A new approach to personalized assessment of functional platelet disorders in children with inherited thrombocytopenias by flow cytometry.

IF 1.2 4区 医学 Q4 HEMATOLOGY
Dmitrii Mikhailovich Polokhov, Anastasiya Alexandrovna Ignatova, Evgeniya Alexandrovna Ponomarenko, Irina Viktorovna Mersiyanova, Anna Leonidovna Khoreva, Aleksandr Vladimirovich Poletaev, Elena Vladislavovna Raykina, Galina Anatolievna Novichkova, Mikhail Aleksandrovich Panteleev, Pavel Aleksandrovich Zharkov
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引用次数: 0

Abstract

Inherited thrombocytopenias are variable in the count and size of platelets, which is related with the number of receptors and intracellular structure. So, the reference ranges do not allow interpretation of functional disorders, especially in macrothrombocytopenias and microthrombocytopenias. The flow cytometry diagnostic approach to use the reference values is necessary. Seventy-five pediatric patients were divided into three groups by platelet size: 25 with normothrombocytopenia ( RUNX1, ANKRD26, ETV6 , and CYCS ), 25 with microthrombocytopenia ( WAS ), 25 with macrothrombocytopenia ( MYH9, TUBB1, SLFN14 , and BSS ). Platelet size, granularity, GPIb/V/IX, GPIIb/IIIa, granules, and procoagulant platelets were analyzed at rest and after activation by a mixture of TRAP+CRP. In addition to the absolute value indicators, a calculated 'index at rest/after activation' in relative units was introduced for personalized changes assessment. The hemorrhage was assessed using a Pediatric Bleeding Questionnaire. The control consisted of 40 children. The bleeding score ranged from 0 to 20 (median of 2). Upon activation, in all groups, weakening in platelet size contraction and procoagulant platelet formation ( P  ≤ 0.02) were observed. In normothrombocytopenia and microthrombocytopenia groups, increased granularity upon activation, attenuation of CD42b shedding/internalization, correlation ( r  ≥ -0.65) between a decrease of procoagulant platelets less than 5% and increase of bleeding were found. Additionally, reduction of δ-granules ( P  ≤ 0.01) in normothrombocytopenias, attenuation of externalization and activation of GP IIb/III, and granules release ( P  ≤ 0.001) in the microthrombocytopenia were detected. The use of 'activation indexes' in relative units allowed to identify and characterize morphofunctional abnormality patterns in different platelet size thrombocytopenia groups and interpreted control values for detecting personalized patient disorders regardless of platelet size.

用流式细胞术对遗传性血小板减少症患儿功能性血小板障碍进行个性化评估的新方法
遗传性血小板减少症的血小板数量和大小是可变的,这与受体的数量和细胞内结构有关。因此,参考范围不允许解释功能障碍,特别是在大血小板减少症和小血小板减少症中。流式细胞术诊断方法中使用参考值是必要的。75例儿童患者按血小板大小分为三组:正常血小板减少25例(RUNX1、ANKRD26、ETV6和CYCS),微血小板减少25例(WAS),巨血小板减少25例(MYH9、TUBB1、SLFN14和BSS)。静息状态和TRAP+CRP混合活化后,分析血小板大小、粒度、GPIb/V/IX、GPIIb/IIIa、颗粒和促凝血小板。除了绝对值指标外,还引入了相对单位计算的“静止/激活后指数”,用于个性化变化评估。使用儿科出血问卷对出血进行评估。对照组包括40名儿童。出血评分范围从0到20(中位数为2)。激活后,各组血小板大小收缩减弱,促凝血小板形成减弱(P≤0.02)。在正常血小板减少组和微血小板减少组,活化后颗粒增加,CD42b脱落/内化减弱,促凝血小板减少小于5%与出血增加之间存在相关性(r≥-0.65)。正常血小板减少时δ-颗粒减少(P≤0.01),微量血小板减少时GP IIb/III外化和活化减弱(P≤0.001)。在相对单位中使用“激活指数”可以识别和表征不同血小板大小的血小板减少症组的形态功能异常模式,并解释了检测个性化患者疾病的控制值,而不管血小板大小如何。
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来源期刊
CiteScore
1.90
自引率
0.00%
发文量
111
审稿时长
4-8 weeks
期刊介绍: Blood Coagulation & Fibrinolysis is an international fully refereed journal that features review and original research articles on all clinical, laboratory and experimental aspects of haemostasis and thrombosis. The journal is devoted to publishing significant developments worldwide in the field of blood coagulation, fibrinolysis, thrombosis, platelets and the kininogen-kinin system, as well as dealing with those aspects of blood rheology relevant to haemostasis and the effects of drugs on haemostatic components
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