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A 19 year old with a 3-week history of diarrhoea
Published in Tim French, Terry Wardle, The Problem-Based Learning Workbook, 2022
LMWH should be used to prevent venous thromboembolism. A high platelet count is a manifestation of the acute inflammatory response. This hyper-coagulable state, combined with bed rest, increases the risk of DVT and PE (see p. 156).
Anticoagulation
Published in Harold R. Schumacher, William A. Rock, Sanford A. Stass, Handbook of Hematologic Pathology, 2019
Louis M. Fink, Nicole A. Massoll, Alex A. Pappas
This case illustrates the need for monitoring the platelet count when patients are treated with heparin. Another salient point is the relative platelet decrease of greater than 50% even though platelet count was still within the normal range. In most cases the platelet count is below 100,000/μL. Small amounts of heparin used to flush catheters may be enough to resensitize patients previous immunized to heparin. It is often difficult to find the heparin sources, since heparin rinses may not be recorded or possibly not recognized as being potent enough to induce HIT. When HIT is considered, warnings should be at the patient’s bedside as well as in the chart. In addition to the laboratory test described above for HIT, the rise in the platelet count after discontinuing the heparin clinically confirms the diagnosis. Failure to recognize and appropriately treat HIT can lead to extreme morbidity or even mortality.
Platelet Disorders Douglas Triplett
Published in Genesio Murano, Rodger L. Bick, Basic Concepts of Hemostasis and Thrombosis, 2019
The bleeding that occurs in thrombocythemia is probably related to the high platelet count; for when the platelet levels are reduced to normal, bleeding will generally cease. The abnormal bleeding has been ascribed to a variety of qualitative platelet defects. Recently, Zucker and Mielke278 and Ginsberg279 have emphasized the importance of platelet function tests in the diagnosis and evaluation of an elevated platelet count. A finding of platelet functional abnormalities, particularly with respect to aggregation, is helpful in separating thrombocythemias from thrombocytosis. Also, the absence of epinephrine and collagen-induced aggregation, decreased platelet factor 3 activity, together with abnormalities of the bleeding time and platelet retention, are helpful in predicting which patients with an elevated platelet count are at a high risk for thrombotic or hemorrhagic complications. Defective platelet lipid peroxidation in myeloproliferative disorders has recently been described.280 Low levels of lipid peroxidation have correlated well with clinical bleeding and bruising problems. In these studies, platelet lipid peroxidation was induced by the sulphydryl-blocking reagent n-ethylmaleimide (NEM). The low levels of lipid peroxidation could be due to: (1) an aged platelet population, (2) an abnormal cell line, (3) a reduction in the cyclo-oxygenase enzyme activity of the platelet prostaglandin synthetic pathway, (4) a reduction in the substrate for platelet prostaglandin synthesis, i.e., arachidonic acid and (5) an abnormality of the phospholipase A activation.
Association between endometriosis, infertility and autoimmune antiplatelet glycoprotein VI antibodies in two patients
Published in Platelets, 2023
Stéphane Loyau, Anne Bauters, Nathalie Trillot, Cédric Garcia, Pierre Cougoul, Hélène Pol, Camille Paris, Geoffroy Robin, Chrystèle Rubod, Bernard Payrastre, Martine Jandrot-Perrus, Sophie Voisin, Annabelle Dupont
ITP occurs with an incidence rate of 1.6 to 3.9 per 100,000 patient-years, which increases with age and has slight female preponderance. It has been proposed that patients with ITP have a state of immune dysregulation that extends beyond platelet autoantibodies.32 The surface expressed major platelet receptors GPIIb/IIIa and GPIb are the most frequently identified targets of antibodies in ITP33 and thrombocytopenia is explained by both an increased destruction and a decreased production. Few patients with an autoantibody to GPVI have been reported so far; most possibly because testing for antibody against GPVI in ITP is not generalized. Of note, the platelet count is relatively weakly affected in our two patients. To our knowledge there is no report describing the association of anti-GPIIb/IIIa or anti-GPIb with endometriosis. Our observation raises the question whether GPVI could be a preferential target for the development of anti-GPVI autoantibodies associated with endometriosis. A more systematic analysis of platelet GPVI expression in patients with endometriosis would be necessary to answer that question.
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.
Alternatives for managing patients with newly diagnosed immune thrombocytopenia: a narrative review
Published in Expert Review of Hematology, 2022
David Gómez-Almaguer, Edgar A. Rojas-Guerrero, Andrés Gómez-De León, Perla R. Colunga-Pedraza, José C. Jaime-Pérez
Conventionally, first-line therapy for ITP aims to obtain a rapid response and reduce bleeding risk by increasing the platelet count. This situation is especially important in patients with an elevated risk of active bleeding. The durability of response, tolerability, and long-term safety of pharmacologic interventions are considered less a priority during the initial treatment stage [11]. It is a heterogeneous disease. Symptoms and signs can differ from patient to patient and do not necessarily correlate with the platelet count. Treatment options must include patients’ values and preferences since improving health-related quality of life (HRQoL) is an important objective [12,13]. The American Society of Hematology ITP clinical guidelines, in an updated version, recommend managing a newly diagnosed adult patient with a platelet count <30 x 109/L with corticosteroids [3]. The addition of intravenous immunoglobulin (IVIG) is for patients in whom a rapid increase in the platelet count is favored. IVIG, where available, may be appropriate in patients with bleeding or at high risk for bleeding, who require a surgical procedure, or who are unresponsive to corticosteroids [14]. Moreover, the International Consensus Report on the investigation and management of primary immune thrombocytopenia still suggests using corticosteroids as a standard initial treatment [4].