Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK.
NIHR Surgical Reconstruction and Microbiology Research Centre, University Hospitals Birmingham Foundation Trust, Birmingham, UK.
Platelets. 2024 Dec;35(1):2420952. doi: 10.1080/09537104.2024.2420952. Epub 2024 Nov 4.
Severe thermal injury significantly impacts upon hemostasis and is associated with classical changes to the circulating platelet count with a nadir followed by a rebound thrombocytosis at days ~3 and ~15 post-injury, respectively. To date, few studies have assessed platelet function following thermal injury as platelet tests often require large quantities of blood, are not representative of normal platelet pathophysiology, and are usually dependent on a normal platelet count. The purpose of this study was to measure platelet thrombus formation using a whole blood flow chip-based system following thermal injury and to study how platelet counts may impact upon the measurement. Adult (≥16 years) patients ( = 10) with ≥ 20% total burn surface area (TBSA) burn were recruited within 24 h of injury. Healthy controls ( = 25) were also recruited. Whole blood counts were measured using a hematology analyzer (Sysmex XN-1000). Platelet function was measured using the Total Thrombus-formation Analyzer System (T-TAS) within chips coated with tissue factor and collagen at shear rates of either 600 sec (AR chips) or 1200 sec (HD chips), the latter test being independent of platelet count. We confirmed the classical nadir in platelet counts following severe thermal injury at days 2, 3, 4 ( < 0.0001) and day 5 ( < 0.01) post-injury compared to healthy controls. Physiological platelet thrombus formation was significantly ( < 0.01) abnormal at day 3 post-injury using the AR chips but was related to the platelet count. However, although platelet dysfunction was not significant using HD chips, some of the results were independent of platelet count. A small number of samples, however, still gave abnormal results suggesting that there can be an underlying acquired platelet functional abnormality. Furthermore, the AR chip Area Under the Curve (AUC) was significantly lower on day 1 post-injury and negatively associated with severity of injury (TBSA, < 0.05) and higher platelet function (AUC) positively associated with survival ( < 0.05). This study suggests that measuring platelet dysfunction within a more physiological test may have potential clinical utility. Larger studies are required to fully understand the impact of platelet dysfunction following severe thermal injury.
严重的热损伤会显著影响止血功能，并与循环血小板计数的经典变化相关，分别在损伤后第 3 天和第 15 天达到最低点，随后出现反弹性血小板增多症。迄今为止，很少有研究评估热损伤后的血小板功能，因为血小板检测通常需要大量血液，不能代表正常的血小板病理生理学，并且通常依赖于正常的血小板计数。本研究的目的是使用基于全血流动芯片的系统测量热损伤后的血小板血栓形成，并研究血小板计数如何影响测量结果。在损伤后 24 小时内招募了 10 名成人（≥16 岁）烧伤面积≥20%总表面积（TBSA）的患者（ = 10），还招募了 25 名健康对照者（ = 25）。使用血液学分析仪（Sysmex XN-1000）测量全血计数。使用总血栓形成分析仪系统（T-TAS）在涂有组织因子和胶原的芯片中测量血小板功能，在剪切率为 600 sec（AR 芯片）或 1200 sec（HD 芯片）下进行测试，后者的测试与血小板计数无关。我们确认了严重热损伤后血小板计数的经典最低点，在损伤后第 2、3、4 天（ < 0.0001）和第 5 天（ < 0.01）与健康对照组相比。使用 AR 芯片，在损伤后第 3 天，生理血小板血栓形成明显异常（ < 0.01），但与血小板计数有关。然而，尽管使用 HD 芯片血小板功能障碍不显著，但部分结果与血小板计数无关。然而，由于一些样本存在异常结果，这表明可能存在获得性血小板功能异常。此外，AR 芯片的曲线下面积（AUC）在损伤后第 1 天显著降低，与损伤严重程度（TBSA， < 0.05）呈负相关，与较高的血小板功能（AUC）呈正相关，与存活率相关（ < 0.05）。这项研究表明，在更生理的测试中测量血小板功能障碍可能具有潜在的临床应用价值。需要更大的研究来全面了解严重热损伤后血小板功能障碍的影响。
