Escolar G, Cases A, Viñas M, Pino M, Calls J, Cirera I, Ordinas A
Servicio de Hemoterapia y Hemostasia, Hospital Clínic, Villarroel 170, Barcelona 08036, Spain.
Haematologica. 1999 Jul;84(7):614-9.
Patients with end-stage renal disease or advanced cirrhosis develop bleeding disorders characterized by defective interaction of platelets with damaged subendothelium. The anemia associated with both clinical entities has a negative influence on hemostasis. We evaluated alterations of platelet function in patients suffering from end-stage renal disease (n=21) or hepatic cirrhosis (n=20) using standard aggregometric techniques and the recently developed platelet function analyzer (PFA-100 ). The impact of low hematocrit was also analyzed.
The hemostatic capacity of platelets was tested in the PFA-100 using citrated blood and standard cartridges containing collagen-ADP (COL-ADP) or collagen-epinephrine (COL-Epi). The hemodynamic influence of hematocrit was also evaluated in blood aliquots in which hematocrit was experimentally increased by adding red blood cells from the same patient.
Aggregation studies demonstrated abnormal responses to several agonists in both group of patients. Closure times obtained by the PFA-100 for control blood samples were 87+/-3 sec for COL-ADP and 113+/-5 sec with COL-EPi cartridges. Closure times in uremic and cirrhotic patients with average hematocrits of 0.26 and 0.27 respectively were significantly prolonged (139+/-12 and 125+/-14 sec, respectively with COL-ADP and 194+/-29 and 151+/-15 sec with COL-Epi cartridges). A 5% increase in the hematocrit caused a reduction in the closure time to 111+/-7 sec (COL-ADP) and 143+/-14 sec (COL-Epi) in the uremic group and to 86+/-4 sec (COL-ADP) and 115+/-16 sec (COL-Epi) in the cirrhotic group. Our studies confirm the platelet dysfunction in uremic and cirrhotic patients.
The PFA-100 device proved to be useful for testing alterations of primary hemostasis in these acquired disorders and was sensitive enough to detect modifications in hemostasis caused by elevations in hematocrit. Conventional aggregometric tests were able to identify the intrinsic platelet abnormality in uremic and cirrhotic conditions, while the PFA-100 seemed more sensitive in detecting the negative influence of the hematocrit reduction.
终末期肾病或晚期肝硬化患者会出现出血性疾病，其特征为血小板与受损内皮下层的相互作用存在缺陷。与这两种临床病症相关的贫血对止血有负面影响。我们使用标准凝集测定技术和最近开发的血小板功能分析仪（PFA - 100）评估了终末期肾病患者（n = 21）或肝硬化患者（n = 20）的血小板功能改变。还分析了低血细胞比容的影响。
使用枸橼酸盐血和含有胶原 - ADP（COL - ADP）或胶原 - 肾上腺素（COL - Epi）的标准检测盒，在PFA - 100中检测血小板的止血能力。还在通过添加同一患者的红细胞使血细胞比容实验性升高的血样中评估血细胞比容的血流动力学影响。
凝集研究表明两组患者对几种激动剂的反应均异常。PFA - 100测得对照血样的封闭时间，COL - ADP检测盒为87±3秒，COL - Epi检测盒为113±5秒。平均血细胞比容分别为0.26和0.27的尿毒症患者和肝硬化患者的封闭时间显著延长（COL - ADP检测盒分别为139±12秒和125±14秒，COL - Epi检测盒分别为194±29秒和151±15秒）。血细胞比容增加5%后，尿毒症组的封闭时间缩短至111±7秒（COL - ADP）和143±14秒（COL - Epi），肝硬化组缩短至86±4秒（COL - ADP）和115±16秒（COL - Epi）。我们的研究证实了尿毒症患者和肝硬化患者存在血小板功能障碍。
PFA - 100设备被证明可用于检测这些后天性疾病中初级止血的改变，并且足够敏感，能够检测出血细胞比容升高引起的止血变化。传统的凝集测定试验能够识别尿毒症和肝硬化状态下血小板的内在异常，而PFA - 100在检测血细胞比容降低的负面影响方面似乎更敏感。
