Procoagulant profile in patients with immune thrombocytopenia
Procoagulant profile in patients with immune thrombocytopenia
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DOI：
10.1111/bjh.14412
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发表时间：
2016-12-01
影响因子：
6.5
通讯作者：
Butta, Nora V.
中科院分区：
文献类型：
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作者：
Alvarez-Roman, Maria T.;Fernandez-Bello, Ihosvany;Butta, Nora V.
尽管血小板计数低，一些免疫性血小板减少症（ITP）患者很少出血，表明存在补偿血小板减少的因素。此外，ITP患者可能有血栓形成的风险增加。这些事实表明存在促凝剂的机制，但尚未澄清。本研究的目的是确定这些可能的因素。此外，还评估了旋转血栓弹性测量（ROTEM (R)）在这些患者中测试止血的效用。ITP患者由于血小板和红细胞微粒数量的增加，对蛋白C的抗性增加，以及由于纤溶酶原激活物抑制剂-1水平的增加而形成的凝块对纤维蛋白溶解更具抗性，这可能反映了ITP患者的内皮损伤/激活。尽管最大凝块硬度增加，溶解减少，但ROTEM (R)谱显示凝血时间延长，这可能依赖于抗血小板抗体的存在，正如ITP患者血浆对健康对照组血小板产生凝血酶试验延迟时间增加所提示的那样。这些结果表明，考虑到ITP患者的促凝剂特征和伴随的危险因素，需要对ITP患者进行个体化治疗。此外，ROTEM (R)似乎可用于评估ITP患者的止血情况。
Despite their low platelet count some immune thrombocytopenia (ITP) patients seldom bleed, indicating the presence of factors to compensate thrombocytopenia. Moreover, ITP patients may have an increased risk for thrombosis. These facts suggest the presence of procoagulant mechanisms that have not been clarified yet. The aim of this study was to identify these possible factors. Moreover, the utility of rotational thromboelastometry (ROTEM (R)) to test haemostasis in these patients was also evaluated. Patients with ITP presented a procoagulant profile due to an increased amount of platelet- and red cell-microparticles, an increased resistance to protein C and the formation of a clot more resistant to fibrinolysis due to augmented levels of plasminogen activator inhibitor-1, which might reflect an endothelial damage/activation in ITP patients. Despite increased maximum clot firmness and reduced lysis, ROTEM (R) profiles showed a prolonged clotting time that might rely on the presence of anti-platelet antibodies as suggested by the increased lagtime in thrombin generation test caused by plasma from ITP patients on platelets from healthy controls. These results indicate the need to individualize therapeutic treatment for ITP patients, considering their procoagulant profile and the presence of concomitant risk factors. Moreover, ROTEM (R) appeared to be useful for evaluating haemostasis in ITP patients.