RESUMO
A Trombocitopenia imune (PTI) é uma doença imuno mediada adquirida de adultos e crianças caracterizada por plaquetopenia transitória ou persistente, onde o grau de plaquetopenia aumenta o risco de sangramento. Geralmente, os pacientes apresentam manifestações clínicas apenas em plaquetopenias abaixo de 50x103/mm3, e contagem de plaquetas entre 100 e 150 x103/mm3, se estável por mais de 6 meses, necessariamente não indica uma condição patológica. Tem sido sugerido diferentes processos fisiopatológicos relacionados às plaquetas de acordo com a intensidade da plaquetopenia, e que alterações na megacariocitopoiese e diminuição da sobrevida plaquetária são eventos determinantes na PTI. Contagem de plaquetas reticuladas em citometria de fluxo é um teste muito útil para avaliação da plaquetopenia, pois reflete a atividade megacariocitopoiética, destruição das plaquetas e a própria contagem de plaquetas. Tanto as plaquetas quanto os megacariócitos apresentam a via intrínseca da apoptose. A atividade dos principais mediadores da apoptose intrínseca, como Bax a Bak, é regulada por proteínas anti-apoptótica da família Bcl-2, tais como Bcl-xL. Um balanço entre Bcl-xL e Bax regula a sobrevivência plaquetária. Pacientes de PTI apresentam aumento da ativação plaquetária e da formação de micropartículas derivadas de plaquetas (MPP). Nosso objetivo foi avaliar a relação entre produção e apoptose plaquetária, e associá-la com a ativação plaquetária e a formação de MPP nos diferentes graus de intensidade da PTI. Os pacientes recrutados foram diagnosticados para trombocitopenia imune (PTI) primária, "idiopática", não esplenectomizados, acompanhados regularmente no ambulatório de Doenças Hemorrágicas e Trombóticas, do Serviço de Hematologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, e foram divididos grupos de acordo com contagem de plaquetas: < 50x103/mm3 (n=7); entre 50-100x103/mm3 (n=7); > 100x103/mm3 (n=7). Como grupo...
Immune thrombocytopenic (ITP) is an immune-mediated acquired disease of adults and children characterized by transient or persistent decrease of the platelet count and, depending upon the degree of thrombocytopenia, increased risk of bleeding. ITP usually presents with clinical manifestations only in platelet counts below 50x103/mm3, and counts between 100 and 150x103/mm3 if they have been stable for more than 6 months do not necessarily indicate a pathologic condition. It has been suggested the existence of different pathophysiological processes involving platelets according to the severity of thrombocytopenia, and that alterations in the megakaryopoiesis and reduced platelet lifespan play a key role in ITP. The flow cytometric analysis of reticulated platelets is useful for evaluating thrombocytopenia that reflect the activity megakaryopoiesis, platelets destruction, plataelet count, and age. Platelets and megakaryocytes contain intrinsic pathway of apoptosis. The activity of key mediators of intrinsic apoptosis, Bak and Bax, is tightly controlled by anti-apoptotic Bcl-2 family members, of which Bcl-xL, wich have been shown to coordinately regulate platelet survival. ITP patients have a larger amount of activated platelets that express P-selectin as well as an increase of platelets-derived microparticles (PMP). We suggest a relationship between platelet production and Bcl-xL and Bax expression in ITP patients from different degrees of thrombocytopenia, that has relate with platelet activation and PMP. Our aim was assessment of ratio between platelets production and apoptosis, and it associate with platelets activation and PMP in differents thrombocytopenia degree in ITP. Patients were considered eligible for the study if they were on regular follow-up at the clinic of haemorrhagic and thrombotic diseases of the Hematology Service of Clinics Hospital of University of São Paulo Medicine School diagnosed with primary immune thrombocytopenia, "idiopathic"....
Assuntos
Apoptose , Plaquetas , Micropartículas Derivadas de Células , Ativação Plaquetária , Púrpura Trombocitopênica IdiopáticaRESUMO
OBJECTIVE: Protein-energy malnutrition (PEM) is an important public health problem affecting millions of people worldwide. Hematopoietic tissue requires a high nutrient supply, and a reduction in leukocytes, especially lymphocytes, suggests that some nutritional deficiencies might be altering bone marrow function and decreasing its ability to produce lymphocytes. In this study, we evaluated the effect that PEM has on lymphocyte subtypes and the cell cycle of CD5(+) cells. METHODS: Swiss mice were subjected to PEM using a low-protein diet containing 4% protein. When the experimental group had lost about 20% of their original body weight, we collected blood and bone marrow cells and evaluated the hemogram, the myelogram, bone marrow lymphoid markers using flow cytometry, and the cell cycle in CD5(+) bone marrow. RESULTS: Malnourished animals presented anemia, reticulocytopenia, and leukopenia with lymphopenia. The bone marrow was hypocellular, and flow cytometric analyses of bone marrow cells showed cells that were CD45(+) (91.2%), CD2(+) (84.9%), CD5(+) (37.3%), CD3(+) (23.5%), CD19(+) (43.3%), CD22(+) (34.7%), CD19(+)/CD2(+) (51.2%), CD19(+)/CD3(+) (24.0%), CD19(+)/CD5(+) (13.2%), CD22(+)/CD2(+) (40.1%), CD22(+)/CD3(+) (30.3%), and CD22(+)/CD5(+) (1.1%) in malnourished animals and CD45(+) (97.5%), CD2(+) (42.9%), CD5(+) (91.5%), CD3(+) (92.0%), CD19(+) (52.0%), CD22(+) (75.6%), CD19(+)/CD2(+) (62.0%), CD19(+)/CD3(+) (55.4%), CD19(+)/CD5(+) (6.7%), CD22(+)/CD2(+) (70.3%), CD22(+)/CD3(+) (55.9%), and CD22(+)/CD5(+) (8.4%) in control animals. Malnourished animals also presented more CD5(+) cells in the G0 phase of cell cycle development. CONCLUSION: Malnourished animals presented bone marrow hypoplasia, maturation interruption, prominent lymphopenia with depletion in the lymphoid lineage, and changes in cellular development. We suggest that these changes are some of the primary causes of lymphopenia in cases of PEM and partly explain the increase in susceptibility to infections found in malnourished individuals.
