Mishra Kundan, Jandial Aditya, Sandal Rajeev, Meshram Ashok, Lad Deepesh, Prakash Gaurav, Khadwal Alka, Kapoor Rajan, Ahluwalia Jasmina, Varma Neelam, Varma Subhash, Dhiman R K, Malhotra Pankaj
Department of Clinical Hematology and Medical Oncology, Post-Graduate Institute of Medical Education and Research, Chandigarh, 160012, India.
Department of Clinical Hematology, Army Hospital (Research and Referral), New Delhi, 110010, India.
Ann Hematol. 2023 Nov;102(11):3007-3014. doi: 10.1007/s00277-023-05466-1. Epub 2023 Sep 23.
The bleeding risk in immune thrombocytopenia (ITP) is related not only to low platelet count but also to the presence of platelet dysfunction. However, diagnosing a concomitant platelet dysfunction is challenging as most of the available platelet function assays (PFAs) require a platelet count of greater than 100,000/μL. Sonoclot coagulation and platelet function analyzer works on the principle of viscoelastometry, and results remain unaffected by the platelet counts. To assess the platelet function in adult acute ITP patients with the help of sonoclot coagulation and platelet function analyzer and correlate it with the risk of bleeding. Newly diagnosed acute ITP patients with a platelet count less than 20,000/μL were divided into two groups based on WHO bleeding grade: ITP non-bleeder (ITP-NB) group (WHO bleeding grade ≤1) and ITP bleeder (ITP-B) group (WHO bleeding grade ≥2). Platelet function was assessed by sonoclot in both groups. The patients without significant bleeding (ITP-NB) were followed up monthly for six months with the assessment of platelet function during each contact. Eighty patients (30 ITP-B and 50 ITP-NB) were prospectively included in this study. The median age of patients in the two groups was 37 years and 30 years, respectively. The female-to-male ratio was 4:1 and 1:1 in ITP-B and ITP-NB groups. The median platelet count in ITP-B and ITP-NB was 12000/μL (range 1000-19000/μL) and 8000/μL (range 1000-19000/μL), respectively. Mean platelet functions by sonoclot in both groups were lower than the normal cut-off (>1.6). However, the mean platelet function in the ITP-B group (0.2 + 0.17) was significantly lower than the ITP-NB group (1.2 ± 0.52) (p = 0.01). During the follow-up period of 6 months, patients in ITP-NB with a normal platelet function (>1.6) on sonoclot had lesser episodes (one episode) of clinically significant bleeding than patients with a low platelet function (4 episodes). Patients with acute severe thrombocytopenia and bleeding phenotype have a greater abnormality on platelet function by sonoclot than patients with non-bleeding phenotype. This information may help in taking therapeutic decisions in patients with acute ITP.
免疫性血小板减少症（ITP）的出血风险不仅与血小板计数低有关，还与血小板功能障碍的存在有关。然而，诊断合并存在的血小板功能障碍具有挑战性，因为大多数现有的血小板功能检测（PFA）要求血小板计数大于100,000/μL。Sonoclot凝血和血小板功能分析仪基于黏弹性测定原理工作，其结果不受血小板计数的影响。旨在借助Sonoclot凝血和血小板功能分析仪评估成年急性ITP患者的血小板功能，并将其与出血风险相关联。将新诊断的血小板计数低于20,000/μL的急性ITP患者根据WHO出血分级分为两组：ITP无出血组（ITP-NB）（WHO出血分级≤1）和ITP出血组（ITP-B）（WHO出血分级≥2）。两组均通过Sonoclot评估血小板功能。对无明显出血的患者（ITP-NB）进行为期6个月的每月随访，每次随访时评估血小板功能。本研究前瞻性纳入了80例患者（30例ITP-B和50例ITP-NB）。两组患者的中位年龄分别为37岁和30岁。ITP-B组和ITP-NB组的女男比例分别为4:1和1:1。ITP-B组和ITP-NB组的中位血小板计数分别为12000/μL（范围1000 - 19000/μL）和8000/μL（范围1000 - 19000/μL）。两组通过Sonoclot检测的平均血小板功能均低于正常临界值（>1.6）。然而，ITP-B组的平均血小板功能（0.2 + 0.17）显著低于ITP-NB组（1.2 ± 0.52）（p = 0.01）。在6个月的随访期内，Sonoclot检测血小板功能正常（>1.6）的ITP-NB患者发生具有临床意义的出血事件（1次）少于血小板功能低的患者（4次）。急性严重血小板减少症且有出血表型的患者，通过Sonoclot检测的血小板功能异常程度大于无出血表型的患者。这一信息可能有助于对急性ITP患者做出治疗决策。
