Correlation of thrombosis with increased platelet turnover in thrombocytosis
Correlation of thrombosis with increased platelet turnover in thrombocytosis
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DOI：
10.1182/blood.v91.4.1288
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发表时间：
1998-02-15
期刊：
影响因子：
20.3
通讯作者：
Smith, BR
中科院分区：
文献类型：
--
作者：
Rinder, HM;Schuster, JE;Smith, BR
没有现成的方法可以常规评估血小板增多症的血栓形成风险和治疗反应。网织血小板 (RP) 定义了循环中最近释放的血小板，RP% 已被证明可以估计血小板减少状态下的血小板周转率。我们检查了 RP 值增加是否与血小板增多症的血栓并发症相关。在就诊时测量了 83 名患有慢性或短暂性血小板增多症的患者、46 名患有深静脉 (DVT) 或动脉 (ART) 血栓且血小板计数正常的患者以及 83 名血小板计数正常的健康对照者的血小板计数、RP% 和绝对 RP 计数。出现血栓形成的慢性血小板增多症患者 (n = 14) 的 RP% (14.7% +/- 10.1%, 平均值 +/- SD) 显着高于无症状慢性血小板增多症患者 (= 23, RP% = 3.4% +/- 1.8%)、健康对照 (3.4% +/- 1.3%)、DVT 患者 = 21 (3.8% +/- 2.1%)、或 ART 患者（n = 25，4.5% +/- 4.1%，所有比较 P < .05）。患有血栓的慢性血小板增多症患者的绝对 RP 计数也显着高于无症状慢性血小板增多症患者 (98 +/- 64 x 10(9)/L [范围，54 至 249 x 10(9)/L] v 30 +/- 13 x 10(9)/L [范围，11 至 51 x 10(9)/L]；P = .0004），而健康患者对照组、DVT 和 ART 患者的绝对 RP 计数同样较低（分别为 6 +/- 6 x 10(9)/L、9 +/- 7 x 10(9)/L 和 11 +/- 7 x 10(9)/L；P > .49）。当患者进一步细分为原发性骨髓增生性疾病与继发性血小板增多症时，合并血栓的慢性血小板增多症患者的 RP% 和绝对 RP 计数仍然显着较高。同样，在伴有血栓的短暂性血小板增多症患者中，RP 百分比和绝对计数也有所升高（与无症状短暂性血小板增多症患者分别为 40、4.5% +/- 2.7% 和 35 +/- 16 x 10(9)/L 相比，分别为 n = 6、11.5% +/- 4.4% 和 90 +/- 46 x 10(9)/L）。对照组（所有比较 P < .05）。此外，在出现血栓形成症状之前接受研究的 8 名血小板增多症患者中，有 7 名的绝对 RP 计数升高，而 63 名无症状血小板增多症患者中只有 1 名。对七名慢性血小板增多症患者的随访研究表明，阿司匹林成功治疗有症状的复发性血栓形成，可显着降低 RP%，从治疗前的 17.1% +/- 10.9% 降至治疗后的 4.8% +/- 2.0%；绝对 RP 计数从 102 +/- 67 x 10(9)/L 降至 26 +/- 10 x 10(9)/L（两者 P < .01）。我们得出的结论是，血小板计数升高时的血栓形成与血小板更新增加有关，而阿司匹林治疗可以逆转血小板更新。测量网织血小板以评估血小板周转率可能有助于评估血小板增多症的治疗反应和血栓形成风险。 (C) 1998 年，美国血液学会。
There are no readily applicable methods to routinely assess thrombosis risk and treatment response in thrombocytosis. Reticulated platelets (RP) define the most recently released platelets in the circulation, and the RP% has been shown to estimate platelet turnover in thrombocytopenic states. We examined whether increased RP values were associated with thrombotic complications in thrombocytosis. Platelet count, RP%, and absolute RP count were measured at presentation in 83 patients with chronic or transient thrombocytosis, 46 patients with deep vein (DVT) or arterial (ART) thrombosis and normal platelet counts, and 83 healthy controls with normal platelet counts. Chronic thrombocytosis patients presenting with thrombosis (n = 14) had significantly higher RP% (14.7% +/- 10.1%, mean +/- SD) than asymptomatic chronic thrombocytosis patients in = 23, RP% = 3.4% +/- 1.8%), healthy controls (3.4% +/- 1.3%), DVT patients in = 21, 3.8% +/- 2.1%), or ART patients (n = 25, 4.5% +/- 4.1%, P < .05 for all comparisons). Chronic thrombocytosis patients with thrombosis also had significantly higher absolute RP counts than asymptomatic chronic thrombocytosis patients (98 +/- 64 x 10(9)/L [range, 54 to 249 x 10(9)/L] v 30 +/- 13 x 10(9)/L [range, 11 to 51 x 10(9)/L]; P = .0004), whereas healthy controls, DVT, and ART patients had similarly low absolute RP counts (6 +/- 6 x 10(9)/L, 9 +/- 7 x 10(9)/L, and 11 +/- 7 x 10(9)/L, respectively; P > .49). The RP% and absolute RP counts remained significantly higher in chronic thrombocytosis patients with thrombosis when patients were further subdivided into primary myeloproliferative disorders versus secondary thrombocytosis. Similarly elevated RP percentages and absolute counts were also noted in transient thrombocytosis patients with thrombosis (n = 6, 11.5% +/- 4.4% and 90 +/- 46 x 10(9)/L, respectively) when compared with asymptomatic transient thrombocytosis patients in = 40, 4.5% +/- 2.7% and 35 +/- 16 x 10(9)/L, respectively) and to all control groups (P < .05 for all comparisons). In addition, 7 of 8 thrombocytosis patients who were studied before developing symptoms of thrombosis had elevated absolute RP counts compared with only 1 of 63 thrombocytosis patients who remained asymptomatic. Follow-up studies in seven chronic thrombocytosis patients showed that successful aspirin treatment of symptomatic recurrent thrombosis significantly reduced the RP% from 17.1% +/- 10.9% before therapy to 4.8% +/- 2.0% after therapy; absolute RP counts decreased from 102 +/- 67 x 10(9)/L to 26 +/- 10 x 10(9)/L (P < .01 for both). We conclude that thrombosis in the setting of an elevated platelet count is associated with increased platelet turnover, which is reversed by aspirin therapy. Measurement of reticulated platelets to assess platelet turnover may be useful in evaluating both treatment response and thrombotic risk in thrombocytosis. (C) 1998 by The American Society of Hematology.