The association between haemorrhage and markers of endothelial insufficiency and inflammation in patients with hypoproliferative thrombocytopenia: a cohort study.

Autor: Ypma PF; Center for Clinical Transfusion Research, Sanquin, Leiden, the Netherlands.; Department of Hematology, Haga Ziekenhuis, Den Haag, the Netherlands., van Geloven N; Department of Biomedical Data Sciences, Section Medical Statistics, Leiden University Medical Center, Leiden, the Netherlands., Kerkhoffs JLH; Center for Clinical Transfusion Research, Sanquin, Leiden, the Netherlands.; Department of Hematology, Haga Ziekenhuis, Den Haag, the Netherlands., Te Boekhorst P; Department of Hematology, Erasmus Medical Center, Rotterdam, the Netherlands., Zwaginga JJ; Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, the Netherlands., Beckers EAM; Department of Hematology, Internal Medicine, Maastricht University Medical Center, Maastricht, the Netherlands., Brand A; Center for Clinical Transfusion Research, Sanquin, Leiden, the Netherlands., van der Meer PF; Center for Clinical Transfusion Research, Sanquin, Leiden, the Netherlands., Eikenboom JCJ; Department of Internal Medicine, Division of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands.
Jazyk: angličtina
Zdroj: British journal of haematology [Br J Haematol] 2020 Apr; Vol. 189 (1), pp. 171-181. Date of Electronic Publication: 2019 Nov 15.
DOI: 10.1111/bjh.16291
Abstrakt: In daily haematological practice, predicting bleeding in thrombocytopenic patients is difficult, and clinicians adhere to transfusion triggers to guide patients through the aplastic phase of chemotherapy. Platelet count is not the only determinant of bleeding and additional mechanisms for impending haemostasis are likely. Beside clot formation, platelets are essential for the maintenance of integrity of vascular beds. We therefore prospectively investigated associations between biomarkers for endothelial damage (urine albumin excretion) and inflammation (C-reactive protein) and bleeding (WHO grading) in 88 patients with 116 on-protocol episodes. We found an increase in grade 2 bleeding with a higher urine albumin/creatinine ratio one day after the measurement [odds ratio (OR) 1·24 for every doubling of the ratio, 95% CI 1·05-1·46, P-value 0·01] and a 29% increase in the odds of grade 2 bleeding for every doubling of serum C-reactive protein (CRP) (95% CI 1·04-1·60, P-value 0·02) after correction for morning platelet count. The 24 h post-transfusion corrected count increment (CCI 24 ) showed a significant association with these biomarkers: increasing urine albumin/creatinine ratio and CRP were associated with lower CCI 24. We report two inexpensive and easy-to-apply biomarkers that could be useful in designing a prediction model for bleeding risk in thrombocytopenic patients.
(© 2019 The Authors. British Journal of Haematology published by British Society for Haematology and John Wiley & Sons Ltd.)
Databáze: MEDLINE
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