THE ROLE OF PLATELET CONCENTRATION TRANSFUSION ON THE CORRELATION BETWEEN PLATELET NUMBER AND MAXIMUM AMPLITUDE WITH BLEEDING VOLUME POST CARDIOPULMONARY BYPASS

Postoperative heart patients with Cardiopulmonary Bypass (CPB) are at risk of excessive bleeding. Excessive bleeding is mainly due to thrombocytopenia and platelet dysfunction. The volume of post-CPB bleeding without the administration of platelet concentrate correlates well with platelet count and Maximum Amplitude (MA). The administration of platelet concentrate in thrombocytopenia and platelet dysfunction post CPB may affect the correlation of platelet count and MA which affects the volume of bleeding. The purpose of this research was to know the role of transfusion of platelet concentration post-CPB on the correlation between platelet number and MA with the volume of bleeding. The analytical observational analytic test with the cross-sectional design was conducted on secondary data from September 2015 to March 2016. A total of 44 postoperative heart patients CPB monitored up to four hours in the room Cardiac Intensive Care Unit (CICU) Dr. HasanxSadikin HospitalxBandung. The platelet count was negatively correlated with bleeding volume (r = -0.157, p = 0.308) and the MA was negatively correlated (very weak) with bleeding volume (r = -0.171, p = 0.266). The post-CPB platelet concentrate concentration led to better patient hemostasis, as evidenced by the majority of platelet counts (97.7%)> 100,000/mm3 and MA (84%)x≥x50xmm. The post-CPB platelet concentrate causes a negative (very weak) correlation between platelet count and MA with bleeding volume

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Viscoelastic properties of a blood clot and the manifestations of hemorrhagic syndrome in thrombocytopeniс patients with hemoblastosis

Тромбоз, гемостаз и реология ◽

10.25555/thr.2020.4.0952 ◽

2020 ◽

Author(s):

А.В. Лянгузов ◽

С.Л. Калинина ◽

С.В. Игнатьев ◽

И.А. Докшина ◽

А.Ю. Буланов ◽

...

Keyword(s):

Platelet Count ◽

Viscoelastic Properties ◽

Blood Clot ◽

Maximum Amplitude ◽

Bleeding Risk ◽

Blood Platelet ◽

Platelet Concentrate ◽

Severe Thrombocytopenia ◽

Group 2 ◽

Group 1

Введение. Тромбоцитопения является частым осложнением онкогематологических заболеваний, которое провоцирует развитие геморрагического синдрома. Уровень тромбоцитов в периферической крови, являющийся пороговым для переливания концентрата тромбоцитов (КТ), окончательно не установлен. Применение тромбоэластографии (ТЭГ) при тромбоцитопениях у онкогематологических больных может повысить прогностические возможности определения риска кровотечений. Цель исследования: оценить вязко-эластические свой ства сгустка крови при тромбоцитопении менее 50×109/л и их взаимосвязь с проявлениями геморрагического синдрома у онкогематологических больных. Материалы и методы. В исследование включено 84 пациента с гемобластозами и тромбоцитопенией менее 50×109/л, 54 (64%) мужчины и 30 (36%) женщин, медиана возраста — 54 года. В зависимости от уровня тромбоцитов в периферической крови пациентов разделили на 2 группы: группа 1 — 44 пациента с числом тромбоцитов от 25 до 50×109/л, группа 2 — 40 больных с содержанием тромбоцитов менее 25×109/л. Исследовали показатели периферической крови, коагулограммы и ТЭГ. Степень тяжести кровотечений оценивали по шкале проявлений геморрагического синдрома (ВОЗ) и по шкале оценки побочных явлений Национального института рака (США). Результаты. Гипокоагуляция по ТЭГ в группе 1 выявлена в 46% случаев, в группе 2 — в 75%. Значимые межгрупповые различия показателей ТЭГ получены только в отношении максимальной амплитуды. Геморрагический синдром в группе 1 диагностирован у 6 (13%) пациентов, в группе 2 — у 14 (35%). Однако предиктивная роль влияния количества тромбоцитов на частоту развития геморрагического синдрома не установлена (β = 0,016; p = 0,92). Сочетание тромбоцитопении и гипокоагуляции по ТЭГ проявлялось в виде геморрагического синдрома в 3,3 раза чаще, чем без гипокоагуляции (RR = 3,3; 95% ДИ = 1,20–9,05). В ряде случаев основанная на результатах ТЭГ трансфузионная тактика позволила избежать переливания КТ при инвазивных манипуляциях у больных с тромбоцитопенией менее 25 × 109 / л. Заключение. Глубина тромбоцитопении не является надежным предиктором геморрагического синдрома. Применение ТЭГ у пациентов с тромбоцитопенией позволяет оптимизировать трансфузионную тактику, избежав ненужных переливаний КТ. Сочетание тяжелой тромбоцитопении с гипокоагуляцией по данным ТЭГ служит показанием для профилактических трансфузий КТ. Background. Thrombocytopenia is a frequent complication of hemoblastosis that causes hemorrhagic syndrome. The threshold of peripheral blood platelet count for transfusion of platelet concentrate is discussed. Thromboelastography (TEG) can be considered as additional prognostic method for bleeding risk assessment in thrombocytopenic patients with leukemia. Objectives: to study changes in the viscoelastic properties of blood clot in hemoblastosis patients with thrombocytopenia less than 50×109/L and their relationship with the manifestations of hemorrhagic syndrome. Patients/ Methods. The study included 84 hemoblastosis patients — 54 (64%) men и 30 (36%) women with thrombocytopenia less than 50 × 109/L, median age — 54 years. All patients are divided into 2 groups according to the platelet count: Group 1 — 25–50×109/L, Group 2 — less than 25×109/L. Peri pheral blood counts, TEG and coagulogram parameters were evaluated in both groups. Manifestations of hemorrhagic syndrome were assessed according to the WHO bleeding scale and Common terminology criteria for adverse events of the National Cancer Institute (USA). Results. Hypocoagulation according TEG in Group 1 was found in 46% of cases, in Group 2 — in 75%. Significant intergroup differences in TEG parameters were obtained only in maximum amplitude. Hemorrhagic syndrome in Group 1 diagnosed in 6 (14%) patients, in Group 2 — in 14 (35%). There was no dependence of hemorrhagic syndrome frequency on the severity of thrombocytopenia (β = 0.016; p = 0.92). The combination of thrombocytopenia and hypocoagulation according TEG manifested as a hemorrhagic syndrome 3.3 times more often than without hypocoagulation (RR = 3.3; 95% CI = 1.20–9.05). In some cases, TEG-based transfusion tactics allowed to avoid unnecessary platelet concentrate transfusion during invasive procedures in patients with thrombocytopenia less than 25 × 109/L. Conclusions. Severity of platelet depletion is not accuracy predictor for hemorrhagic events. Use of TEG in patients with thrombocytopenia allows to optimize the transfusion tactics and to avoid unnecessary platelet concentrate transfusions. The combination of severe thrombocytopenia with hypocoagulation according TEG serves as indication for prophylactic platelet concentrate transfusion.

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Predictive role of perioperative platelet count on posthepatectomy liver failure and mortality: a systematic review and meta-analysis

Zeitschrift für Gastroenterologie ◽

10.1055/s-0037-1612829 ◽

2018 ◽

Vol 56 (01) ◽

pp. E2-E89

Author(s):

M Golriz ◽

O Ghamarnejad ◽

E Khajeh ◽

K Hoffmann ◽

A Mehrabi

Keyword(s):

Systematic Review ◽

Platelet Count ◽

Liver Failure ◽

Meta Analysis ◽

Posthepatectomy Liver Failure ◽

Predictive Role

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Bleeding Time in Rats: A Comparison of Different Experimental Conditions

Thrombosis and Haemostasis ◽

10.1055/s-0038-1657230 ◽

1982 ◽

Vol 48 (01) ◽

pp. 108-111 ◽

Cited By ~ 118

Author(s):

Elisabetta Dejana ◽

Silvia Villa ◽

Giovanni de Gaetano

Keyword(s):

Platelet Function ◽

Bleeding Time ◽

Platelet Dysfunction ◽

Experimental Conditions ◽

Platelet Number ◽

Coagulation Defects ◽

Tail Tip ◽

And Function ◽

Storage Pool Disease ◽

Type Of Anaesthesia

SummaryThe tail bleeding time (BT) in rats definitely varies according to the method applied. Of the various variables that may influence BT, we have evaluated the position (horizontal or vertical) of the tail, the environment (air or saline), the temperature (4°, 23° or 37° C) and the type of anaesthesia. Transection of the tail tip cannot be used to screen drugs active on platelet function since it is sensitive to coagulation defects. Template BT in contrast is not modified by heparin and is sensitive to defects of platelet number and function (“storage pool disease”, dipyridamole-like drugs, exogenous prostacyclin). In contrast the test fails to detect aspirin-induced platelet dysfunction. The evidence reported indicates that thromboxane A2-prostacyclin balance is not a factor regulating BT. Aspirin treatment however may be a precipitating factor when associated with other abnormalities of platelet function.Template BT is a valid screening test for platelet disorders and for antiplatelet drugs.

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Differences in coagulopathy indices in patients with severe versus non-severe COVID-19: a meta-analysis of 35 studies and 6427 patients

Scientific Reports ◽

10.1038/s41598-021-89967-x ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Alberto Polimeni ◽

Isabella Leo ◽

Carmen Spaccarotella ◽

Annalisa Mongiardo ◽

Sabato Sorrentino ◽

...

Keyword(s):

Platelet Count ◽

Meta Analysis ◽

Severe Disease ◽

Coagulation Factors ◽

Primary Analysis ◽

Severe Group ◽

Intravascular Coagulopathy ◽

The Difference ◽

D Dimer

AbstractCoronavirus disease 2019 (COVID-19) is a highly contagious disease that appeared in China in December 2019 and spread rapidly around the world. Several patients with severe COVID-19 infection can develop a coagulopathy according to the ISTH criteria for disseminated intravascular coagulopathy (DIC) with fulminant activation of coagulation, resulting in widespread microvascular thrombosis and consumption of coagulation factors. We conducted a meta-analysis in order to explore differences in coagulopathy indices in patients with severe and non-severe COVID-19. An electronic search was performed within PubMed, Google Scholar and Scopus electronic databases between December 2019 (first confirmed Covid-19 case) up to April 6th, 2020. The primary endpoint was the difference of D-dimer values between Non-Severe vs Severe disease and Survivors vs Non-Survivors. Furthermore, results on additional coagulation parameters (platelet count, prothrombin time, activated partial thromboplastin time) were also analyzed. The primary analysis showed that mean d-dimer was significantly lower in COVID-19 patients with non-severe disease than in those with severe (SMD − 2.15 [− 2.73 to − 1.56], I2 98%, P < 0.0001). Similarly, we found a lower mean d-dimer in Survivors compared to Non-Survivors (SMD − 2.91 [− 3.87 to − 1.96], I2 98%, P < 0.0001). Additional analysis of platelet count showed higher levels of mean PLT in Non-Severe patients than those observed in the Severe group (SMD 0.77 [0.32 to 1.22], I2 96%, P < 0.001). Of note, a similar result was observed even when Survivors were compared to Non-Survivors (SMD 1.84 [1.16 to 2.53], I2 97%, P < 0.0001). Interestingly, shorter mean PT was found in both Non-Severe (SMD − 1.34 [− 2.06 to − 0.62], I2 98%, P < 0.0002) and Survivors groups (SMD − 1.61 [− 2.69 to − 0.54], I2 98%, P < 0.003) compared to Severe and Non-Survivor patients. In conclusion, the results of the present meta-analysis demonstrate that Severe COVID-19 infection is associated with higher D-dimer values, lower platelet count and prolonged PT. This data suggests a possible role of disseminated intravascular coagulation in the pathogenesis of COVID-19 disease complications.

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A Novel Approach to the Assessment of Variations in the Human Platelet Count

Thrombosis and Haemostasis ◽

10.1055/s-0037-1613840 ◽

2000 ◽

Vol 83 (03) ◽

pp. 480-484 ◽

Cited By ~ 70

Author(s):

John James ◽

Dianne Brown ◽

Gordon Whyte ◽

Mark Dean ◽

Colin Chesterman ◽

...

Keyword(s):

Platelet Count ◽

Seasonal Variation ◽

Individual Variation ◽

Human Platelet ◽

First Report ◽

Platelet Counts ◽

Novel Approach ◽

Platelet Number ◽

Genetically Determined

SummaryThis is the first report of a method to assess the significance of numerical changes in the platelet count based upon a result exceeding the normal intra-individual variation in platelet numbers. Serial platelet counts from 3,789 subjects were analysed to determine the intra-individual variation in platelet numbers. A platelet count difference of 98 × 109/L in males was found to represent a change that would occur by chance in less than 1 in 1,000 platelet count determinations. Tables to determine the significance of platelet number variations, given N previous observations, are provided at two probability levels. The repeatability of the platelet count was calculated as 0.871 (males) and 0.849 (females) indicating that the heritability of platelet count is high and that the platelet count is predominantly genetically determined. A seasonal variation in platelet count was found with a ‘winter’ versus ‘summer’ difference of 5.10 × 109/L (males) and 5.82 × 109/L (females).

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Unexpected excessive bleeding during operation: Role of acetyl salycilic acid

Canadian Anaesthetists Society journal / Journal de la Société canadienne des anesthésistes ◽

10.1007/bf03005449 ◽

1977 ◽

Vol 24 (4) ◽

pp. 452-458 ◽

Cited By ~ 13

Author(s):

D. W. Davies ◽

D. J. Steward

Keyword(s):

Excessive Bleeding

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Advances in the understanding of trauma-induced coagulopathy

Blood ◽

10.1182/blood-2016-01-636423 ◽

2016 ◽

Vol 128 (8) ◽

pp. 1043-1049 ◽

Cited By ~ 120

Author(s):

Ronald Chang ◽

Jessica C. Cardenas ◽

Charles E. Wade ◽

John B. Holcomb

Keyword(s):

Animal Studies ◽

Causes Of Death ◽

Endothelial Activation ◽

The United States ◽

Trauma Patients ◽

Platelet Dysfunction ◽

Intracranial Injury ◽

Trauma Induced Coagulopathy ◽

Common Causes

Abstract Ten percent of deaths worldwide are due to trauma, and it is the third most common cause of death in the United States. Despite a profound upregulation in procoagulant mechanisms, one-quarter of trauma patients present with laboratory-based evidence of trauma-induced coagulopathy (TIC), which is associated with poorer outcomes including increased mortality. The most common causes of death after trauma are hemorrhage and traumatic brain injury (TBI). The management of TIC has significant implications in both because many hemorrhagic deaths could be preventable, and TIC is associated with progression of intracranial injury after TBI. This review covers the most recent evidence and advances in our understanding of TIC, including the role of platelet dysfunction, endothelial activation, and fibrinolysis. Trauma induces a plethora of biochemical and physiologic changes, and despite numerous studies reporting differences in coagulation parameters between trauma patients and uninjured controls, it is unclear whether some of these differences may be “normal” after trauma. Comparisons between trauma patients with differing outcomes and use of animal studies have shed some light on this issue, but much of the data continue to be correlative with causative links lacking. In particular, there are little data linking the laboratory-based abnormalities with true clinically evident coagulopathic bleeding. For these reasons, TIC continues to be a significant diagnostic and therapeutic challenge.

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EDTA‑dependent pseudothrombocytopenia in child (clinical case report)

Medical alphabet ◽

10.33667/2078-5631-2021-13-51-54 ◽

2021 ◽

pp. 51-54

Author(s):

N. A. Sokolova ◽

M. I. Savina ◽

O. S. Shokhina

Keyword(s):

Platelet Count ◽

Clinical Case ◽

Sodium Citrate ◽

Ethylenediaminetetraacetic Acid ◽

Hemorrhagic Diathesis ◽

Platelet Dysfunction ◽

Rare Presentation ◽

Blood Samples ◽

Low Platelet Count ◽

Aggregation Of Platelets

Ethylenediaminetetraacetic acid (EDTA)-dependent pseudothrombocytopenia is the phenomenon of a spurious low platelet count due to antiplatelet antibodies that cause platelet clumping in blood anticoagulated with EDTA. The aggregation of platelets in EDTA-dependent pseudothrombocytopenia is usually prevented by other anticoagulants, such as sodium citrate. EDTA-dependent pseudothrombocytopenia has never been associated with hemorrhagic diathesis or platelet dysfunction. In this article, a 2,5-year-old boy with EDTA-dependent pseudothrombocytopenia is presented because of rare presentation. We report that EDTA can induce platelet clumping, and thus spuriously low platelet counts. However, aggregation of platelets was not detected in blood samples with sodium citrate, and platelet count was normal.

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