Walsh P N, Murphy S, Barry W E
Thromb Haemost. 1977 Dec 15;38(4):1085-96.
Some patients with thrombocytosis due to myeloproliferative diseases or other etiologies experience thromboembolic complications and others may bleed excessively. It seems unlikely that elevations in platelet count per se are a direct cause either of thrombosis or of hemorrhage. In an effort to ascertain whether variations in platelet function might determine whether an individual patient experiences thrombotic or hemorrhagic complications we have evaluated platelet function in 22 patients with thrombocytosis due to a variety of etiologies. The results of platelet counts, bleeding time determinations, and studies of platelet aggregation were similar in patients with thrombosis, in patients with bleeding and in patients with neither complication. Therefore, detailed studies of platelet coagulant activities were carried out in 8 patients. The results of platelet coagulant activity assays were normal in all 3 patients with thrombocytosis and neither thrombotic nor bleeding complications and an additional 3 patients with myeloproliferative diseases, normal platelet counts and no thrombohemorrhagic complications. In 2 patients with thrombotic complications significant elevation of platelet coagulant activities concerned with the early phases of intrinsic coagulation were observed whereas in 2 patients with severe hemorrhagic complications deficiencies of either contact forming activity or collagen-induced coagulant activities were evident. This preliminary study suggests the possibility that variations in platelet coagulant activities concerned with the early stages of intrinsic coagulation may determine whether patients with thrombocytosis will experience bleeding or thrombotic complications.
一些因骨髓增殖性疾病或其他病因导致血小板增多的患者会出现血栓栓塞并发症，而其他患者可能会有过度出血的情况。血小板计数升高本身似乎不太可能直接导致血栓形成或出血。为了确定血小板功能的变化是否可能决定个体患者是否会出现血栓形成或出血并发症，我们评估了22例因各种病因导致血小板增多的患者的血小板功能。血栓形成患者、出血患者和无并发症患者的血小板计数、出血时间测定以及血小板聚集研究结果相似。因此，我们对8例患者进行了血小板凝血活性的详细研究。在所有3例血小板增多且无血栓形成或出血并发症的患者以及另外3例患有骨髓增殖性疾病、血小板计数正常且无血栓出血并发症的患者中，血小板凝血活性测定结果均正常。在2例有血栓形成并发症的患者中，观察到与内源性凝血早期相关的血小板凝血活性显著升高，而在2例有严重出血并发症的患者中，接触形成活性或胶原诱导的凝血活性明显缺乏。这项初步研究表明，与内源性凝血早期相关的血小板凝血活性变化可能决定血小板增多症患者是否会出现出血或血栓形成并发症。
