Department of Clinical Science, University of Bergen, Norway.
Department of Immunology and Transfusion Medicine, Haukeland University Hospital, Bergen, Norway.
Blood Transfus. 2019 May;17(3):181-190. doi: 10.2450/2018.0140-18. Epub 2018 Dec 13.
In thrombocytopenic patients better assessment of bleeding risk than that provided by platelet count alone is required. Multiplate aggregometry and thromboelastography (TEG) could be used, but information on their role in such patients is limited. The primary aim of this study was to investigate the feasibility of Multiplate analyses in patients with haematological malignancies. A secondary aim was to explore whether a multiple logistic regression model combining Multiplate, TEG, clinical and laboratory variables was associated with risk of bleeding.
This was an exploratory, prospective observational study of thrombocytopenic patients with haematological malignancies. Total platelet count (TPC), white blood cell count, C-reactive protein (CRP) level, temperature and bleeding status were recorded daily. TEG and Multiplate analyses with four agonists were performed on weekdays.
Ten patients were enrolled into the study. The median number of days in a study period was 21. Bleeding was observed on 64 of 298 study days. TPC <20×10/L and <10×10/L occurred on 119 and 25 days, respectively. When TPC was <33×10/L, many samples showed no aggregation, regardless of bleeding status. Despite this, the odds of World Health Organization (WHO) grade 2 bleeding decreased significantly as aggregation increased and Multiplate had a negative predictive value (NPV) of 96% and a positive predictive value (PPV) of 19% for significant bleeding. In the multiple logistic regression model collagen-activated Multiplate aggregation, TEG angle, TEG reaction time and CRP significantly affected the odds of WHO grade 2 bleeding. The combined model had a NPV of 99% and a PPV of 19%.
Our findings suggest that the markers of platelet function and haemostasis provided by Multiplate aggregometry and TEG may add information to support prediction of bleeding, although platelet count still remains the most accessible analysis for routine testing.
在血小板减少症患者中，需要比血小板计数更能准确评估出血风险。多血小板聚集仪和血栓弹力图（TEG）可用于评估，但有关其在这类患者中的作用的信息有限。本研究的主要目的是调查多血小板分析仪在血液恶性肿瘤患者中的可行性。次要目的是探讨将多血小板分析与 TEG、临床和实验室变量相结合的多变量逻辑回归模型是否与出血风险相关。
这是一项针对血液恶性肿瘤血小板减少症患者的探索性、前瞻性观察性研究。每天记录总血小板计数（TPC）、白细胞计数、C 反应蛋白（CRP）水平、体温和出血状态。在工作日进行 TEG 和四种激动剂的多血小板分析。
研究共纳入 10 例患者。研究期间的中位天数为 21 天。298 天的研究中有 64 天出现出血。TPC＜20×10/L 和＜10×10/L 分别发生在 119 天和 25 天。当 TPC＜33×10/L 时，许多样本无论是否有出血，均无聚集。尽管如此，随着聚集的增加，世界卫生组织（WHO）出血分级 2 出血的几率显著降低，多血小板的阴性预测值（NPV）为 96%，阳性预测值（PPV）为 19%，用于预测显著出血。在多变量逻辑回归模型中，胶原激活的多血小板聚集、TEG 角、TEG 反应时间和 CRP 显著影响 WHO 出血分级 2 的几率。联合模型的 NPV 为 99%，PPV 为 19%。
我们的研究结果表明，多血小板聚集仪和 TEG 提供的血小板功能和止血标志物可能会提供更多信息，以支持出血预测，尽管血小板计数仍然是常规检测中最易获得的分析。
