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1.
Medicine (Baltimore) ; 101(35): e30275, 2022 Sep 02.
Artículo en Inglés | MEDLINE | ID: mdl-36107503

RESUMEN

BACKGROUND: There is no study analyzing and evaluating the prognostic role of thrombocytosis in Asian patients with colorectal cancer (CRC). METHODS: A systematic search of articles (PubMed, Embase, and the Cochrane Library) was performed to identify studies using the terms Platelet count, Thrombocytosis, Thrombocytoses, Thrombocythemia or Thrombocythemias with colon, colonic, rectal, rectum, colorectal and prognostic, prognosis, survival or outcome. RESULTS: Thirteen eligible studies with 3964 patients were included. Thrombocytosis was associated with a poorer overall survival (HR of 1.88 [95% CI: 1.24-2.85; P = .003] with univariate analyses, HR of 2.07 [95% CI: 1.2-3.56; P = .008] with multivariate analyses), disease-free survival (HR of 2.58 [95% CI: 1.87-3.57; P < .00001] with multivariate analyses) and cancer specific survival (HR of 2.55 [95% CI: 1.68-3.85; P < .00001]) in Asian patients with CRC. Thrombocytosis had a significant association with female gender, tumor location in the colon, higher pathological T-stage, pathological positive N-stage, but not with lymphatic involvement and venous involvement. CONCLUSION: The present meta-analysis demonstrates that thrombocytosis is a potentially useful tool for predicting poor survival in Asian patients with CRC, especially for overall survival.


Asunto(s)
Neoplasias Colorrectales , Trombocitosis , Neoplasias Colorrectales/patología , Supervivencia sin Enfermedad , Femenino , Humanos , Recuento de Plaquetas , Pronóstico , Trombocitosis/complicaciones
2.
Medicine (Baltimore) ; 101(36): e30488, 2022 Sep 09.
Artículo en Inglés | MEDLINE | ID: mdl-36086763

RESUMEN

Liver fibrosis is the most important factor in the prognosis and treatment plan of patients with chronic hepatitis B (CHB). Aspartate aminotransferase (AST)-to-platelet ratio index (APRI), fibrosis index based on 4 factors (FIB-4), and fibrosis index based on 5 factors (FIB-5) scores are noninvasive fibrosis markers, and previous comparative studies have shown that they are as effective as liver biopsy in detecting liver fibrosis in different liver diseases. The aim of our study is to investigate whether existing scoring systems are effective in demonstrating fibrosis in CHB patients and to compare the APRI, FIB 4, and FIB 5 scores in differentiating early and advanced fibrosis in 123 patients who underwent liver biopsy for CHB infection. APRI, FIB-4, and FIB-5 scores of patients who underwent liver biopsy due to CHB were calculated by means of calculators and recorded to be compared with liver biopsies in terms of fibrosis scoring. One hundred twenty-three patients who underwent liver biopsy due to chronic hepatitis B were included in the study. APRI (area under the receiver-operating characteristic [ROC] curve 0.728), FIB-4 (area under the ROC curve 0.693) and FIB-5 (area under the ROC curve 0.643) scores were evaluated as significant predictors of advanced fibrosis. The scoring system with the highest positive and negative predictive value was evaluated as FIB-4. APRI, FIB-4, and FIB-5 scoring systems are appropriate scoring systems in the assessment of advanced fibrosis in patients with CHB. Our study is the first to compare APRI, FIB-4, and FIB-5 values in CHB patients, and more comprehensive studies are needed.


Asunto(s)
Hepatitis B Crónica , Hepatitis B Crónica/complicaciones , Hepatitis B Crónica/patología , Humanos , Cirrosis Hepática/diagnóstico , Cirrosis Hepática/patología , Pruebas de Función Hepática , Recuento de Plaquetas , Índice de Severidad de la Enfermedad
4.
Front Immunol ; 13: 936662, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-36059447

RESUMEN

Objective: Platelet (PLT) engages in immune and inflammatory responses, all of which are related to the prognosis of critically ill patients. Although thrombocytopenia at ICU admission contributes to in-hospital mortality, PLT is repeatedly measured during ICU hospitalization and the role of longitudinal PLT trajectory remains unclear. We aimed to identify dynamic PLT trajectory patterns and evaluate their relationships with mortality risk and thrombocytopenia. Methods: We adopted a three-phase, multi-cohort study strategy. Firstly, longitudinal PLT trajectory patterns within the first four ICU days and their associations with 28-day survival were tested in the eICU Collaborative Research Database (eICU-CRD) and independently validated in the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Secondly, the relationships among PLT trajectory patterns, thrombocytopenia, and 28-day mortality were explored and validated. Finally, a Mortality GRade system for ICU dynamically monitoring patients (Mortality-GRID) was developed to quantify the mortality risk based on longitudinal PLT, which was further validated in the Molecular Epidemiology of Acute Respiratory Distress Syndrome (MEARDS) cohort. Results: A total of 35,332 ICU patients were included from three cohorts. Trajectory analysis clustered patients into ascending (AS), stable (ST), or descending (DS) PLT patterns. DS patients with high baseline PLT decline quickly, resulting in poor prognosis. AS patients have low baseline PLT but recover quickly, favoring a better prognosis. ST patients maintain low PLT, having a moderate prognosis in between (HR ST vs AS = 1.26, 95% CI: 1.14-1.38, P = 6.15 × 10-6; HR DS vs AS = 1.58, 95% CI: 1.40-1.79, P = 1.41 × 10-13). The associations remained significant in patients without thrombocytopenia during the entire ICU hospitalization and were robust in sensitivity analyses and stratification analyses. Further, the trajectory pattern was a warning sign of thrombocytopenia, which mediated 27.2% of the effects of the PLT trajectory on 28-day mortality (HR indirect = 1.11, 95% CI: 1.06-1.17, P = 9.80 × 10-6). Mortality-GRID well predicts mortality risk, which is in high consistency with that directly estimated in MEARDS (r = 0.98, P = 1.30 × 10-23). Conclusion: Longitudinal PLT trajectory is a complementary predictor to baseline PLT for patient survival, even in patients without risk of thrombocytopenia. Mortality-GRID could identify patients at high mortality risk.


Asunto(s)
Síndrome de Dificultad Respiratoria , Trombocitopenia , Estudios de Cohortes , Enfermedad Crítica , Humanos , Unidades de Cuidados Intensivos , Recuento de Plaquetas
5.
Acta Anaesthesiol Scand ; 66(9): 1146-1155, 2022 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-36054145

RESUMEN

INTRODUCTION: Thrombocytopenia is frequent in intensive care unit (ICU) patients and has been associated with worse outcome. Platelet transfusions are often used in the management of ICU patients with severe thrombocytopenia. However, the reported frequencies of thrombocytopenia and platelet transfusion practices in the ICU vary considerably. Therefore, we aim to provide contemporary epidemiological data on thrombocytopenia and platelet transfusion practices in the ICU. METHODS: We will conduct an international inception cohort, including at least 1000 acutely admitted adult ICU patients. Routinely available data will be collected at baseline (ICU admission), and daily during ICU stay up to a maximum of 90 days. The primary outcome will be the number of patients with thrombocytopenia (a recorded platelet count < 150 × 109 /L) at baseline and/or during ICU stay. Secondary outcomes include mortality, days alive and out of hospital, days alive without life-support, the number of patients with at least one bleeding episode, at least one thromboembolic event and at least one platelet transfusion in the ICU, the number of platelet transfusions and the indications for transfusion. The primary and secondary outcomes will be presented descriptively. In addition, we will assess risk factors for developing thrombocytopenia during ICU stay and the association between thrombocytopenia at baseline and 90-day mortality using logistic regression analyses. CONCLUSION: The outlined international PLOT-ICU cohort study will provide contemporary epidemiological data on the burden and clinical significance of thrombocytopenia in adult ICU patients and describe the current platelet transfusion practice.


Asunto(s)
Transfusión de Plaquetas , Trombocitopenia , Adulto , Estudios de Cohortes , Humanos , Unidades de Cuidados Intensivos , Recuento de Plaquetas , Transfusión de Plaquetas/efectos adversos , Transfusión de Plaquetas/métodos , Trombocitopenia/complicaciones , Trombocitopenia/epidemiología , Trombocitopenia/terapia
6.
PLoS One ; 17(9): e0274398, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-36103491

RESUMEN

BACKGROUND: Preeclampsia (PE) is a pregnancy-specific disorder characterized by endothelial dysfunction, and activation of the coagulation system. Alteration of PLT parameters is the common hematological abnormality observed in women with PE. The main aim of this study was to systematically review previous studies from around the world to generate evidence about the relationship between platelet count (PC) and PE, as well as mean platelet volume (MPV) and PE, by calculating the pooled weighted mean difference (WMD) of PC and MPV between PE and normotensive (NT) groups. METHODS: Relevant articles which were published in the English language from January 10, 2011, to January 10, 2021, were systematically searched through PubMed, Web of Science, and African journals online. In addition, reference probing of published articles searching was employed through Google Scholar and Google for searching grey literature. The methodological qualities of articles were assessed using Joana Brigg's institute critical appraisal checklist. A random-effects model was used to estimate pooled WMD of PLT parameters between the two groups with the respective 95% confidence intervals (CI) using Stata version 11.0. The I2 statistics and Egger's regression test were used to assess heterogeneity and publication bias among included studies, respectively. RESULTS: A total of 25 articles were included in this systematic review and meta-analysis. Of which, 23 studies were used in each PC and MPV analysis. The overall pooled WMD of PC and MPV between PE and NT groups were -41.45 × 109/L [95% CI; -51.8, -31.0] and 0.98 fl [95% CI; 0.8, 1.1], respectively. The pooled WMD revealed that PC decreased significantly in the PE group compared to the NT group while MPV increased significantly in the PE group. CONCLUSIONS: This systematic review and meta-analysis indicated that there is a significant decrease in PC and a significant increase in MPV during PE development among pregnant women. As a result, a change in these parameters among pregnant women may indicate the development of PE.


Asunto(s)
Volúmen Plaquetario Medio , Preeclampsia , Coagulación Sanguínea , Femenino , Humanos , Recuento de Plaquetas , Embarazo
7.
Artículo en Inglés | MEDLINE | ID: mdl-36078719

RESUMEN

Platelets are increasingly considered a bridge between mental and immunological disorders. However, data relating to platelet parameters in patients with autoimmune disorders are limited. The aim of the present study was to investigate, for the first time, the association of platelet parameters with the symptoms of affective disorders in patients with autoimmune conditions. In this cross-sectional study, we measured the complete blood count (CBC), the Generalized Anxiety Disorder Scale for anxiety (GAD-7), and the Beck Depression Inventory for depression (BDI) in 121 patients with autoimmune disorders. Mean platelet volume (MPV) was positively correlated with both anxiety and depression. Platelet distribution width (PDW) was negatively correlated with anxiety and depression. Before adjustment for covariates, logistic regression analysis revealed a significant association of MPV with depression and anxiety. After adjustment for covariates, only depression was associated with MPV. The area under the ROC curve of MPV for GAD-7 determined anxiety and BDI determined depression was 0.63. Our study showed that among the CBC hematological parameters, the MPV might be a useful biomarker of depression and anxiety in patients with autoimmune disorders. Further investigations of platelet parameters in controlled prospective studies are warranted to confirm our preliminary results.


Asunto(s)
Enfermedades Autoinmunes , Volúmen Plaquetario Medio , Ansiedad/epidemiología , Plaquetas , Estudios Transversales , Depresión/epidemiología , Humanos , Recuento de Plaquetas
8.
Dis Markers ; 2022: 4889616, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-36061352

RESUMEN

Purpose: To evaluate the diagnostic value of carcinoembryonic antigen (CEA) combined with inflammatory cell ratios in colorectal cancer (CRC). Methods: This retrospective study compared the data of CRC patients with healthy controls. The CEA levels were measured, and the neutrophil-to-lymphocyte ratio (NLR), derived neutrophil-to-lymphocyte ratio (d-NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR) were calculated. The receiver-operating characteristic (ROC) curve was used to assess the diagnostic value of each marker and combined detection. Spearman's rank correlation test was used to analyze the correlation between CEA and NLR, d-NLR, and PLR. Results: Inflammatory cell ratios and CEA were significantly higher in the CRC group. ROC curve analysis showed that NLR, d-NLR, and PLR had good diagnostic efficacy. The threshold showed that NLR, d-NLR, and PLR were all related to TNM stage, not to age, gender, tumor location, and degree of differentiation. CEA combined with NLR, d-NLR, and PLR (CNDNP) had a significant diagnostic value in CRC. Correlation studies showed that CEA was positively correlated with NLR and d-NLR but not with PLR. Conclusion: The combination of CEA with CNDNP might be a valuable indicator for CRC diagnosis.


Asunto(s)
Antígeno Carcinoembrionario , Neoplasias Colorrectales , Neoplasias Colorrectales/diagnóstico , Neoplasias Colorrectales/patología , Humanos , Linfocitos/patología , Recuento de Plaquetas , Estudios Retrospectivos
9.
Ann Palliat Med ; 11(8): 2709-2719, 2022 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-36064361

RESUMEN

BACKGROUND: Chemotherapy-induced thrombocytopenia (CIT) is a common adverse reaction to chemotherapy that can lead to treatment delay, platelet transfusion, thereby increasing treatment costs, reducing chemotherapy effectiveness and affecting prognosis. Based on real-world data, this study analyzed the safety, efficacy, and economic of recombinant human thrombopoietin (rhTPO) and recombinant human interleukin-11 (rhIL-11) in the treatment of CIT in hematological tumors from the perspective of the health care system. METHODS: We retrospectively collected the data of hematological tumor patients treated with rhTPO and rhIL-11 due to thrombocytopenia caused by chemotherapy. The propensity score matching (PSM) method was used to balance the baseline information of the two groups and they were further stratified according to the degree of thrombocytopenia (grade I-II and grade III-IV). The platelet compliance rate at 2 weeks of treatment was used as the efficacy evaluation index, and the cost-effectiveness method was used to evaluate the economic value of the two drugs in the treatment of thrombocytopenia based on drug effectiveness. Univariate and probabilistic sensitivity analyses were performed. RESULTS: A total of 1,571 patients met the inclusion and exclusion criteria, and 476 patients were included after 1:1 PSM. For patients with grade I-II thrombocytopenia, no significant difference in the platelet compliance rate was found between the two groups after 1 and 2 weeks of treatment. The platelet compliance rate in the rhTPO group was higher than that in the rhIL-11 group for patients with grade III-IV thrombocytopenia. Cost-effectiveness analysis (CEA) showed that the incremental cost-effectiveness ratio (ICER) for the rhTPO and rhIL-11 groups was 226,615.8. The ICER value was sensitive to the platelet compliance rate of the two groups, the cost of rhTPO, the cost of platelet transfusion in the rhTPO group. Probabilistic sensitivity analysis showed that when willingness to pay was less than approximately 220,000 yuan, rhIL-11 economy presented 100% better than that of rhTPO. CONCLUSIONS: In CIT treatment for hematological tumors, rhTPO yielded a higher platelet compliance rate than rhIL-11 treatment, especially for patients with grade III-IV thrombocytopenia. However, whether rhTPO has economic advantages still requires further exploration.


Asunto(s)
Antineoplásicos , Neoplasias Hematológicas , Trombocitopenia , Antineoplásicos/efectos adversos , Análisis Costo-Beneficio , Neoplasias Hematológicas/tratamiento farmacológico , Humanos , Interleucina-11 , Recuento de Plaquetas , Proteínas Recombinantes , Estudios Retrospectivos , Trombocitopenia/inducido químicamente , Trombocitopenia/tratamiento farmacológico , Trombopoyetina/uso terapéutico
10.
Vet Clin North Am Exot Anim Pract ; 25(3): 613-630, 2022 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-36122943

RESUMEN

The mammalian hemostatic system is highly conserved, and companion exotic mammals are commonly used as biomedical models for normal and disordered hemostasis. Challenges associated with sample collection, test validation, and test interpretation have limited the use of these tests in clinical exotic animal practice. However, evaluation of platelet counts, coagulation screening times, and fibrin(ogen) degradation products can be valuable for monitoring exotic patients with a range of disease presentations including intoxications, anemia, systemic viral disease, hepatopathy, and endocrinopathy.


Asunto(s)
Hemostáticos , Animales , Productos de Degradación de Fibrina-Fibrinógeno , Hemostasis , Mamíferos , Recuento de Plaquetas/veterinaria
11.
Am Fam Physician ; 106(3): 288-298, 2022 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-36126009

RESUMEN

Thrombocytopenia is a platelet count of less than 150 × 103 per µL and can occur from decreased platelet production, increased destruction, splenic sequestration, or dilution or clumping. Patients with a platelet count greater than 50 × 103 per µL are generally asymptomatic. Patients with platelet counts between 20 and 50 × 103 per µL may have mild skin manifestations such as petechiae, purpura, or ecchymosis. Patients with platelet counts of less than 10 × 103 per µL have a high risk of serious bleeding. Although thrombocytopenia is classically associated with bleeding, there are conditions in which bleeding and thrombosis can occur, such as antiphospholipid syndrome, heparin-induced thrombocytopenia, and thrombotic microangiopathies. Patients with isolated thrombocytopenia in the absence of systemic illness most likely have immune thrombocytopenia or drug-induced thrombocytopenia. In stable patients being evaluated as outpatients, the first step is to exclude pseudothrombocytopenia by collecting blood in a tube containing heparin or sodium citrate and repeating the platelet count. If thrombocytopenia is confirmed, the next step is to distinguish acute from chronic thrombocytopenia by obtaining or reviewing previous platelet counts. Patients with acute thrombocytopenia may require hospitalization. Common causes that require emergency hospitalization are heparin-induced thrombocytopenia, thrombotic microangiopathies, and the hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome. Common nonemergency causes of thrombocytopenia include drug-induced thrombocytopenia, immune thrombocytopenia, and hepatic disease. Transfusion of platelets is recommended when patients have active hemorrhage or when platelet counts are less than 10 × 103 per µL, in addition to treatment (when possible) of underlying causative conditions. It is important to ensure adequate platelet counts to decrease bleeding risk before invasive procedures; this may also require a platelet transfusion. Patients with platelet counts of less than 50 × 103 per µL should adhere to activity restrictions to avoid trauma-associated bleeding.


Asunto(s)
Púrpura Trombocitopénica Idiopática , Microangiopatías Trombóticas , Hemorragia/diagnóstico , Hemorragia/etiología , Hemorragia/terapia , Heparina/efectos adversos , Humanos , Recuento de Plaquetas , Púrpura Trombocitopénica Idiopática/complicaciones , Citrato de Sodio , Microangiopatías Trombóticas/complicaciones , Microangiopatías Trombóticas/terapia
12.
Cell Mol Biol (Noisy-le-grand) ; 68(5): 186-191, 2022 May 31.
Artículo en Inglés | MEDLINE | ID: mdl-36029490

RESUMEN

Intra Venous Immunoglobulin (IVIG) is a plasma-derived product used to treat many autoimmune diseases, including thrombocytopenia, immunodeficiency, and infectious diseases. In this study, the effect of IVIG injection was evaluated on the number of white blood cells, neutrophils, lymphocytes, and platelets. The effect of IVIG was also considered on the percentage of CD4 and CD8 positive cells T cell lymphocytes and their absolute number in pediatric patients with immune thrombocytopenic purpura. The study was a cross-sectional study performed on 32 patients with ITP. In these patients, a blood sample was taken before and one hour after the start of the IVG injection. For all samples, a complete blood cell, platelet count, and differential blood leukocyte count were performed by Sysmex kx-21. Then labeled anti-CD4 and anti-CD8 markers were used to evaluate the type of lymphocytes. SPSS software version 15 and a t-test with a significant level of p <0.05 were used for statistical analysis of the obtained results. Pearson correlation coefficient was also used to evaluate the relationship between patients' age and the total volume of injected IVIG results. Examination of blood cell counts showed a significant decrease in the mean of white blood cells, neutrophils, and lymphocytes after intravenous immunoglobulin injection. However, these changes were not statistically significant for platelets. A comparison of the mean percentage of CD4 and CD8 cells shows a significant increase in the CD4 / CD8 cell ratio after injection. The absolute number of CD4 and CD8 lymphocytes one hour after IVIG injection was significantly decreased, but their proportion increased after injection. Generally, IVIG reduces the absolute number of neutrophils, but this reduction is not associated with infection problems. This decrease is also seen in the number of lymphocytes. However, the change in the number and percentage of CD4 and CD8 cells depends on the sampling time following IVIG injection.


Asunto(s)
Inmunoglobulinas Intravenosas , Púrpura Trombocitopénica Idiopática , Niño , Estudios Transversales , Humanos , Recuento de Leucocitos , Recuento de Plaquetas
13.
Afr Health Sci ; 22(1): 183-190, 2022 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-36032500

RESUMEN

Background: Disseminated intravascular coagulation (DIC) is one of the commonest causes of abnormal bleeding during pregnancy and puerperium. Its successful management is a challenging feat in resource limited settings (RLS). Aim: To determine Obstetricians' approach in diagnosing and treating obstetrics DIC in a RLS. Method: A semi-structured pre-tested 4-sectioned questionnaire was used to collect demographic data of Nigerian obstetricians and data on their practice in the diagnosis and treatment of obstetrics DIC. Results: A total of 171 obstetricians responded. Preeclampsia was the most frequent cause identified (70.2%) followed by postpartum haemorrahge (58.3%). Platelet count determination was the test mostly used (95.9%) to make a diagnosis of DIC whereas, antithrombin assay was the least (20.6%) requested investigation. While about two-third would monitor the evolution of DIC, a little less than half of the obstetricians would not repeat laboratory testing more than every 2 days, reason mainly (61.8%) due to patient's financial constraint. Almost three-quarter of them preferred fresh whole blood as the first line of treatment of DIC. Conclusion: DIC remains a challenge in the obstetrics practice in RLS especially in investigations, monitoring and index of suspicion for non-overt DIC.


Asunto(s)
Coagulación Intravascular Diseminada , Dacarbazina , Femenino , Humanos , Recuento de Plaquetas , Embarazo
14.
Reumatol. clín. (Barc.) ; 18(7): 406-409, Ago.- Sep. 2022. tab
Artículo en Inglés | IBECS | ID: ibc-207311

RESUMEN

Background: Platelets have an effect on the hemostatic defense of the lung. Immature platelet fractions (iPF) reflects the number of young platelets containing ribonucleic acid in the circulation and real-time production. Information about their roles in rheumatic diseases is limited and there are no studies on iPF in RA with interstitial lung disease (ILD). Our aim is to investigate the association between the iPF level and occurrence of ILD in RA and the correlation of iPF with disease activity in general or only in RA with ILD. Methods: the study included 50 RA patients without ILD, 33 RA patients with ILD, and 30 healthy controls. Demographic data, Disease Activity Score 28 (DAS28), autoantibodies, and iPF were evaluated. ILD was diagnosed by using high-resolution computed tomography with clinical findings and chest X-ray. The samples were analyzed for complete blood count with platelet indices included, on Mindray BC-6800 hematology analyzer, Hamburg, Germany. Results: iPF levels were higher in RA patients with ILD compared to healthy controls and RA patients without ILD. A weakly positive correlation between DAS28 with iPF was found in all RA patients. iPF levels were found as 2.85 to detect ILD with 66.7% sensitivity and 65% specificity. Conclusions: Our results showed that the iPF was detected higher in RA with ILD compared to RA without ILD. iPF, a routine cheap and easy test during hemogram, can provide important information in terms of disease activity and lung involvement in RA.(AU)


Antecedentes: Las plaquetas tienen un efecto sobre la defensa hemostática del pulmón. Las fracciones de plaquetas inmaduras (FPi) reflejan el número de plaquetas jóvenes que contienen ácido ribonucleico en la circulación y la producción en tiempo real. La información sobre su papel en las enfermedades reumáticas es limitada y no existen estudios sobre la FPi en la AR con enfermedad pulmonar intersticial (EPI). Nuestro objetivo es investigar la asociación entre el nivel de FPi y la aparición de EPI en la AR y la correlación de la FPi con la actividad de la enfermedad en general o solo en la AR con EPI. Métodos: El estudio incluyó a 50 pacientes con AR sin EPI, 33 pacientes con AR con EPI y 30 controles sanos. Se evaluaron los datos demográficos, la puntuación de actividad de la enfermedad 28 (DAS28), los autoanticuerpos y la FPi. La EPI se diagnosticó mediante tomografía computarizada de alta resolución, con hallazgos clínicos y radiografía de tórax. Las muestras fueron analizadas para un recuento sanguíneo completo con índices de plaquetas incluidos, en el analizador de hematología Mindray BC-6800, Hamburgo, Alemania. Resultados: Los niveles de FPi fueron más altos en los pacientes con AR con EPI en comparación con los controles sanos y los pacientes con AR sin EPI. Se encontró una correlación débilmente positiva entre DAS28 y FPi en todos los pacientes con AR. Se encontró que los niveles de FPi eran de 2,85 para detectar ILD con una sensibilidad del 66,7% y una especificidad del 65%. Conclusiones: Nuestros resultados mostraron que la FPi se detectó más en AR con EPI en comparación con AR sin EPI. La FPi, una prueba de rutina barata y fácil durante el hemograma, puede proporcionar información importante en términos de la actividad de la enfermedad y la afectación pulmonar en la AR.(AU)


Asunto(s)
Humanos , Recuento de Plaquetas , Artritis Reumatoide , Enfermedades Pulmonares Intersticiales , Estudios de Casos y Controles , Reumatología
15.
Comput Math Methods Med ; 2022: 5002681, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35936364

RESUMEN

The risk factors of upper respiratory tract infection (URI) within 6 months after diagnosis in patients with idiopathic thrombocytopenic purpura (ITP) were analyzed, and the nomogram model was established and verified, with 242 and 50 ITP patients as the training and validation set, respectively. The patients were followed up for six months after the diagnosis of ITP. The clinical data of patients were collected, and the risk factors of URI in ITP patients within six months after diagnosis were analyzed using univariable, followed by multivariable logistic regression. Among the 242 ITP patients in the training set, 52 cases (21.49%) had URI, including 24 cases of viral infection, 11 cases of Mycoplasma pneumoniae infection, and 17 cases of bacterial infection. Logistic regression analysis showed that advanced age, use of glucocorticoid, smoking history, platelet count, serum CRP level, and lymphocyte subsets CD4 + and CD8 + were all risk factors for ITP patients to develop symptoms within six months after diagnosis (P < 0.05). Using the above five indicators, a nomogram prediction model was built for URI occurrence in patients with ITP within half a year after diagnosis, and the results showed an AUC, a sensitivity, and a specificity of 0.936 (95% CI: 0.878-0.983), 0.942, and 0.865, respectively. The nomogram model was internally verified by the bootstrap method for 500 self-sampling times, and the prediction of the calibration curve was in high consistency with the real results. External validation of the nomogram model resulted in an AUC, a sensitivity, and a specificity of 0.890 (95% CI: 0.757-0.975), 0.949, and 0.727, respectively. The nomogram model of URI in ITP patients within half a year after diagnosis based on logistic regression analysis has good discrimination and prediction accuracy. This provides important guidance value for individualized prediction of URI in ITP patients.


Asunto(s)
Púrpura Trombocitopénica Idiopática , Infecciones del Sistema Respiratorio , Humanos , Lactante , Nomogramas , Recuento de Plaquetas , Púrpura Trombocitopénica Idiopática/diagnóstico , Infecciones del Sistema Respiratorio/diagnóstico , Estudios Retrospectivos
16.
BMC Cardiovasc Disord ; 22(1): 351, 2022 08 03.
Artículo en Inglés | MEDLINE | ID: mdl-35922765

RESUMEN

BACKGROUND: Heparin-induced thrombocytopenia (HIT) is an antibody-mediated adverse drug reaction characterized by thrombocytopenia and thromboembolism. Herein, we present a case of HIT with subcutaneous hemorrhage after cardiovascular interventional therapy. CASE PRESENTATION: A 74-year-old man was admitted to the hospital for elective atrial fibrillation (AF) catheter ablation and left atrial appendage closure because of intermittent dizziness and palpitations. At presentation, the routine laboratory test results showed no abnormalities. He received subcutaneous enoxaparin for stroke prevention and unfractionated heparin for intraprocedural anticoagulation during coronary angiography and the AF procedure. On the second day after the AF procedure, the patient developed profound thrombocytopenia, moderate anemia, and mild subcutaneous hematoma. Blood tests and imaging examinations excluded acute hemolysis and other active bleeding. A 4Ts score of 5 and markedly positive platelet factor 4 IgG antibody established the diagnosis of HIT. Due to progressive subcutaneous hemorrhage in the thighs that could not be suppressed by pressure dressing, the patient received platelet transfusion and rivaroxaban for anticoagulation. The following days, the patient remained clinically stable from the hemorrhage, and his platelet count recovered. No thrombotic events occurred during hospitalization or follow-up. CONCLUSION: This case emphasizes the significance of suspecting HIT in patients with unexplained rapid thrombocytopenia after frequent heparin exposure. Decision-making regarding alternative anticoagulation and platelet transfusion in HIT with hemorrhage must be based on unique patient characteristics.


Asunto(s)
Heparina , Trombocitopenia , Anciano , Anticoagulantes/efectos adversos , Enoxaparina/efectos adversos , Heparina/efectos adversos , Humanos , Masculino , Recuento de Plaquetas , Trombocitopenia/inducido químicamente , Trombocitopenia/diagnóstico , Trombocitopenia/terapia
17.
Clin Appl Thromb Hemost ; 28: 10760296221106779, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35924375

RESUMEN

Objective:To investigate the application value of bone marrow megakaryocyte count, the proportion of megakaryocytes at each stage, and the platelet parameter in the clinical diagnosis of primary immune thrombocytopenia (ITP). Methods: The megakaryocyte and platelet parameter level in 62 ITP and 40 control group patients were compared and analyzed. Linear correlation analysis, Pearson correlation analysis, and ROC curves were performed for the correlation between megakaryocytes and platelet parameters. Results: Compared to the control group, the total number of megakaryocytes, the promegakaryocytes the granular megakaryocytes (GMeg), and naked megakaryocytes (NMeg), MPV, and P-LCR% in the ITP group increased. All differences were statistically significant (P<0.05). While the proportion of platelet-producing megakaryocytes (PMeg), PLT, and PCT decreased in the ITP group. These differences were statistically significant (P < 0.05). PLT was strongly positively correlated with PCT (r = 0.921, p<0.01). PCT was weakly positively with MPV (r = 0.309, p<0.05). MPV was positively correlated with P-LCR (r = 0.856, p<0.01). PDW was weakly positively correlated with P-LCR (r = 0.296, p<0.05) and Meg (r = 0.301, p<0.05), and negatively correlated with PMeg (r = -0.336, p<0.05). ROC curve analysis showed that PLT, PCT MPV and P-LCR% gave a high sensitivity(100.0%,81.0%,74.6%,90.5%,respectively.) and specificity (100.0%, 92.5%, 80.0%, 77.5%, respectively.) in diagnosis of ITP. Conclusion: The combined analysis of bone marrow megakaryocyte count, the proportion of megakaryocyte classification at each stage, and platelet parameters have an important reference value for auxiliary diagnosis of ITP.


Asunto(s)
Megacariocitos , Púrpura Trombocitopénica Idiopática , Plaquetas , Humanos , Volúmen Plaquetario Medio , Recuento de Plaquetas , Púrpura Trombocitopénica Idiopática/diagnóstico
18.
Contrast Media Mol Imaging ; 2022: 2256690, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35909587

RESUMEN

Even though cytopenia caused by either chemotherapy or radiotherapy is a common complication in cancer patients, chemoradiotherapy remains an essential treatment for the majority of patients. The purpose of this study was to look into the clinical efficacy and cost-effectiveness of recombinant human thrombopoietin (rhTPO) in treating chemo- or chemoradiotherapy-induced grade II, III, and IV thrombocytopenia. From December 2019 to November 2020, 233 lung cancer patients admitted to our hospital with chemotherapy- or chemoradiotherapy-induced thrombocytopenia were enrolled and treated with rhTPO. The study's findings revealed a significant disparity in the use of concurrent chemoradiotherapy in patients with grade II, III, and IV thrombocytopenia. All costs, including rhTPO treatment costs, platelet costs, drug costs, and nondrug costs, tended to rise as the severity of thrombocytopenia increased. In the treatment of chemotherapy or radiotherapy-induced thrombocytopenia, rhTPO has shown good clinical efficacy. In the treatment of grade II thrombocytopenia, rhTPO has a favorable economic evaluation. As a result, early intervention and thrombocytopenia treatment should be provided, which warrants further clinical investigation.


Asunto(s)
Neoplasias Pulmonares , Trombocitopenia , Quimioradioterapia/efectos adversos , Humanos , Recuento de Plaquetas , Proteínas Recombinantes/efectos adversos , Proteínas Recombinantes/uso terapéutico , Trombocitopenia/inducido químicamente , Trombocitopenia/tratamiento farmacológico , Trombopoyetina/uso terapéutico , Resultado del Tratamiento
19.
Clin Chem Lab Med ; 60(10): 1675-1682, 2022 09 27.
Artículo en Inglés | MEDLINE | ID: mdl-35938913

RESUMEN

OBJECTIVES: The prognostic role of baseline platelet count (PLT) in acute ischemic stroke patients with large vessel occlusion undergoing endovascular thrombectomy is unclear. Whether PLT modifies alteplase treatment effect on clinical outcome in those patients is also uncertain. METHODS: We derived data from a multicenter randomized clinical trial (DIRECT-MT) comparing intravenous alteplase before endovascular treatment vs. endovascular treatment only. The 654 patients with available PLT data were included. Primary outcome was the ordinal modified Rankin Scale (mRS) score evaluated at 90 days. We also assessed various secondary and safety outcomes. RESULTS: After adjusting for confounding factors, patients in the top tertile of PLT had a significantly lower risk of a worse shift in the distribution of mRS score (Odds Ratio: 0.671, 95% Confidence Interval: 0.473-0.953, p for trend=0.025), major disability and death (Odds Ratio: 0.617, 95% Confidence Interval: 0.393-0.97, p for trend=0.037) as well as death (Odds Ratio: 0.544, 95% Confidence Interval: 0.313-0.947, p for trend=0.031), respectively, compared with the bottom one. Among patients in the bottom tertile of PLT, combination therapy was associated with a better imaging outcome of eTICI score of 2b, 2c or 3 on final angiogram (Odds Ratio: 3.23, 95% Confidence Interval: 1.49-7.002) with a marginally significant interaction effect. CONCLUSIONS: Participants with higher baseline PLT had a decreased risk of poor functional outcomes. Low baseline PLT modified alteplase treatment effect on the eTICI score on final angiogram. Combination therapy was beneficial for patients with low baseline PLT to have a better reperfusion status.


Asunto(s)
Isquemia Encefálica , Procedimientos Endovasculares , Accidente Cerebrovascular Isquémico , Accidente Cerebrovascular , Humanos , Recuento de Plaquetas , Trombectomía , Activador de Tejido Plasminógeno , Resultado del Tratamiento
20.
Front Immunol ; 13: 953716, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-36003388

RESUMEN

Immune thrombocytopenia (ITP) is an acquired autoimmune bleeding disorder featured by increased platelet destruction and deficient megakaryocyte maturation. First-line treatments include corticosteroids, intravenous immunoglobulin and intravenous anti-D immunoglobulin. Second-line treatments consist of rituximab, thrombopoietin receptor agonists and splenectomy. Although most patients benefit from these treatments, an individualized treatment approach is warranted due to the large heterogeneity among ITP patients. In addition, ITP patients may relapse and there remains a subset of patients who become refractory to treatments. The management of these refractory patients is still a challenge. This review aims to summarize emerging therapeutic approaches for refractory ITP in several categories according to their different targets, including macrophages, platelets/megakaryocytes, T cells, B cells, and endothelial cells. Moreover, current management strategies and combination regimens of refractory ITP are also discussed.


Asunto(s)
Púrpura Trombocitopénica Idiopática , Trombocitopenia , Plaquetas , Células Endoteliales , Humanos , Recuento de Plaquetas , Púrpura Trombocitopénica Idiopática/tratamiento farmacológico , Esplenectomía
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