Stiegler G, Stohlawetz P, Peck-Radosavljevic M, Jilma B, Pidlich J, Wichlas M, Höcker P, Panzer S
Clinic for Blood Group Serology and Transfusion Medicine, University of Vienna, Austria.
Eur J Clin Invest. 1998 Sep;28(9):755-9. doi: 10.1046/j.1365-2362.1998.00348.x.
In advanced liver cirrhosis, thrombocytopenia results from 'hypersplenism' due to increased platelet sequestration and platelet 'pooling' in the enlarged spleen and/or from reduced platelet production in the bone marrow. We sought to differentiate between these two mechanisms by studying thrombopoiesis before and after orthotopic liver transplantation by the determination of reticulated platelets, direct indicators for the thrombopoietic activity in the bone marrow.
Reticulated platelets, peripheral platelet counts, mean platelet volumes and platelet-reactive antibodies were determined in 15 patients suffering from advanced liver cirrhosis before and during an observation period of 14 days after orthotopic liver transplantation (OLT). Thrombopoietin levels of ten patients were determined before transplantation and consecutively for 14 days after surgery.
All patients except one were thrombocytopenic before transplantation (median count 94 x 10(9) L-1, range 69-114 x 10(9) L-1). Although levels of reticulated platelets rose 2 days after surgery from baseline values of 1.0% (range 0.2-1.6%) to peak values of 4.6% (range 1.7-17.9%, P < 0.05) on day 6, platelet counts declined during the first 5 days after transplantation. When peripheral platelet counts increased to the normal range (median day 11, range day 8-33), reticulated platelets were again at pretransplant levels. Thrombopoietin levels before OLT were within the normal range (< 85 pg mL-1). On day 5 post surgery, a maximum increase of 5.8-fold (range 2.2- to 28-fold) over baseline values was observed. Mean platelet volume did not show any significant deviation from the baseline values and platelet antibodies could not be detected during the observation period.
Our findings provide direct evidence for an increase in de novo platelet production after orthotopic liver transplantation. As the elevation of reticulated platelets precedes platelet recovery, it could serve as an early indicator to predict thrombopoiesis as a result of reconstituted liver function.
在晚期肝硬化中，血小板减少是由于脾肿大导致血小板隔离增加和血小板“池化”引起的“脾功能亢进”，和/或骨髓中血小板生成减少。我们试图通过原位肝移植前后研究血小板生成情况来区分这两种机制，方法是测定网织血小板，它是骨髓中血小板生成活性的直接指标。
对15例晚期肝硬化患者在原位肝移植（OLT）前及术后14天观察期内测定网织血小板、外周血小板计数、平均血小板体积和血小板反应性抗体。测定了10例患者移植前及术后连续14天的血小板生成素水平。
除1例患者外，所有患者移植前均有血小板减少（中位数计数94×10⁹/L，范围69 - 114×10⁹/L）。虽然网织血小板水平在术后2天从基线值1.0%（范围0.2 - 1.6%）上升到第6天的峰值4.6%（范围1.7 - 17.9%，P < 0.05），但移植后前5天血小板计数下降。当外周血小板计数增加到正常范围（中位数第11天，范围第8 - 33天）时，网织血小板再次处于移植前水平。OLT前血小板生成素水平在正常范围内（< 85 pg/mL）。术后第5天，观察到比基线值最大增加5.8倍（范围2.2 - 28倍）。平均血小板体积与基线值无显著差异，观察期内未检测到血小板抗体。
我们的研究结果为原位肝移植后新生血小板生成增加提供了直接证据。由于网织血小板升高先于血小板恢复出现，它可作为预测肝功能恢复导致血小板生成的早期指标。
