Dale G L, Alberio L
Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City 73190, USA.
Lancet. 1998 Aug 15;352(9127):566-7. doi: 10.1016/S0140-6736(97)11506-9.
Children with sickle-cell anaemia are predisposed to thrombotic strokes, the aetiology of which is unclear. We propose that erythropoietin, produced in response to chronic anaemia, is responsible for changes in platelet reactivity with a resulting increase in thromboses. This hypothesis is based on reports of enhanced aggregability of erythropoietin-driven platelets and an increased rate of thrombosis in patients receiving large doses of recombinant erythropoietin. Experiments in animals have shown that erythropoietin stimulates synthesis of platelets, that erythropoietin-driven platelets are hyper-reactive compared with age-matched control platelets, and that erythropoietin is pro-thrombotic. These data suggest that erythropoietin-dependent changes in platelet reactivity may potentiate thrombosis in sickle-cell anaemia, particularly in children who, compared with adults, have markedly higher erythropoietin concentrations and incidence of strokes.
患有镰状细胞贫血的儿童易患血栓性中风，其病因尚不清楚。我们提出，慢性贫血所产生的促红细胞生成素会导致血小板反应性发生变化，从而增加血栓形成。这一假设基于以下报道：促红细胞生成素驱动的血小板聚集性增强，以及接受大剂量重组促红细胞生成素的患者血栓形成率增加。动物实验表明，促红细胞生成素会刺激血小板的合成，与年龄匹配的对照血小板相比，促红细胞生成素驱动的血小板反应性更高，且促红细胞生成素具有促血栓形成作用。这些数据表明，血小板反应性的促红细胞生成素依赖性变化可能会增强镰状细胞贫血中的血栓形成，尤其是在儿童中，与成人相比，儿童的促红细胞生成素浓度和中风发生率明显更高。
