TY - JOUR
T1 - A novel approach using ancillary tests to guide treatment of Glanzmann thrombasthenia patients undergoing surgical procedures
AU - Barg, Assaf Arie
AU - Hauschner, Hagit
AU - Misgav, Mudi
AU - Lubetsky, Aaron
AU - Levy-Mendelowitz, Sarina
AU - Livnat, Tami
AU - Avishai, Einat
AU - Rosenberg, Nurit
AU - Kenet, Gili
N1 - Publisher Copyright:
© 2018 Elsevier Inc.
PY - 2018/9
Y1 - 2018/9
N2 - Background: Glanzmann thrombasthenia (GT) is a disorder of platelet function. Standard therapy includes platelet transfusions, which may be hampered by antiplatelet antibodies. Aims: To assess potential correlation between bleeding and number of active platelets in GT patients undergoing surgery. Clinical peri- operative patients' hemostasis was compared with flow cytometry analysis (FC), and whole blood clot formation. Methods: GT patients undergoing surgery were included. Blood counts, platelet activation studies, FC and rotational thromboelastography (ROTEM) were performed as ancillary tests to estimate the effectiveness of treatment. Results: A total of 4 GT patients undergoing 5 surgeries were included. Consecutive FC analysis following platelet transfusions showed gradual decrease of donor platelets with a nadir of 3280 platelets in patients who experienced no post procedural bleeding following minor procedures. After major surgery, bleeding occurred when donor platelets decreased to 2600–4280. Decline in donor platelets was associated with reduced clot firmness as noted by ROTEM. Conclusion: Results suggest that very low number of active donor platelets may suffice to achieve proper hemostasis in certain procedures. Our study points to the potential role of consecutive FC examinations to demonstrate the number of donor platelets as an ancillary tool for decision making in GT patients undergoing surgery.
AB - Background: Glanzmann thrombasthenia (GT) is a disorder of platelet function. Standard therapy includes platelet transfusions, which may be hampered by antiplatelet antibodies. Aims: To assess potential correlation between bleeding and number of active platelets in GT patients undergoing surgery. Clinical peri- operative patients' hemostasis was compared with flow cytometry analysis (FC), and whole blood clot formation. Methods: GT patients undergoing surgery were included. Blood counts, platelet activation studies, FC and rotational thromboelastography (ROTEM) were performed as ancillary tests to estimate the effectiveness of treatment. Results: A total of 4 GT patients undergoing 5 surgeries were included. Consecutive FC analysis following platelet transfusions showed gradual decrease of donor platelets with a nadir of 3280 platelets in patients who experienced no post procedural bleeding following minor procedures. After major surgery, bleeding occurred when donor platelets decreased to 2600–4280. Decline in donor platelets was associated with reduced clot firmness as noted by ROTEM. Conclusion: Results suggest that very low number of active donor platelets may suffice to achieve proper hemostasis in certain procedures. Our study points to the potential role of consecutive FC examinations to demonstrate the number of donor platelets as an ancillary tool for decision making in GT patients undergoing surgery.
KW - Flow cytometry
KW - Glanzmann thrombasthenia
KW - Platelet transfusion
KW - Surgery
UR - http://www.scopus.com/inward/record.url?scp=85050871450&partnerID=8YFLogxK
U2 - 10.1016/j.bcmd.2018.07.003
DO - 10.1016/j.bcmd.2018.07.003
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C2 - 30078718
AN - SCOPUS:85050871450
SN - 1079-9796
VL - 72
SP - 44
EP - 48
JO - Blood Cells, Molecules, and Diseases
JF - Blood Cells, Molecules, and Diseases
ER -