Platelet function tests, independent of platelet count, are associated with bleeding severity in ITP
Platelet function tests, independent of platelet count, are associated with bleeding severity in ITP
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DOI：
10.1182/blood-2015-02-628461
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发表时间：
2015-08-13
期刊：
影响因子：
20.3
通讯作者：
Michelson, Alan D.
中科院分区：
文献类型：
--
作者：
Frelinger, Andrew L., III;Grace, Rachael F.;Michelson, Alan D.
血小板计数同样低的免疫性血小板减少症（ITP）患者的出血倾向不同。为了确定ITP患者血小板功能的差异是否可以解释这种出血倾向的变化，我们对ITP儿童患者进行了一项单中心横断面研究。在57例ITP患者（中位年龄9.9岁）中评价了使用和不使用激动剂刺激的出血严重程度（通过标准化出血评分评估）和血小板功能（通过全血流式细胞术评估）。在调整血小板计数后，凝血酶受体激活肽（TRAP）刺激的P-选择素和活化糖蛋白（GP）IIb-IIIa阳性血小板百分比较高水平与出血评分较低显著相关，而未成熟血小板分数（IPF）、TRAP刺激的血小板表面CD 42 b、未刺激的血小板表面P-选择素、和血小板前向光散射（FSC）与较高的出血评分相关。因此，与血小板年龄（IPF、FSC）相关的血小板功能检查和通过蛋白酶激活受体1（PAR 1）凝血酶受体（TRAP刺激的P-选择素、活化的GPIIb-IIIa和CD 42 b）的活化（不依赖于血小板计数）与ITP并发出血严重程度相关。这些测试可能是有用的标记物，未来出血的风险在ITP。
Immune thrombocytopenia (ITP) patients with similarly low platelet counts differ in their tendency to bleed. To determine if differences in platelet function in ITP patients account for this variation in bleeding tendency, we conducted a single-center, cross-sectional study of pediatric patients with ITP. Bleeding severity (assessed by standardized bleeding score) and platelet function (assessed by whole blood flow cytometry) with and without agonist stimulation was evaluated in 57 ITP patients (median age, 9.9 years). After adjustment for platelet count, higher levels of thrombin receptor activating peptide (TRAP)-stimulated percent P-selectin- and activated glycoprotein (GP) IIb-IIIa-positive platelets were significantly associated with a lower bleeding score, whereas higher levels of immature platelet fraction (IPF), TRAP-stimulated platelet surface CD42b, unstimulated platelet surface P-selectin, and platelet forward light scatter (FSC) were associated with a higher bleeding score. Thus, platelet function tests related to platelet age (IPF, FSC) and activation through the protease activated receptor 1 (PAR1) thrombin receptor (TRAP-stimulated P-selectin, activated GPIIb-IIIa, and CD42b), independent of platelet count, are associated with concurrent bleeding severity in ITP. These tests may be useful markers of future bleeding risk in ITP.