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Platelet-Rich Plasma
Published in Rubina Alves, Ramon Grimalt, Techniques in the Evaluation and Management of Hair Diseases, 2021
Lu Yin, Katerina Svigos, Kristen Lo Sicco, Jerry Shapiro
Although no study has been performed assessing risk of skin cancer recurrence after local PRP treatment, given its mechanism of action via growth factors, it should be used with caution in patients with either active or history of skin cancers involving the scalp. Caution should be taken when considering PRP treatment for alopecia in these patients, as there is a theoretical risk that injected growth factors may stimulate cell proliferation. Care should also be taken when treating patients who are on antiplatelet therapy or have low platelet counts, as these conditions may decrease the treatment's efficacy. However, there are no studies evaluating associations between patients' serum platelet counts and responses to PRP injections. Finally, the safety profile of PRP injections for treatment of alopecia in pregnant women is currently unknown. Blood composition is also altered during pregnancy, which may theoretically impact treatment efficacy. During pregnancy, blood volume is increased, and though increased erythropoietin compensates somewhat for the increased blood volume, there is still a degree of dilutional anemia [47, 48]. Due to dilution and sequestration in the spleen from splenic enlargement, platelet counts also decrease [47, 49]. However, no study has evaluated whether these physiologic changes impact PRP efficacy. We recommend that physicians consider the option of PRP treatment carefully when treating patients who are pregnant or breastfeeding with regard to both treatment safety and efficacy.
Valproate
Published in Stanley R. Resor, Henn Kutt, The Medical Treatment of Epilepsy, 2020
J. Christine Dean, J. Kiffin Penry
Published reports of VPA-induced blood disorders are rare. There have been some reports of fibrinogen depletion or abnormality in the sedimentation rate, but these are not confirmed (83). Numerous reports of platelet defects and abnormalities of coagulation and bleeding time were documented by Sutor et al. (84,85). Although several authors [Neophytides et al. (86), Monnet et al. (87), Espir et al. (78), and other authors] have reported decreased platelet counts and coagulation defects, none of the patients had counts below 130,000/mm3 and most of the low platelet counts and coagulation defects occurred with a daily dose of 4 grams or greater. Although VPA may affect platelet counts, thrombocytopenia is rare and often asymptomatic. It is most likely to cause symptoms if the daily dose exceeds 50 mg/kg (88).
Methods for assigning impairment
Published in Ramar Sabapathi Vinayagam, Integrated Evaluation of Disability, 2019
Thrombocytopenia refers to a blood platelet count of less than 150 × 109/L and less than 120 × 109/L in late pregnancy (123). Thrombocytopenia manifests as skin bruising, petechiae, gum and nasal bleeding, bleeding in gastrointestinal, urinary tracts, and menorrhagia. Platelet count defines the severity of thrombocytopenia. Persons with platelet count over 50,000/µL do not have any significant bleeding diathesis. A platelet count of between 20,000 and 50,000/µL denotes mild thrombocytopenia. These individuals may bleed only on major trauma or surgery. Platelet count of between 10,000 and 20,000/µL refers to moderate thrombocytopenia. In general, there is no severe spontaneous bleeding with a platelet count of above 10,000/µL. Severe thrombocytopenia shows very low platelet count of <10,000/µL with spontaneous bleeding (124).
Platelet to white blood cell ratio was an independent prognostic predictor in acute myeloid leukemia
Published in Hematology, 2022
Shuqi Zhao, Hanzhang Pan, Qi Guo, Wanzhuo Xie, Jinghan Wang
Notably, clinical parameters are still important factors for classification in CN-AML [3]. In clinical practice, patients with AML often present with leukocytosis and thrombocytopenia. Leukocytosis is usually caused by leukemia blasts, which release from bone marrow storage pool to peripheral blood. At the same time, leukemia blasts can suppress hematopoiesis including the inhibition of the generation of platelets [4]. Notably, high WBC had been regarded as a reliable indicator of poor clinical outcome [5]. Generally, platelet count has been used to predict bleed risk in AML. Low platelet count can contribute to bleeding complications, which is a dangerous and potentially fatal complication [5]. Recently, a combinational index of platelet and WBC had been proved as an independent prognostic predictor in several diseases such as acute-on-chronic liver failure, renal malignancy, ischemic stroke, and acute promyelocytic leukemia [5–8]. However, whether this ratio of platelet and WBC counts (PWR) has somewhat prognostic indication in CN-AML is still not investigated. Therefore, we analyzed the prognostic value of PWR in a large cohort of CN-AML patients.
Avoiding Spurious Low Platelet Counts by Redrawing Specimens with First Time Low Platelet Counts
Published in Fetal and Pediatric Pathology, 2022
The data support confirmation of the initial low platelet counts in pediatric patients by repeating the CBC on a redrawn sample. While this may delay the reporting of the results, between 1/3 and 3/4ths of the time, incorrect platelet counts would have been reported. A busy but astute physician may have detected this unexpected low platelet count and requested a repeat analysis, incurring another laboratory charge (the first would not have been credited). A delay would occur due to the time it takes to place the order/obtain the specimen after the physician becomes aware of the low platelet values. An illustrative example is an early morning draw, with results not seen by the physician until rounds, then reordered. An additional charge would be incurred, and the physician would have to check the repeated results later.
Chronic immune thrombocytopenia in a child with X-linked agammaglobulinemia-an uncommon phenotype
Published in Platelets, 2022
Jing Yin, Jijun Ma, Xiaoxue Liu, Jingyue Xia, Qi Ai, Chongwei Li
The patient showed no hemorrhagic symptoms until he was 9 months old when he presented with cutaneous bleeding. There was no family history of congenital thrombocytopenia. He looked well with no other manifestations or prodromal symptoms. A full blood count revealed a low platelet count of 19 × 109/L, and normal hemoglobin and white blood cell count. There were no signs of red cell fragments in the peripheral smear, and all etiological examinations, such as herpes viruses, common respiratory viruses, enterovirus, and human parvovirus B19 were all negative. Although his platelet counts initially improved with high dose IVIG therapy (2 g/kg), he eventually became refractory to IVIG. Further, bone marrow aspiration revealed trilineage hematopoiesis and megakaryocyte hyperplasia, which was consistent with ITP. No antiplatelet antibodies against glycoprotein (GP)IIb/IIIa, GPIb/Ix and GPIa/IIa were detected by enzyme-linked immunosorbent assay. Oral prednisone (15 mg/day; 1.5 mg/kg/day) was administered when he was 10 months old, and the platelet count was normalized thereafter. Whole-exome sequencing was performed at another institution for suspected X-linked congenital thrombocytopenia (XLT) and identified the same BTK mutation with no mutations for Wiskott-Aldrich syndrome. With the rapid tapering of prednisone to 1.25 mg/day within one month, his platelet count declined, and a more frequent IVIG (2 g/kg/dose) was necessary.