Department of Pediatrics, School of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan.
Int J Hematol. 2018 Aug;108(2):151-160. doi: 10.1007/s12185-018-2454-y. Epub 2018 Apr 16.
Various disorders cause severe thrombocytopenia, which can lead to critical hemorrhage. Procedures that rapidly support the diagnosis and risk factors for serious bleeding were explored, with a focus on immune thrombocytopenia (ITP). Twenty-five patients with thrombocytopenia, including 13 with newly diagnosed ITP, 3 with chronic ITP, 6 with aplastic anemia (AA), and 3 with other thrombocytopenia (one acute myeloid leukemia, one acute lymphoblastic leukemia, and one hemophagocytic lymphohistiocytosis), were reviewed. In addition to platelet-related parameters obtained by an automated hematology analyzer, flow cytometric analysis of platelets was performed. A characteristic flow cytometric pattern with broad forward scatter and narrowed side scatter, which is specific to ITP, but not other types of thrombocytopenia, was found. CD62P-positive platelets were increased in newly diagnosed ITP cases compared to control (P < 0.0001), AA (P = 0.0032). Moreover, detection of dramatic changes in these parameters on sequential monitoring may suggest internal hemorrhage, even absent skin or visible mucosal bleeding. The bleeding score for visible mucosae had a negative correlation with platelet count and a positive correlation with immature platelet fraction (%), forward scatter, and CD62P. This characteristic flow cytometric pattern makes it possible to distinguish ITP from other thrombocytopenic disorders.
各种疾病可导致严重血小板减少症，从而引起严重出血。本研究旨在探讨能够快速支持诊断和严重出血风险因素的方法，重点关注免疫性血小板减少症（ITP）。研究共纳入 25 例血小板减少症患者，包括 13 例新诊断的 ITP、3 例慢性 ITP、6 例再生障碍性贫血（AA）和 3 例其他类型血小板减少症（1 例急性髓细胞白血病、1 例急性淋巴细胞白血病和 1 例噬血细胞性淋巴组织细胞增多症）。除了通过自动血液分析仪获得的血小板相关参数外，还对血小板进行了流式细胞术分析。发现一种特征性的流式细胞术模式，具有广泛的前向散射和狭窄的侧向散射，这是 ITP 特有的，而不是其他类型的血小板减少症所特有的。与对照组（P<0.0001）和 AA（P=0.0032）相比，新诊断的 ITP 病例中 CD62P 阳性血小板增加。此外，在连续监测中检测到这些参数的显著变化可能提示存在内出血，即使没有皮肤或可见黏膜出血。可见黏膜的出血评分与血小板计数呈负相关，与未成熟血小板分数（%）、前向散射和 CD62P 呈正相关。这种特征性的流式细胞术模式使得能够将 ITP 与其他血小板减少症区分开来。
