 – 46.6) which was significantly higher (p<0.0001) than that of subjects (n=28) with platelet count above 150×103/μ l,in which mean IPF (%) value was (8.94 ± 5.79, range:2.3 − 24.9). The cut–off value of IPF > 12.5% was found in patients having platelet count < 150×103/μ l. Similarly, the patients (n=22) with platelet count < 100×103/μ l showed mean IPF (%) (22.04 ± 9.94, range:10.8-46.6) which was significantly higher (p<0.0001) than that of patients (n=47) with platelet count above 100×103/μ l in which mean IPF (%) value was (10.87 ± 6.51, range:2.3 − 35.4). The cut–off value of IPF > 14.95 % was found in patients having platelet count <100×103/μ l. Using Kruskal-Wallis test, IPF (%) value (23.31 ± 10.44, range: 11.2 – 46.6) in patients (n=18) with platelet count between (50×103/μ l – 100×103/μ l) was found to be significantly higher (p=0.003) than the value (13.73 ± 6.58, range: 4 – 35.4) obtained in patients (n=19 ) with platelet count between (100×103/μ l – 150×103/μ l). No statistical significance was found between IPF (%) value (13.73 ± 6.58, range: 4 – 35.4) obtained in patients (n=19) with platelet counts between (100×103/μ l – 150×103/μ l) and IPF(%) value (16.3 ± 4.41, range:10.8-20.3) in patients (n=4) with platelet count below 50×103/μ l. Similar result was obtained between IPF(%) value (23.31 ± 10.44, range:11.2-46.6) in patients (n=18) with platelet count between (50×103/μ l – 100×103/μ l) and IPF(%)value (16.3 ± 4.41,range:10.8-20.3) in patients (n=4) with platelet count below 50×103/μ l. IPF value (19.64 ± 7.88, range:6.6 − 35.4) was found to be significantly higher (p<0.0001) in patients (n=19) with SOFA score ≥8 as compared to the patients with SOFA score <8,which showed IPF (%) value (12.46±9.10, range:2.3-46.6). In contrast, no significant difference in IPF value was found in the context of New ISS score. Conclusion: Immature platelet fraction could be a reasonable and reliable measure of thrombocytopenia which can be used to diagnose and monitor the severity of thrombocytopenia in trauma patients. Disclosures: No relevant conflicts of interest to declare.

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Does emergency medicine length of stay predict trauma outcomes at a Level 1 Trauma Center?

Journal of Hospital Administration ◽

10.5430/jha.v4n5p1 ◽

2015 ◽

Vol 4 (5) ◽

pp. 1 ◽

Cited By ~ 2

Author(s):

Erin Powers Kinney ◽

Kamal Gursahani ◽

Eric Armbrecht ◽

Preeti Dalawari

Keyword(s):

Length Of Stay ◽

Trauma Center ◽

Injury Severity ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Trauma Patients ◽

Hospital Capacity ◽

Significant Difference ◽

Level 1 ◽

Level 1 Trauma Center

Objective: Previous studies looking at emergency department (ED) crowding and delays of care on outcome measures for certain medical and surgical patients excluded trauma patients. The objectives of this study were to assess the relationship of trauma patients’ ED length of stay (EDLOS) on hospital length of stay (HLOS) and on mortality; and to examine the association of ED and hospital capacity on EDLOS.Methods: This was a retrospective database review of Level 1 and 2 trauma patients at a single site Level 1 Trauma Center in the Midwest over a one year period. Out of a sample of 1,492, there were 1,207 patients in the analysis after exclusions. The main outcome was the difference in hospital mortality by EDLOS group (short was less than 4 hours vs. long, greater than 4 hours). HLOS was compared by EDLOS group, stratified by Trauma Injury Severity Score (TRISS) category (< 0.5, 0.51-0.89, > 0.9) to describe the association between ED and hospital capacity on EDLOS.Results: There was no significant difference in mortality by EDLOS (4.8% short and 4% long, p = .5). There was no significant difference in HLOS between EDLOS, when adjusted for TRISS. ED census did not affect EDLOS (p = .59), however; EDLOS was longer when the percentage of staffed hospital beds available was lower (p < .001).Conclusions: While hospital overcrowding did increase EDLOS, there was no association between EDLOS and mortality or HLOS in leveled trauma patients at this institution.

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A Novel Engineered Single-Chain Antibody Fragment for Targeting Pediatric Philadelphia Chromosome-like Acute Lymphoblastic Leukemia

Blood ◽

10.1182/blood-2020-138421 ◽

2020 ◽

Vol 136 (Supplement 1) ◽

pp. 36-36

Author(s):

Sara M.A. Mohamed ◽

Keith Sia ◽

Karl-Heinz Friedrich ◽

Andreas Wohlmann ◽

Savvas Savvides ◽

...

Keyword(s):

Indirect Immunofluorescence ◽

Conflicts Of Interest ◽

Lymphoblastic Leukemia ◽

Statistical Significance ◽

Immunofluorescence Assay ◽

Laser Scanning Microscopy ◽

Indirect Immunofluorescence Assay ◽

Single Chain ◽

Genetic Characteristics ◽

Significant Difference

Introduction: Philadelphia-like acute lymphoblastic leukaemia (Ph-like ALL) is a high-risk ALL subtype characterized by an inferior survival rate and chemotherapeutic drug resistance (Tasian et al, Blood 130: 2064-2072, 2017). Around 50% of Ph-like ALL cases harbour gene rearrangements leading to the overexpression of cytokine receptor-like factor 2 (CRLF2) (Loh et al, Blood 121: 485-488, 2013). CRLF2 (also known as thymic stromal lymphopoietin receptor, TSLPR) heterodimerizes with the interleukin-7 receptor alpha (IL-7Rα) subunit to form the functional TSLPR. Upon TSLP binding, CRLF2 activates the JAK/STAT signalling pathway, leading to enhanced proliferation and survival of leukemia cells resulting in poor outcomes in patients (Harvey et al, Blood 115: 5312-5321, 2010). The extracellular overexpression of CRLF2 and association with poor prognosis suggest the translational value of designing precision-based therapeutics targeting CRLF2 in Ph-like ALL. Although conventional immunotherapy using full-sized antibodies is a promising treatment strategy that can improve treatment efficiency and minimize off-target toxicity, their clinical translation is challenging due to the high production cost and large size affecting targeting efficiency (Holliger et al, Nat Biotech 23: 1126-1136, 2005). Herein, we validated a novel single-chain variable fragment against CRLF2 (CRLF2-ScFv) for targeting Ph-like ALL cells. Methods: A CRLF2-rearranged Ph-like ALL cell line (MHH-CALL-4) was lentivirally transduced with a CRLF2-targeting shRNA driven by an inducible promoter, enabling the inducible knockdown of CRLF2. CRLF2 expression in MHH-CALL-4 cells after shRNA induction (KD-CALL-4) was evaluated using fluorescence-activated cell sorting (FACS). The cellular association of the CRLF2-ScFv was determined in MHH-CALL-4 and KD-CALL-4 at 4° and 37°C using an indirect immunofluorescence assay. Confocal laser scanning microscopy was used to visualize and compare the cellular association of CRLF2-ScFv in MHH-CALL-4 and KD-CALL-4. The cellular association of CRLF2-ScFv was also investigated ex vivo using a small panel of Ph-like and non-Ph-like ALL patient-derived xenografts (PDXs), representing similar immunophenotype and genetic characteristics to their original disease subtypes (Liem et al, Blood 103: 3905-3914, 2004), and peripheral blood mononuclear cells (PBMCs) to investigate the non-selective association. CRLF2 expression in MHH-CALL-4 and Ph-like ALL PDX cells was quantified using indirect immunofluorescence assay. The downstream impact of CRLF2-ScFv on STAT5 phosphorylation (pSTAT5) was determined by FACS either with or without TSLP stimulation. The statistical significance was tested using Unpaired unequal variances t-test or one-way ANOVA followed by multiple comparisons test. Statistical significance was considered when P ≤ 0.05. All experiments were performed in triplicate. Results: KD-CALL-4 showed a 75% reduction in CRLF2 expression compared with MHH-CALL-4 cells (P = 0.0009). CRLF2-ScFv exhibited a 94% higher association with MHH-CALL-4 compared with KD-CALL-4 cells at 37°C (P = 0.0013). The association of CRLF2-ScFv with MHH-CALL-4 cells was reduced by 75% at the non-proliferating state of cells at 4°C compared to 37°C (P = 0.006). Orthogonally viewed confocal microscopy images showed 82% higher intracellular uptake of CRLF2-ScFv in MHH-CALL-4 compared to KD-CALL-4 cells (P = 0.0003). CRLF2-ScFv showed >80% higher association with a Ph-like PDX sample compared with a control CRLF2low PDX and PBMCs (P < 0.001). Of note, a Ph-like ALL PDX exhibited only one-third of the association with CRLF2-ScFv compared with MHH-CALL-4 cells (P = 0.04), corresponding to the significant difference in CRLF2 surface expression (P = 0.01). CRLF2-ScFv significantly reduced pSTAT5 expression in MHH-CALL-4 cells (P = 0.05) and prevented TSLP-induced STAT5 phosphorylation (P = 0.01), suggesting competition with the TSLP binding site. Conclusion: CRLF2-ScFv is a selective targeting moiety for CRLF2 with a significant internalization potential and receptor antagonistic effect, highlighting the therapeutic implications for targeting Ph-like ALL. Keywords: CRLF2, ScFv, STAT5 phosphorylation, Patient-Derived Xenografts. Disclosures No relevant conflicts of interest to declare.

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Functional Status after Injury: A Longitudinal Study of Geriatric Trauma

The American Surgeon ◽

10.1177/000313481007601006 ◽

2010 ◽

Vol 76 (10) ◽

pp. 1055-1058 ◽

Cited By ~ 8

Author(s):

Lorraine Kelley-Quon ◽

Lillian Min ◽

Eric Morley ◽

Jonathan R. Hiatt ◽

Henry Cryer ◽

...

Keyword(s):

Functional Status ◽

Injury Severity ◽

Living Arrangement ◽

Statistical Significance ◽

Functional Decline ◽

Traumatic Injury ◽

Community Dwelling ◽

Geriatric Trauma ◽

Trauma Patients ◽

Trauma Population

We evaluated self-rated functional status measured longitudinally in the year after injury in a geriatric trauma population. The longitudinal (L) group included 37 of 60 eligible trauma patients aged 65 years or older admitted December 2006 to November 2007 for greater than 24 hours who completed a Short Functional Status questionnaire (SFS) at 3, 6, and 12 months after injury. The SFS yields scores of 0 to 5 (5 = independent in all five activities of daily living [ADLs]) and has been validated among community-dwelling elders. The control (C) group included 63 trauma patients aged 65 years or older admitted December 2007 to July 2009 for greater than 24 hours who reported their preinjury functional status using the SFS at hospital admission. We used characteristics and scores of the C group to impute preinjury ADL scores for the L group. The groups were similar in baseline characteristics (age, ethnicity, Injury Severity Score, Charlson Comorbidity Index, and living arrangement; P > 0.05). For the C group, the preinjury ADL score was 4.6 (SD = 0.9). For the L group, ADL scores declined at all intervals reaching statistical significance at 12 months. We conclude that in the year after traumatic injury, geriatric patients lost the equivalent of approximately one ADL, increasing their risk of further functional decline, loss of independence, and death.

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Plasma ADAMTS13 Activity Associates with Injury Severity in Pediatric Trauma Patients

Blood ◽

10.1182/blood.v128.22.3777.3777 ◽

2016 ◽

Vol 128 (22) ◽

pp. 3777-3777

Author(s):

Jenny K. McDaniel ◽

Ilan I Maizlin ◽

Michelle C. Shroyer ◽

Morgan E. Banks ◽

Jean-Francois Pittet ◽

...

Keyword(s):

Injury Severity ◽

Pediatric Trauma ◽

Initial Presentation ◽

Trauma Patients ◽

Adamts13 Activity ◽

Acute Traumatic Coagulopathy ◽

Time Period ◽

Increased Risk ◽

Significant Difference ◽

Traumatic Coagulopathy

Abstract Background: Acute traumatic coagulopathy occurs in both pediatric and adult trauma patients and is associated with an increased risk of mortality. Trauma patients not only have increased risk for hemorrhagic complications, but also are at increased risk for thrombosis due to multiple factors including local tissue injury, inflammation, and immobility. The complex underlying pathophysiology of coagulation abnormalities associated with traumatic injury have yet to be fully elucidated. Additionally, there are significant differences in the hemostatic system of pediatric patients compared to adults. Objectives: The purpose of this study was to determine the levels of coagulation parameters including von Willebrand factor (VWF) antigen and ADAMTS13 activity in pediatric trauma patients and evaluate for possible association with injury severity and/or mortality. Methods: This study utilized plasma specimens collected from pediatric trauma patients that presented to our institution over a 2-year time period. The specimens were collected at initial presentation and 24 hours later. The injury severity was estimated using both the Glasgow Coma Scale (GCS) and Injury Severity Score (ISS). A cohort of control samples was obtained from pediatric patients for elective surgical procedures over the same time period. Plasma VWF antigen was determined by a sandwich ELISA; plasma ADAMTS13 activity was determined by FRETS-VWF73. The results were determined by nonparametric tests for the differences in median values. Results: A total of 106 trauma patient samples at initial time point, 78 trauma samples at 24 hour time point, and 54 control samples were obtained and utilized for study. There were statistically significant differences (p<0.05) in the plasma levels of VWF antigen, ADAMTS13 activity, and the ratio of ADAMTS13 activity to VWF antigen for the trauma patient samples at initial presentation when compared to controls (Table 1). At 24 hours, there were still statistically significant differences between ADAMTS13 activity and the ratio of ADAMTS13 activity to VWF antigen in trauma patients compared to controls, but there was no significant difference in VWF antigen between the two cohorts (Table 2). There was a significant difference between the decrease in ADAMTS13 activity and injury severity as estimated by ISS ³ 15 or GCS < 8 at both time points; however, ADAMTS13 activity was not statistically different in survivors vs. non-survivors. A higher VWF antigen level at initial presentation was the only factor found to be significantly different in non-survivors. Conclusions: This study demonstrates significant differences in plasma ADAMTS13 activity and VWF antigen in pediatric trauma patients compared to controls. In patients with more severe injuries as estimated by GCS and ISS, there was also a significant association with decreased levels of ADAMTS13 activity. These finding may underlie part of the prothrombotic propensity in microcirculation that occurs in patients post-trauma. Further investigation is warranted to better understand the mechanisms of acute traumatic coagulopathy and potential prognostic factors, and to determine the most effective interventions for acute traumatic coagulopathy in the pediatric population. Disclosures Zheng: Ablynx: Consultancy; Alexion: Research Funding.

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Differential Diagnosis of Hereditary and Acquired Thrombocytopenia By the Immature Platelet Fraction and Thrombopoietin Levels

Blood ◽

10.1182/blood.v126.23.1049.1049 ◽

2015 ◽

Vol 126 (23) ◽

pp. 1049-1049 ◽

Cited By ~ 1

Author(s):

Fabio Luiz Bandeira Ferreira ◽

Marina Pereira Colella ◽

Samuel de Souza Medina ◽

Maiara Marx Luz Fiusa ◽

Loredana Nilkenes Gomes da Costa ◽

...

Keyword(s):

Bone Marrow ◽

Differential Diagnosis ◽

Platelet Count ◽

Healthy Volunteers ◽

Complete Blood Count ◽

Conflicts Of Interest ◽

Bone Marrow Failure ◽

Healthy Individuals ◽

Technical Limitation ◽

Immature Platelet Fraction

Abstract Introduction: The differential diagnosis of hereditary and acquired thrombocytopenias can be challenging, especially when between immune thrombocytopenia (ITP) and less well characterized hereditary thrombocytopenias (HT) such as MYH9-related disorders. Fundamental differences in the management of these two conditions add clinical relevance to the search for novel parameters that differentiate these conditions. The immature platelet count (IPF) represents the fraction of platelets with higher RNA content, and in analogy to the reticulocyte count for erythropoiesis is a biomarker of thrombopoietic activity. In a recent report (Miyazaki et al, 2015), IPF values that were more than 5-fold higher than those observed in ITP patients were reported in a population of 15 patients with HT. However, whether this increased values represented a real increase in thrombopoietic activity, or reflected a technical limitation of IPF determination in large platelets could not be clarified. Here, we aimed to evaluate the role of IPF determination in the differential diagnosis between HT and several forms of acquired thrombocytopenia in a larger and more diverse population of patients. We also evaluated thrombopoietin (TPO) levels in HT compared to ITP, to further investigate the mechanisms by which extremely large IPF values are observed in HT. Methods: IPF and mean platelet volume (MPV) were prospectively determined using a Sysmex XE5000 hematologic analyzer (as part of the complete blood count) in a cohort of patients with post-chemotherapy thrombocytopenia (n=56), bone marrow failure (myelodysplastic syndromes and aplastic anemia; n=22), ITP (ITP; n=105) and inherited thrombocytopenias (n=27). The latter population consists of a well-defined cohort of individuals with HT thrombocytopenia characterized by clinical, familial, laboratory and molecular data. TPO levels were determined by ELISA (R&D Systems) in 21 HT patients and 22 ITP patients matched for platelet count and age. A group of 178 healthy volunteers were used to determine normal IPF and MPV values. Results: Median platelet counts were similar in post-chemotherapy patients (CTx) (32.0*109/L), bone marrow failure (BMF) (33.5*109/L), ITP (52.0*109/L) and HT (52.0*109/L) (P=0.15). Similar IPF levels were observed in CTx and BMF patients (5.6%; IQR 3.4-8.8% and 6.5%; IQR 3.5-13.7%. Compared to these two groups, higher IPF values were observed in both ITP (12.3%; 7.0-21.0%) and HT patients (29.8%; 17.5-56.4%) (both P values < 0.05). In addition, IPF were significantly higher in HT compared to ITP (Kruskall-Wallis test and Dunn's post test,P=0.001). MPV values were different between HT and CTx/BMF groups, but could not differentiate ITP from HT. TPO levels. The accuracy of IPF to discriminate HT from all other causes of thrombocytopenia estimated by ROC analysis was 0.88 (CI95%0.8-0.96, p<0.0001). Similar TPO levels were observed in platelet count-matched ITP, HT patients and healthy volunteers without thrombocytopenia. Interestingly, TPO presented marked correlations with both platelet count (Rs = - 0.61, P=0.002) and IPF (Rs= 0.59, P=0.003), even with TPO levels in the same range of healthy individuals. In contrast, no significant correlation could be observed between TPO and IPF or platelet count in HT patients. Conclusions: IPF represents an informative biomarker for the differential diagnosis of hereditary and acquired thrombocytopenias, and accurately differentiates ITP from the most common HT. As expected, TPO levels in patients with ITP were not higher than in individuals with normal platelets counts. The inverse correlation between TPO and platelet count in these patients confirm a blunted TPO response to thrombocytopenia in these patients. Similarly, patients with HT did not present increased TPO levels compared to healthy individuals. Accordingly, increased IPF levels in these patients cannot be attributed to higher TPO levels. Disclosures No relevant conflicts of interest to declare.

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Impact of Multiprofessional Rounds on Critical Care Outcomes in the Surgical Trauma Intensive Care Unit

The American Surgeon ◽

10.1177/000313481908500108 ◽

2019 ◽

Vol 85 (1) ◽

pp. 15-22

Author(s):

Michael R. Nahouraii ◽

Colleen H. Karvetski ◽

Rita A. Brintzenhoff ◽

Gaurav Sachdev ◽

Susan L. Evans ◽

...

Keyword(s):

Injury Severity ◽

Statistical Significance ◽

Outcome Data ◽

Surgical Trauma ◽

Trauma Patients ◽

Linear Regression Models ◽

Icu Length Of Stay ◽

Severity Scores ◽

Mortality Difference ◽

The Impact

Multiprofessional rounds (MPR) represent a mechanism for the coordination of care in critically ill patients. Herein, we examined the impact of MPR on ventilator days (Vent-day), ICU length of stay (LOS), hospital LOS (HLOS), and mortality. A team developed guidelines for MPR, which began in February 2016. Patients admitted between November 2015 and March 2017 with Acute Physiology and Chronic Health Evaluation (APACHE) IV and injury severity scores were included. Outcome data consisted of Vent-day, Vent-day observed/expected ratio (O/E), ICU LOS, ICU LOS O/E, HLOS, HLOS-O/E, and mortality. Linear regression models are constructed to assess statistical significance. A total of 3372 patients were included. Among surgical patients (n = 343 pre-MPR, n = 1675 post-MPR), MPR was associated with decreases in Vent-day O/E (0.74 pre, 0.59 post, P = 0.03), ICU LOS O/E (0.67 pre, 0.61 post, P = 0.01), and HLOS-O/E (1.47 pre, 1.22 post, P = 0.0005). No mortality difference was observed. For trauma patients (n = 221 pre, n = 1133 post), MPR resulted in a reduction in Vent-days (2.2 days pre, 1.6 days post, P = 0.05). However, no differences were observed for Vent-day O/E, ICU LOS O/E, HLOS-O/E, and mortality. Implementation of MPR was associated with improved outcomes for surgical trauma ICU patients. Sustainability of MPR remains a challenge and requires education and engagement.

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Impact of stress-induced hyperglycemia on the outcome of children with trauma: A cross-sectional analysis based on propensity score-matched population

Scientific Reports ◽

10.1038/s41598-019-52928-6 ◽

2019 ◽

Vol 9 (1) ◽

Author(s):

Yi-Wen Tsai ◽

Shao-Chun Wu ◽

Chun-Ying Huang ◽

Shiun-Yuan Hsu ◽

Hang-Tsung Liu ◽

...

Keyword(s):

Propensity Score ◽

Hospital Mortality ◽

Injury Severity ◽

Pediatric Trauma ◽

Trauma Patients ◽

Cross Sectional ◽

Icu Admission ◽

Significant Difference ◽

History Of ◽

Sectional Analysis

Abstract This was a retrospective study of pediatric trauma patients and were hospitalized in a level-1 trauma center from January 1, 2009 to December 31, 2016. Stress-induced hyperglycemia (SIH) was defined as a hyperglycemia level ≥200 mg/dL upon arrival at the emergency department without any history of diabetes or a hemoglobin A1c level ≥6.5% upon arrival or during the first month of admission. The results demonstrated that the patients with SIH (n = 36) had a significantly longer length of stay (LOS) in hospital (16.4 vs. 7.8 days, p = 0.002), higher rates of intensive care unit (ICU) admission (55.6% vs. 20.9%, p < 0.001), and higher in-hospital mortality rates (5.6% vs. 0.6%, p = 0.028) compared with those with non-diabetic normoglycemia (NDN). However, in the 24-pair well-balanced propensity score-matched patient populations, in which significant difference in sex, age, and injury severity score were eliminated, patient outcomes in terms of LOS in hospital, rate of ICU admission, and in-hospital mortality rate were not significantly different between the patients with SIH and NDN. The different baseline characteristics of the patients, particularly injury severity, may be associated with poorer outcomes in pediatric trauma patients with SIH compared with those with NDN. This study also indicated that, upon major trauma, the response of pediatric patients with SIH is different from that of adult patients.

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Time is of the Essence: Impact of a More Aggressive Chemical Venous Thromboembolism Prophylaxis Regimen on Trauma Patients

The American Surgeon ◽

10.1177/00031348211050839 ◽

2021 ◽

pp. 000313482110508

Author(s):

Thomas J. Schroeppel ◽

Lesley P. Clement ◽

Alyssa A. Douville ◽

Nathan H. Schmoekel ◽

Jerry Stassinopoulos ◽

...

Keyword(s):

Venous Thromboembolism ◽

Length Of Stay ◽

Injury Severity Score ◽

Severity Score ◽

Injury Severity ◽

Statistical Significance ◽

Linear Regression Analysis ◽

Trauma Patients ◽

Thromboembolism Prophylaxis ◽

Vte Prophylaxis

Background Trauma patients are at high risk for venous thromboembolism (VTE). Opportunity for chemical VTE prophylaxis improvement was identified and practice was altered to start chemoprophylaxis on admission in most patients. The purpose of this study was to determine if early VTE prophylaxis is safe and reduces VTE. Methods The trauma registry was queried over a 12-month period for patients admitted greater than 1 day for traumatic injury. The study spanned 6 months on either side of instituting aggressive chemoprophylaxis. Patients were risk adjusted on demographics, Injury Severity Score, transfusions, procedure type, length of stay, and mortality. Pre-intervention patients were then compared to patients in the aggressive cohort with the primary outcome of VTE. Secondary outcomes included transfusions, mortality, and length of stay (LOS). Results 1597 patients were identified over the study period with 754 (47%) patients in the aggressive period. There were no differences in age, sex, Injury Severity Score, transfusions, procedures, or LOS between cohorts. Pre-algorithm patients were more likely to have penetrating mechanism (9.3% vs 6.6%; P = .009) and longer time to VTE prophylaxis (23.3 vs 13.9 hours; P < .001). No differences were noted in anticoagulant, VTE rate (2.0% vs 1.2%; P = .195), or mortality. Linear regression analysis identified time to chemical prophylaxis as significant predictor of VTE (β = 43.9, P < .001). Conclusions Early aggressive chemical VTE prophylaxis is safe without increasing transfusions. Venous thromboembolism rates were decreased, but did not reach statistical significance.

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Gender-Based Differences in Hemostatic Responses. Implications in Effective Anticoagulant Management.

Blood ◽

10.1182/blood.v114.22.2103.2103 ◽

2009 ◽

Vol 114 (22) ◽

pp. 2103-2103

Author(s):

Omer Iqbal ◽

Nasir Sadeghi ◽

Fadi Bakhos ◽

Debra Hoppensteadt ◽

Jawed Fareed

Keyword(s):

Whole Blood ◽

Conflicts Of Interest ◽

Statistical Significance ◽

Factor Xa ◽

The United States ◽

Saline Control ◽

Anticoagulant Drugs ◽

Significant Difference ◽

Males And Females ◽

Gender Based

Abstract Abstract 2103 Poster Board II-80 Abstract: Recent reports from the National Heart, Lung and Blood Institute indicate that as many as 3 million women (particularly young) in the United States suffer from a form of heart disease fundamentally different from that in men, characterized by more even plaque development inside major and smaller blood vessels, posing diagnostic and treatment challenges leading to increased morbidity and mortality. It is hypothesized that women have variable but attenuated hemostatic responses to anticoagulant drugs when compared to men. In order to validate this hypothesis the hemostatic responses in healthy males (n=10) and females (n=10) were evaluated by performing the global clotting assays, fibrinokinetic assays and thrombin generation assays in the presence of Rivaroxaban, an oral Factor Xa inhibitor likely to replace warfarin, Enoxaparin, a low molecular weight heparin and saline as a control. Blood (20 ml) was drawn from healthy volunteers, males (n=10) and females (n=10) and placed into citrated tubes with one part of 3.2% sodium citrate to 9 parts of blood. The citrated whole blood was supplemented with Rivaroxaban (FC=0.3mg/ml), Enoxaparin (FC=5mg/ml) and saline as a control. The samples were analyzed to determine the whole blood APTT and Heptest clotting assays. The remaining citrated blood was centrifuged at 3000 rpm to obtain platelet poor plasma that was aliquoted and kept frozen at -70°C until further analysis. The plasma was then thawed and supplemented with saline, rivaroxaban (FC=0.3mg/ml) and Enoxaparin (FC=5mg/ml). A statistically significant difference between males and females was noted in APTT (p=0.0442)) and Heptest (p=0.0345) assays in the saline control values. However, the anticoagulant response to supplementation of the plasma samples with rivaroxaban at a final concentration of 0.3ug/ml and Enoxaparin at 5 ug/ml showed a statistically significant difference between males and females in the Heptest (P=0.0423) while the APTT assay felt a little short of statistical significance (P=0.0511). Fibrinokinetics was performed and absorbance recorded (405 nm) at every minute for the next 30 minutes. There are gender-based differences in fibrinokinetic responses to anticoagulant drugs with females showing faster fibrin formation than males. The attenuated hemostatic responses observed in women compared to men may interfere in achieving adequate and effective anticoagulation leading to thrombotic complications. Time (min) 0 30 Gender Male ODs Female ODs Male - ODs Female - ODs Male - ODs Female - ODs Saline control 0.857±0.31 0.611±0.22 1.367±0.28 1.214±0.28 1.377±0.26 1.24±0.28 Rivaroxaban (0.3ug/ml) 0.853±0.32 0.602±0.21 1.353±0.27 1.221±0.18 1.363±0.27 1.23±0.18 Enoxaparin (5ug/ml) 0.713±0.35 0.507±0.24 0.794±0.33 0.621±0.23 0.802±0.33 0.629±0.23 Disclosures: No relevant conflicts of interest to declare.

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Pseudonormokalemia in Patients with Thrombocytosis.

Blood ◽

10.1182/blood.v114.22.2420.2420 ◽

2009 ◽

Vol 114 (22) ◽

pp. 2420-2420

Author(s):

Raimonda Goldman ◽

Amir Steinberg ◽

Jennifer Carreiro ◽

Georgia Panagopoulos ◽

Marvin Cooper ◽

...

Keyword(s):

Platelet Count ◽

Serum Potassium ◽

Conflicts Of Interest ◽

Elevated Serum ◽

Plasma Potassium ◽

Control Group ◽

Computer Search ◽

Strong Positive Correlation ◽

Significant Difference ◽

The Difference

Abstract Abstract 2420 Poster Board II-397 Introduction: Pseudohyperkalemia represents an artificial elevation in serum potassium concentration. It is well described that patients with thrombocytosis may have elevated serum but normal plasma potassium. The difference between serum and plasma potassium is felt to be due to potassium release from platelets during clotting. We propose that a similar mechanism will lead to “pseudonormokalemia,” where serum potassium appears to be in the normal range (3.5-5.0 MEq/L) despite below-normal levels in the plasma(<3.5 MEq/L). Method: The interim analysis of this study was sent for consideration to ASH Annual Meeting on November 2006 (108: 3964) We now present the final analysis by comparing 69 thrombocytosis patients (platelets>500,000/uL) to 68 control patients (platelets<500,000/uL). Patients were identified from a list of lab results generated by a computer search and serum and plasma potassium and CBC were then drawn simultaneously. Results: There was no statistically significant difference in sex distribution or age between the two groups. The average platelet count was 667,960/uL in the thrombocytosis group (SD 151,1 uL) and 286,790/uL (SD 103,9 uL) in the control group (p value <0.001). In both groups, serum potassium was higher than plasma potassium. The analysis comparing serum potassium levels between the two groups showed that serum potassium was significantly higher in the thrombocytosis group than in the control. In fact, we found a strong positive correlation (spearman's rho=0.61, p<.001) between platelet count and the difference in values in serum potassium minus plasma potassium. As the platelet count increases, so does the difference between the serum and plasma potassium. The thrombocytosis group was noted to have a difference between serum and plasma potassium of .51 MEq/L (SD .30 MEq/L) while the control group had a difference of .21 MEq/L (SD .20 MEq/L) Conclusion: Patients with thrombocytosis and normal serum potassium may actually be hypokalemic as this study demonstrates. Disclosures: No relevant conflicts of interest to declare.

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