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Our results do not support any effect of FVIII on platelet function in patients with severe HA treated under the regime of prophylaxis.

Objectives: The most common disease of anus is hemorrhoids. The definition of external hemorrhoids suggests the acute phase, often characterized by thrombosis or edema. External thrombosed hemorrhoid is a specific complication. In this study, we aimed to investigate the effects of different platelet parameters in the presence of internal or external thrombosed hemorrhoids. Methods: Patients examined were divided into two groups: Group 1: Thrombosed hemorrhoids group (THG), Group 2: Hemorrhoidectomy group (HG). Demographic and clinical data were identified. In terms of laboratory findings, preoperative hemoglobin, hematocrit and all platelet parameters were recorded. Main results: Fifty-two patients in THG, and 75 patients in HG were included in the study. In female sex and young age group, the risk of developing thrombosed hemorrhoids was statistically significant (p= 0.029, p= 0.039, respectively). When the platelet parameters were evaluated; while PDW was higher in THG (p= 0.008), any significant difference could not found in all other values (p> 0.05). Thrombosed hemorrhoids were mostly (59.25%) found to be located in the left laterodorsal part of anus. Conclusion: Internal hemorrhoids are frequently seen in the ages of 45–65 with similar rates in both sexes, while external thrombosed hemorrhoids occur at a younger age ( 0,05). A maioria das hemorróidas trombosadas (59,25%) localizava-se na região lateral-dorsal esquerda do ânus. Conclusão: As hemorróidas internas são frequentemente vistas nas idades de 45 a 65 anos com taxas semelhantes em ambos os sexos, enquanto as hemorróidas externas trombosadas ocorrem em uma idade mais jovem (

SUMMARY BACKGROUND Easily accessible, inexpensive, and widely used laboratory tests that demonstrate the severity of COVID-19 are important. Therefore, in this study, we aimed to investigate the relationship between mortality in COVID-19 and platelet count, Mean Platelet Volume (MPV), and platelet distribution width. METHODS In total, 215 COVID-19 patients were included in this study. The patients were divided into two groups. Patients with room air oxygen saturation < 90% were considered as severe COVID-19, and patients with ≥90% were considered moderate COVID-19. Patient medical records and the electronic patient data monitoring system were examined retrospectively. Analyses were performed using the SPSS statistical software. A p-value

Introduction: Although primary immune thrombocytopenia (ITP) is rare in childhood, it is the most frequent cause of thrombocytopenia. There have been attempts to establish risk factors to predict the progression of the disease in order to optimise its management, which has changed in recent years due to, among other reasons, specialised care. Material and methods: A retrospective, observational and analytical study was conducted on patients diagnosed with ITP over a 3-year period in a Paediatric Haematology specialist clinic. Results: From the epidemiological, clinical and analytical point of view, the characteristics of this group are similar to others. Most of the patients (23/31, 74.2 %) had ITP for less than 12 months, with there being no serious complications related to the disease or the treatment received. It was established that risk factors were related to being slowly evolving (lower event-free survival (EFS)) with no statistical significance, female gender, age over 10 years, leukopenia absence of initial severe thrombocytopenia, and non-specialised care. The absence of a history of infection was significantly related to a lower EFS. Conclusions: The epidemiological and analytical risk factors for a slowly evolving ITP are the same that described in the literature. Patients treated before the beginning of specialised care also had a lower EFS. These data seem to support the current recommendation that rare diseases should be managed in specialised units. Resumen: Introducción: La trombopenia inmune primaria (PTI) es poco frecuente en la infancia, pero es la causa más habitual de trombopenia. Se han intentado establecer factores de riesgo para predecir su evolución, con el objetivo de poder optimizar su manejo, que se ha modificado en los últimos años, debido entre otros factores, a una atención más especializada. Material y métodos: Estudio retrospectivo, observacional y analítico de los pacientes con PTI, en un periodo de 3 años, en una consulta especializada en Hematología Pediátrica. Resultados: Desde el punto de vista epidemiológico, clínico y analítico, las características de esta serie son similares a las de otros grupos. La mayoría de los pacientes (23/31; 74.2 %) presentaron una PTI de duración menor de 12 meses, sin complicaciones graves relacionadas con la enfermedad ni con el tratamiento. Se establecieron como factores de riesgo relacionados con una evolución tórpida (supervivencia libre de eventos (SLE) menor), sin alcanzar la significación estadística, el sexo femenino, la edad mayor de 10 años, la leucopenia, la ausencia de trombopenia grave inicial y la atención no especializada. La ausencia de antecedente de infección se relacionó significativamente con una SLE menor. Conclusiones: Los factores de riesgo de evolución tórpida de PTI epidemiológicos y analíticos de este estudio coinciden con los descritos en la literatura. Presentaron una SLE menor los pacientes tratados antes del inicio de la atención especializada. Estos datos parecen apoyar la recomendación actual de que las enfermedades poco frecuentes, como ésta, se controlen en unidades especializadas.

Aim: The use of recombinant human platelet-derived growth factor–BB (rhPDGF) has received Food and Drug Administration approval for the treatment of periodontal and orthopedic bone defects and dermal wound healing. Many studies have investigated its regenerative potential in a variety of other oral clinical indications. The aim of this systematic review was to assess the efficacy, safety, and clinical benefit of recombinant human platelet-derived growth factor (rhPDGF) use for alveolar bone and/or soft tissue regeneration. Material and Methods: Comprehensive electronic and manual literature searches according to the PRISMA guidelines were performed to identify interventional and observational studies evaluating the regenerative applications of rhPDGF-BB. The primary outcomes were the safety, efficacy, and overall clinical benefit of rhPDGF use in oral regenerative procedures. Results: Sixty-three human clinical studies (mean ± SD follow-up period of 10.7 ± 3.3 mo) were included in the qualitative analysis. No serious adverse effects were reported in any of the 63 studies, aside from the postoperative complications routinely associated with surgical therapy. Use of rhPDGF was shown to be beneficial when combined with allografts, xenografts, and alloplasts (the latter tricalcium phosphate [β-TCP]) for the treatment of periodontal defects and gingival recession. The use of rhPDGF also led to favorable clinical outcomes when combined with allografts or xenografts for guided bone regeneration (GBR) and alveolar ridge preservation. While favorable clinical results support the use of the combination of rhPDGF plus allograft or xenograft for GBR, ARP, and sinus floor augmentation, current data support the use of rhPDGF and alloplasts (e.g., β-TCP) only in periodontal defects and gingival recession. Conclusions: Based on the clinical evidence, rhPDGF is safe and provides clinical benefits when used in combination with bone allografts, xenograft, or β-TCP for the treatment of intrabony and furcation periodontal defects and gingival recession or when used with allografts or xenograft for GBR and ARP (PROSPERO CRD42020142446). Knowledge Transfer Statement: Clinicians should be aware that rhPDGF is a safe and effective approach for the treatment of intrabony and furcation periodontal defects and gingival recession or when used with allografts or xenograft for bone regeneration and alveolar ridge preservation. With consideration of cost and patient preference, this result could lead to more appropriate therapeutic decisions.

SUMMARY OBJECTIVE: Patients in intensive care units (ICU) have greater morbidity and mortality. We aimed to study neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) in the ICU population. METHODS: Medical and laboratory data of patients treated in ICU were retrospectively analyzed. Patients were divided into deceased and survived groups. RESULTS: The NLR of survived and deceased groups were 3.6 (0.2-31) and 9.5 (1-40), respectively (p

Introduction:Anabolic-androgenic steroids (AAS) modify the physiological functioning of the cardiovascular system and have possible effects on the origin of cardiovascular thrombosis.Objective:To determine the impact of the testosterone metabolite on platelet quantification in ORX rats with or without DHT replacement.Material and methods:24 male 45-day-old Wistar rats underwent orchidectomy with a simple scrotal incision. At 2.5 months of age, the 24 rats were divided into 4 study groups. Half of the 12 male ORX rats received hormone replacement with dihydrotestosterone propionate (DHT) at a 2 mg/kg dose via subcutaneous injection for 7 days and the other half received a physiological solution (0.9% NaCl). The same occurred in the 12 non-ORX males (SHAM). After 7 days of the administration, blood was collected by orbital puncture, and platelet quantification was performed.Results:A significant difference (ANOVA, p < 0.005) was found between the 4 groups. When performing the Dunn Method, a significant difference (p < 0.05) was found in the endogenous administration of DHT between Sham rats and rats ORX + 0.9% NaCl but not with ORX + DHT.Conclusions:DHT induces an increase in platelet quantification inrats Sham and not in ORX rats with DHT, which may affect the increase in platelet quantification. Introducción:Los esteroides androgénicos anabólicos (EAA) modifican el funcionamiento fisiológico del sistema cardiovascular y tienen posibles efectos en el origen de trombosis cardiovascular.Objetivo:Determinar el efecto del metabolito de la testosterona en la cuantificación de plaquetas en ratas ORX con o sin reemplazo de DHT.Material y métodos:24 ratas macho wistar de 45 días de edad fueron sometidas a orquidectomía con una incisión simple escrotal. A los 2 meses y medio de edad, las 24 ratas fueron divididas en 4 grupos de estudio. De las 12 ratas macho ORX, la mitad recibió reemplazo hormonal con propionato de dihidrotestosterona (DHT) a dosis de 2 mg / kg a través de una inyección subcutánea durante 7 días y la otra mitad recibió solución fisiológica (0.9% NaCl). De la misma manera ocurrió en los 12 machos no ORX (SHAM). Después de 7 días de administración, se extrajo sangre mediante punción orbital y se realizó la cuantificación de plaquetas.Resultados:Se encontró una diferencia significativa (ANOVA, p < 0.005) entre los 4 grupos. Al realizar el Método Dunn, se encontró una diferencia significativa (p < 0.05) en la administración endógena de DHT entre ratas Sham y ratas ORX + NaCl al 0.9% pero no con ORX + DHT.Conclusiones:DHT induce un aumento en la cuantificación de plaquetas en ratas Sham y no en ratas ORX con DHT, lo que puede afectar el aumento en la cuantificación de plaquetas.

We thank Pablo Lardelli Claret for his helpful advice in statistical methods. We also acknowledge the staff of Hospital Universitario Virgen de las Nieves who took (and are taking) care of the COVID-19 patients., Tocilizumab (TCZ) has been administered in SARS-CoV-2 pneumonia but the factors associated with mortality before and after treatment remain unclear. Cox regression models were used to estimate the predictors of time to death in a cohort of hospitalized patients with COVID-19 receiving TCZ. In addition, the mean differences between discharged and deceased patients in laboratory parameters measured before and 3, 6 and 9 days after TCZ administration were estimated with weighted generalized estimation equations. The variables associated with time to death were immunosuppression (Hazard Ratio-HR 3.15; 95% confidence interval-CI 1.17, 8.51), diabetes mellitus (HR 2.63; 95% CI 1.23–5.64), age (HR 1.05; 95% CI 1.02–1.09), days since diagnosis until TCZ administration (HR 1.05, 95% CI 1.00–1.09), and platelets (HR 0.27; 95% CI: 0.11, 0.69). In the post-TCZ analysis and compared to discharged patients, deceased patients had more lactate dehydrogenase (p 0.013), troponin I (p 0.013), C-reactive protein (p 0.013), neutrophils (p 0.024), and fewer platelets (p 0.013) and lymphocytes (p 0.013) as well as a lower average PaO2/FiO2 ratio. In conclusion, in COVID-19 diagnosed patients receiving TCZ, early treatment decreased the risk of death, while age, some comorbidities and baseline lower platelet counts increased that risk. After TCZ administration, lower platelet levels were again associated with mortality, together with other laboratory parameters.

The high prevalence of exercise-induced pulmonary hemorrhage (EIPH) in athletic horses constitutes to be a challenge to the racing industry and a source of major concern to animal welfare. Both experimental and clinical evidence indicate that the use of autologous platelet-rich plasma (PRP) is a promising effector of repair in a variety of pulmonary conditions. The present study evaluated the effect of intrabronchial instillation of PRP on EIPH endoscopic scores from 37 Thoroughbred racehorses. Inclusion criteria were for animals to be EIPH-positive in, at least, two consecutive post-exercise endoscopic exams and to receive 250mg of furosemide IV four hours before racing. Animals were randomly assigned into 3 groups: placebo, control, and PRP instillation. All 37 Thoroughbred racehorses included had EIPH endoscopic scores pre- and post- treatment compared by statistical analysis. The bleeding score from the group receiving PRP was significantly lower than in the control and placebo groups. No adverse effects were observed in any animal during or after the experiment. It was possible to conclude that the intrabronchial instillation of autologous PRP was effective in reducing EIPH scores in racehorses receiving furosemide and that this bioproduct can be considered as a promising coadjuvant in controlling EIPH in athletic horses. RESUMO A alta prevalência de hemorragia pulmonar induzida por exercício (HPIE) em cavalos atletas é um desafio de longa data para a indústria de corridas, além de figurar como grande preocupação sobre o bem-estar animal. As evidências experimentais e clínicas indicam que o uso do plasma rico em plaquetas (PRP) de fonte autógena é promissor na terapêutica de diversas lesões pulmonares. O presente estudo objetivou avaliar as mudanças após corrida no escore endoscópico de HPIE de 37 cavalos Puro-Sangue Inglês que receberam instilação intrabronquial de PRP autólogo. Os animais selecionados eram HPIE-positivos em, ao menos, dois exames endoscópicos consecutivos e recebiam 250mg de furosemida IV administrado quatro horas antes de cada corrida. Na comparação dos escores endoscópicos pré e pós-tratamento, verificou-se que o escore de HPIE do grupo tratado com PRP foi significantemente menor que o dos grupos controle e placebo. Nenhum efeito adverso foi observado nos animais durante ou após o experimento. Concluiu-se que a instilação intrabronquial de PRP autólogo foi efetiva na redução do escore de HPIE de cavalos de corrida usuários de furosemida e que este bioproduto pode ser considerado uma alternativa promissora no controle de HPIE em cavalos atletas.

Simple Summary Liquid biopsy is a noninvasive approach that provides tumor molecular profiling. On the other hand, the vast majority of pancreatic tumors are pancreatic ductal adenocarcinomas (PDAC), which are characterized by pronounced inflammation. Therefore, we hypothesized that the combination of biomarkers of systemic inflammation, such as the neutrophil-to-lymphocyte-ratio (NLR) and platelet-to-lymphocyte ratio (PLR), with liquid biopsy-based biomarkers may increase their clinical usefulness. Our study shows that combining NLR, PLR, and the standard PDAC marker CA19-9 with circulating cell-free DNA and circulating RAS-mutated DNA outperforms traditional clinical tools for the clinical management of metastatic PDAC patients. Abstract Pancreatic ductal adenocarcinoma (PDAC) is an aggressive cancer with a highly inflammatory microenvironment and liquid biopsy has emerged as a promising tool for the noninvasive analysis of this tumor. In this study, plasma was obtained from 58 metastatic PDAC patients, and neutrophil–lymphocyte ratio (NLR), platelet–lymphocyte ratio (PLR), circulating cell-free DNA (cfDNA) concentration, and circulating RAS mutation were determined. We found that NLR was significantly associated with both overall survival (OS) and progression-free survival. Remarkably, NLR was an independent risk factor for poor OS. Moreover, NLR and PLR positively correlated, and combination of both inflammatory markers significantly improved the prognostic stratification of metastatic PDAC patients. NLR also showed a positive correlation with cfDNA levels and RAS mutant allelic fraction (MAF). Besides, we found that neutrophil activation contributed to cfDNA content in the plasma of metastatic PDAC patients. Finally, a multi-parameter prognosis model was designed by combining NLR, PLR, cfDNA levels, RAS mutation, RAS MAF, and CA19-9, which performs as a promising tool to predict the prognosis of metastatic PDAC patients. In conclusion, our study supports the idea that the use of systemic inflammatory markers along with circulating tumor-specific markers may constitute a valuable tool for the clinical management of metastatic PDAC patients.

Background: Multiple infections, nutrient deficiencies and inflammation (MINDI) occur in indigenous communities, but their associations with perinatal outcomes have not been described. Objective: To assess maternal and cord blood micronutrient and inflammation status in peripartum mothers from the Ngäbe-Buglé comarca in Panama, and their associations with placental and infant outcomes. Methods: In 34 mother-newborn dyads, placental weight and diameter were measured, and maternal and cord blood were processed for complete cell counts, serum C-reactive protein, ferritin, serum transferrin receptor (sTfR), vitamins A and D. Blood volumes were calculated using Nadler’s formula. Results: Mothers had low plasma volume (40%, 17.6%) and inflammation (C-reactive protein >8.1 mg/L, 85.3%). Birthweights were normal, but low placental weight (35.3%), low head circumference Z-scores (17.6%), and low cord hemoglobin (5.9%), iron (79.4%), vitamin A (14.7%) and vitamin D (82.3%) were identified. Maternal and cord vitamin D were highly correlated. Higher maternal plasma volume was associated with heavier placentae (β= 0.57), and higher cord D (β= 0.43) and eosinophils (β= 0.43) with larger placentae. Hemoconcentration (higher cord hematocrit) was associated with lower newborn weight (β= -0.48) and head circumference (β= -0.56). Inflammation [higher maternal neutrophils (β= -0.50), and cord platelets (β= -0.32)] was associated with lower newborn length and head circumference. Conclusion: Maternal-newborn hemoconcentration, subclinical inflammation and multiple nutrient deficiencies, particularly neonatal vitamin D deficiency, were identified as potential targets for interventions to improve pregnancy outcomes in vulnerable communities. Resumen Antecedentes: Las Múltiples Infecciones, Nutrición Deficiente e Inflamación (MINDI), son frecuentes en comunidades indígenas, sin embargo, sus asociaciones con resultados de salud perinatales no han sido descritos. Objetivo: Evaluar la inflamación y los micronutrientes en sangre materna y de cordón de madres en trabajo de parto en la comarca Ngäbe-Buglé en Panamá, así como sus asociaciones con medidas placentarias y del recién nacido. Métodos: En 34 pares madre-recién nacido, se midieron peso y diámetro placentario, y se analizaron muestras de sangre materna y de cordón umbilical para hemograma completo, proteína-C reactiva (PCR), ferritina, receptor sérico de transferrina (RsTf), vitaminas A y D. Se usó la fórmula de Nadler para calcular volúmenes sanguíneos. Resultados: Las madres presentaron volumen plasmático (40% y 85.3% presentaron inflamación (PCR >8.1 mg/L). Los pesos al nacer fueron normales, pero se identificó bajo peso placentario (35.3%), bajo puntaje-z de circunferencia cefálica neonatal, y en sangre de cordón, bajos hemoglobina (5.9%), hierro (79.4%), vitamina A (14.7%) y vitamina D (82.3%). Se encontró una fuerte correlación positiva entre la vitamina D materna y de sangre de cordón. Un mayor volumen plasmático materno se asoció con placentas de mayor peso (β= 0.57), en tanto que concentraciones más altas de vitamina D (β= 0.43) y mayor número de eosinófilos (β= 0.43) se asociaron con mayor diámetro placentario. Una mayor hemoconcentración (hematocrito en cordón más alto) se asoció con menores peso al nacer (β= -0.48) y circunferencia cefálica (β= -0.56). La inflamación [mayor número de neutrófilos maternos (β= -0.50) y plaquetas en sangre de cordón (β= -0.32)] se asoció con menor talla y circunferencia cefálica neonatales. Conclusión: La hemoconcentración materna y del recién nacido, la inflamación subclínica y las múltiples deficiencias en micronutrientes, particularmente la deficiencia de vitamina D neonatal, se identificaron como potenciales áreas de intervención para mejorar los resultados de salud del embarazo en comunidades vulnerables.

SUMMARY OBJECTIVE Cellulite infection is a non-necrotizing inflammation of the skin and subcutaneous tissue and is one of the most common reasons for admission to hospital. This retrospective study aimed to investigate the Neutrophil to Lymphocyte Ratio (NLR), Platelet to Lymphocyte Ratio (PLR), and Lymphocyte to Monocyte Ratio (LMR) in patients with cellulitis. METHODS In our study, we retrospectively analyzed 96 patients with cellulitis and 98 age- and sex-matched healthy controls. The study and control groups were compared regarding NLR, PLR, and LMR.0.001). When patients with cellulitis were divided into two groups, i.e., ≥65 years and

Currently, the most likely hypotheses as the cause of Alzheimer’s disease are deposition of amyloid beta peptide in the cerebral cortex and hyperphosphorylation of Tau protein. The diagnosis of Alzheimer’s disease is based on the exclusion of other diseases, behavioral assessments, and blood and imaging tests. Biotechnology has created interesting perspectives for the early detection of Alzheimer’s disease through blood analysis, with special attention to platelets, hemoglobin and vitamin B12. Objective: To evaluate the concentrations of platelets, hemoglobin and vitamin B12 in the blood of older adults with and without dementia of Alzheimer’s disease. Methods: A case-control study involving 120 individuals was conducted, seeking to establish a correlation between changes in platelet, hemoglobin and vitamin B12 concentrations in patients with confirmed AD and in individuals in the inclusion group without AD. The study met the established ethical requirements. Results: Hemoglobin and platelet levels were statistically lower in patients with AD. The biochemical evaluation in AD patient and healthy groups for vitamin B12 showed a decrease in the levels of this compound in patients with AD. Conclusion: We demonstrated the feasibility of the use of blood biomarkers as predictive markers for the diagnosis of AD. RESUMO Atualmente, as hipóteses mais prováveis como causa da doença de Alzheimer são a deposição do peptídeo beta amiloide no córtex cerebral e a hiperfosforilação da proteína Tau. O diagnóstico da doença de Alzheimer baseia-se na exclusão de outras doenças, avaliações comportamentais e exames de imagem e sangue. A biotecnologia criou perspectivas interessantes para a detecção precoce da doença de Alzheimer, pela análise sanguínea, com atenção especial às plaquetas, hemoglobina e vitamina B12. Objetivo: Avaliar as concentrações de plaquetas, hemoglobina e vitamina B12 no sangue de idosos com e sem demência de Alzheimer. Métodos: O estudo de caso-controle envolveu 120 indivíduos, buscando correlação entre mudanças nas concentrações de plaquetas, hemoglobina e vitamina B12 em pacientes com DA confirmada e indivíduos do grupo de inclusão, sem DA. Resultados: Os níveis de hemoglobina e plaquetas são estatisticamente mais baixos em pacientes com DA. A avaliação bioquímica em pacientes com DA e grupos saudáveis para vitamina B12 mostrou uma diminuição nos níveis deste composto em pacientes com DA. Conclusão: Demonstramos a viabilidade do uso de biomarcadores sanguíneos como marcadores preditivos para o diagnóstico de DA.

SUMMARY OBJECTIVE Periodontitis may stimulate infectious and immune response and cause the development of atherogenesis, coronary heart disease, and myocardial infarction. The aim of this study was to compare the plateletcrit (PCT) and mean platelet volume (MPV) levels derived from complete blood count (CBC) tests in patients suffering from stage 3 periodontitis with those of healthy individuals without periodontal disease. METHODS The study included 57 patients (28 females and 29 males) with Stage 3 Periodontitis and 57 volunteering individuals (31 females and 26 males) who were periodontally healthy. The age of study participants ranged from 18 to 50 years. Their periodontal condition was investigated with probing depth (PD), clinical attachment level, bleeding on probing, and plaque index. Leukocyte (WBC) and erythrocyte count (RBC), hemoglobin (Hb) and hematocrit (HCT) levels, mean corpuscular volume (MCV) and red cell distribution width (RDW), thrombocyte count, mean platelet volume (MPV), plateletcrit (PCT ), and neutrophil and lymphocyte counts were evaluated based on the CBC test results of the study participants. RESULTS PCT, WBC, Neutrophil, and MPV values were found to be significantly higher in the periodontitis group (p0.05). CONCLUSIONS PCT and MPV levels may be a more useful marker to determine an increased thrombotic state and inflammatory response in periodontal diseases. RESUMO OBJETIVO A periodontite pode estimular a resposta infecciosa e imunitária e causar o desenvolvimento da aterogênese, doença coronária e infarto do miocárdio. O objetivo deste estudo foi comparar os níveis de plaquetócrito (PCT) e de volume médio de plaquetas (VMP) derivados dos testes de hemograma completo (CBC) em doentes que sofrem de periodontite de fase 3 com os de indivíduos saudáveis, sem doença periodontal. MÉTODOS O estudo incluiu 57 doentes (28 mulheres e 29 homens) com periodontite de fase 3 e 57 voluntários (31 mulheres e 26 homens) que eram periodontalmente saudáveis. A idade dos participantes do estudo variou de 18 a 50 anos. A condição periodontal dos participantes do estudo foi investigada com profundidade de sonda (PD), nível de ligação clínica, hemorragia na sonda e índice de placas. Contagem de leucócitos (WBC) e eritrócitos (RBC), níveis de hemoglobina (Hb) e hematócrito (HCT), volume corpuscular médio (VCM) e largura de distribuição das células vermelhas (RDW), contagem de trombócitos, volume plaquetário médio (MPV), plaquetócrito (PCT) e contagem de neutrófilos e linfócitos foram avaliados com base nos resultados do teste CBC dos participantes do estudo. RESULTADO Verificou-se que os valores de PCT, WBC, neutrófilos e MPV eram significativamente mais elevados no grupo da periodontite (p0, 05). CONCLUSÃO Os níveis de PCT e MPV podem ser um marcador mais útil para determinar um estado trombótico aumentado e a resposta inflamatória em doenças periodontais.

BACKGROUND: Biomarkers from routine complete blood count are known predictive factors of long-term outcomes in cancer patients. The value of these biomarkers in the setting of trimodal therapy for esophageal cancer in predicting early postoperative outcomes is not studied. OBJECTIVE: The present study evaluated the value of cellular blood components changes during neoadjuvant chemoradiotherapy followed by curative intent esophagectomy for cancer in predicting postoperative mortality and morbidity. METHODS: A cohort of 149 consecutive patients that underwent chemoradiotherapy using platinum- and taxane-based regimens followed by esophagectomy was analyzed. Cellular components of blood collected before neoadjuvant therapy (period A) and before surgery (period B) were assessed for postoperative mortality and complications. Univariate and multivariate Cox regression models were applied to evaluate the independent prognostic significance of blood count variables. RESULTS: Postoperative morbidity was present in 46% of the patients. On multiple regression analysis platelet volume (B) (OR: 1.53; 95% CI: 1.2-2.33) was an independent predictor of general complications. Severe postoperative surgical complications were present in 17% of the patients. On multiple regression analysis, lymphocyte decrease between B-A periods (OR: 0.992; 95% CI: 0.990-0.997) was related to higher risk for severe complications. Cervical anastomotic leakage was present in 25.6% of the patients. On univariate analysis eosinophil count in A and B periods was related to cervical anastomotic leakage. For this outcome, multivariate joint model could not identify independent risk variables of cellular components of blood. The 30-day mortality rate was 7.4%. On univariate analysis, platelet count in period B was associated to higher risk for mortality. The multivariate joint model could not accurately predict mortality due to the few number of patients in the mortality group. CONCLUSION: This is the first study to assess the relationship between peripheral blood count variables changes during neoadjuvant chemoradiotherapy using a platinum- and taxane-based regimen followed by curative intent esophagectomy for cancer in predicting postoperative complications. The platelet volume prior to surgery is related to postoperative complications and the lymphocyte count change prior to surgery predicts severe postoperative complications in the setting of trimodal therapy for esophageal cancer. RESUMO CONTEXTO: Os biomarcadores obtidos do hemograma completo são fatores prognósticos a longo prazo em pacientes com câncer. No entanto, o valor desses biomarcadores no contexto da terapia trimodal para o câncer de esôfago na predição de resultados pós-operatórios precoces não é estudado. OBJETIVO: O presente estudo avaliou o papel dos componentes celulares do sangue na predição de mortalidade e morbidade pós-operatória. MÉTODOS: Uma coorte de 149 pacientes consecutivos submetidos à quimiorradioterapia usando esquemas baseados em platina e taxano seguidos por esofagectomia foi analisada. Os componentes celulares do sangue coletados antes da terapia neoadjuvante (período A) e antes da cirurgia (período B) foram avaliados quanto à mortalidade e complicações pós-operatórias. Modelos de regressão de Cox univariada e multivariada foram aplicados para avaliar a significância prognóstica independente das variáveis da contagem sanguínea. RESULTADOS: A morbidade pós-operatória esteve presente em 46% dos pacientes. Na análise de regressão múltipla, o volume plaquetário (B) (OR: 1,53; IC95%: 1,2-2,33) foi um preditor independente de complicações gerais. Complicações cirúrgicas pós-operatórias graves estavam presentes em 17% dos pacientes. Na análise de regressão múltipla, a diminuição de linfócitos entre os períodos B-A (OR: 0,992; 95% CI: 0,990-0,997) esteve relacionada ao maior risco de complicações graves. Fístula da anastomose cervical esteve presente em 25,6% dos pacientes. Na análise univariada, a contagem de eosinófilos nos períodos A e B relacionou-se com a fístula da anastomose cervical. Para este resultado, o modelo multivariado de articulação não conseguiu identificar variáveis de risco independentes entre os componentes celulares do sangue. A taxa de mortalidade em 30 dias foi de 7,4%. Na análise univariada, a contagem no período B foi associada a maior risco de mortalidade. O modelo multivariado de articulação não pôde predizer mortalidade devido ao pequeno número de pacientes no grupo de mortalidade. CONCLUSÃO: Este é o primeiro estudo a avaliar o papel das variáveis do hemograma durante a quimiorradioterapia neoadjuvante para câncer na predição de complicações pós-operatórias. Volume plaquetário e variação da contagem de linfócitos séricos antes da cirurgia podem ser utilizados como biomarcadores preditivos de complicações pós-operatórias nos pacientes com neoplasia de esôfago submetidos a terapia trimodal.

Thrombocytosis refers to the increase in number of platelets per microliter (µL) of blood. Platelet counts greater than 1,000,000/µL may be associated with clinical signs of bleeding or thrombosis. Previous studies on underlying causes of thrombocytosis have aroused the interest of researchers about its clinical importance in dogs. The objective of this study was to analyze the blood cell counts in dogs in order to define the main diseases or clinical conditions that were associated with thrombocytosis, from 2016 to 2017. This was done to determine the incidence of thrombocytosis, and categorize the increase in platelet count with respect to severity. Of the 12,676 blood samples analyzed, 4.5% presented thrombocytosis (n = 573). Similar mean platelet counts were observed in all diagnosis or different categories of clinical conditions (neoplasms; gastrointestinal, endocrine, and ophthalmological diseases; trauma and surgery; dermatological, cardiac, neurological, infectious, respiratory, genitourinary, idiopathic, and multiple diseases; and pregnancy) with no significant difference (P ≥ 0.05). The disorders most commonly associated with thrombocytosis were gastrointestinal diseases, followed by neoplasms. Furthermore, increased platelet counts were observed in dogs treated with glucocorticoids and vincristine drugs. As for the degree of severity, extreme thrombocytosis occurred more frequently in the presence of gastrointestinal diseases. Resumo A trombocitose é o aumento do número de plaquetas por microlitro (µL) de sangue e contagens maiores que 1.000.000/µL podem estar associadas a sinais clínicos de sangramento ou trombose. Estudos anteriores sobre as causas subjacentes da trombocitose tem despertado o interesse quanto a sua importância clínica em cães. O presente estudo teve como objetivo analisar hemogramas de cães, com a finalidade de definir as principais doenças ou condições clínicas associadas à trombocitose dentro do período de dois anos, determinar a incidência e ainda categorizar as contagens de acordo com a severidade do aumento de plaquetas. De 12.676 hemogramas analisados, observou-se incidência de trombocitose de 4,5% (n=573). As contagens médias de plaquetas em todas as categorias de diagnósticos ou condições clínica (neoplasias, doenças gastrointestinais, endócrinas, oftalmológicas, traumas e cirurgias, dermatológicas, cardíacas, neurológicas, infecciosas, respiratórias, geniturinárias, idiopáticas, múltiplas e gestação) foram semelhantes, não havendo diferença significativa entre elas (P≥0,05). Os distúrbios mais comumente associados à trombocitose foram as doenças gastrointestinais seguidas de neoplasias. Além disso, os aumentos na contagem de plaquetas foram observados em cães tratados com glicocorticoides e vincristina. Quanto ao grau de severidade, a trombocitose extrema ocorreu mais frequentemente nas doenças gastrointestinais.

Introduction: Transfusion therapy is probably one of the most widely used therapies with poor supporting evidence, despite the long years of practical clinical use. Objective: To adapt the evidence-based recommendations on the use of blood products to the Colombian setting: red blood cells, platelets, cryoprecipitates and irradiated blood products in cancer patients under 18 years of age. Methods: Standard methodologies were followed in the development of recommendations. First, the clinical questions were addressed, and the evidence-based clinical practice guidelines were identified, graded and selected to answer the clinical questions. A systematic methodology was used to qualify, obtain and describe the relevant information to generate recommendations based on the SIGN system. The results were then presented and discussed in a group of experts to establish the practical value of the evidence and to adapt the recommendations to the Colombian environment. Results: Out of 107,441 preliminary titles, 56 studies were analyzed, and from them 3 clinical practice guidelines and 4 Cochrane systematic reviews were selected. This evidence was evaluated using AGREE II and AMSTAR. Red blood cells transfusion support is recommended using the restrictive strategy. Prophylactic platelet transfusion is the recommended indication. Cryoprecipitate is recommended when fibrinogen levels fall below 100mg/dL, and indications on irradiated blood products were established. Conclusion: This paper is an evidence-base approach on the recommendations for transfusion therapy in children with cancer. Introducción: La terapia transfusional es quizá una de los tratamientos de mayor uso sin buen respaldo de evidencia, a pesar de muchos años de uso en la práctica clínica. Objetiuo:Adaptar recomendaciones basadas en evidencia al contexto colombiano sobre el uso de hemocomponentes: glóbulos rojos, plaquetas, crioprecipitados y hemocomponentes irradiados en el paciente oncológico menor de 18 años. Métodos: Se utilizaron metodologías estándares para el desarrollo de las recomendaciones. Primero se formularon las preguntas clínicas, se identificaron, calificaron y seleccionaron las guías de práctica clínica basadas en la evidencia que respondían las preguntas clínicas, utilizando una metodología sistemática se realizó la calificación, extracción y descripción de los aspectos relevantes para generar recomendaciones usando el sistema SIGN, luego se realizaron exposición y discusión de los resultados obtenidos con un grupo de expertos para seleccionar la utilidad de la evidencia y adaptar las recomendaciones al contexto colombiano. Resultados: De 107.441 títulos preliminares, se analizaron 56 estudios, y de estos se escogieron 3 guías de práctica clínica y 4 revisiones sistemáticas Cochrane. Se evaluó esta evidencia con AGREE II y AMSTAR. Se recomienda soporte transfusional de glóbulos rojos usando la estrategia restrictiva, la estrategia transfusional profiláctica de plaquetas es la indicación recomendada. El valor de fibrinógeno menor de 100mg/dl es el recomendado para utilizar crioprecipitados y se determinaron las indicaciones sobre hemocomponentes irradiados. Conclusiones Este trabajo representa un enfoque basado en la evidencia sobre las recomendaciones de terapia transfusional para niños con cáncer.

Introduction. Platelets are not strictly "cells", they are cytoplasmic fragments that are produced by the division of the cytoplasm of the megakaryocytes in the bone marrow; among its properties of adhesion and aggregation, platelets are involved in primary hemostasis, thrombosis, repair and tissue regeneration processes. To modify the pro-thrombotic platelet properties aspirin (ASA) is provided, which allows blocking the synthesis of prostaglandins in order to irreversibly inhibit the COX1 and prevent platelet aggregation. The current guidelines govern the use of aspirin in the prevention of cardiovascular diseases.Objective. In this review paper graphics were created to facilitate the understanding of platelets and its interaction with various physiological and pathological processes.Methodology. A literature review of a total of 74 documents such as articles and books was carried out; it was obtained from bibliographic searches in the following databases: Scielo, NEJM, Elsevier, Pubmed, Redalyc, Wiley, Springer, ScienceDirect, BVS, Nature Riviews, EBSCO, Naxos (databases offered by the University of Cauca). Mendeley free access program was used for the management and organization of information.Conclusion. It is recognized the role of platelet in different physiopathological processes and thus its interaction with aspirin, preventing its aggregation and thrombus formation in the spleen and other organs, this way contributing to the prevention of future cardiovascular events. Introducción. Las plaquetas no son estrictamente células, son fragmentos citoplasmáticos que se originan por la división del citoplasma de los megacariocitos en la médula ósea; entre sus propiedades de adhesión y agregación, las plaquetas participan en procesos de hemostasia primaria, trombosis, reparación y regeneración de tejidos. Para modificar las propiedades protrombóticas de las plaquetas, se administra aspirina (ASA), la cual permite bloquear la síntesis de prostaglandinas para inhibir irreversiblemente la COX1 y para prevenir la agregación plaquetaria. Las directrices actuales determinan el uso de la aspirina para la prevención de las enfermedades cardiovasculares.Objetivo. Crear gráficos que faciliten la comprensión de las plaquetas y su interacción con diversos procesos fisiológicos y patológicos.Metodología. Se desarrolló una revisión bibliográfica de un total de 74 documentos como artículos y libros obtenidos a partir de la búsqueda bibliográfica de las bases de datos Scielo, NEJM, Elsevier, Pubmed, Redalyc, Wiley, Springer, ScienceDirect, Medwave, BVS, Nature Riviews, EBSCO, Naxos —Bases de datos que ofrece la Universidad del Cauca—. Para la gestión y organización de la información se utilizó el programa Mendeley de libre acceso.Conclusión. Se reconoce el rol de la plaqueta en diversos procesos fisiopatológicos y de esta manera la interacción con la aspirina, evitando su agregación y la formación de trombos en el bazo y otros órganos. Se contribuye de esta manera en la prevención de futuros eventos cardiovasculares.

Objective: To compare the neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios as possible parameters of systemic inflammation in hyperglycemic and normoglycemic subjects. Methods: A retrospective, cross-sectional study of data collected from patients tested for fasting blood glucose, glycated hemoglobin (HbA1c) and blood count on the same day, between July and December 2016. Patients were divided into hyperglycemic and normoglycemic, and matched by age and sex. The data were analyzed using Epi Info™, version 7.2.1.0, for the Windows® platform. Results: We enrolled 278 subjects, 139 hyperglycemic and 139 normoglycemic. The absolute number of leukocytes and neutrophils was higher in the Hyperglycemic Group (p=0.006 and p=0.004, respectively). There was no difference in the neutrophil-to-lymphocyte ratio between the Hyperglycemic Group and the Normoglycemic Group (2.1 versus 2.0; p=0.264), and both neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios showed no differences between those with HbA1c ≥7% (n=127, p=0.778) and those with HbA1c

Introduction: Several theories attempt to explain the pathophysiology of sudden hearing loss. Objective: The objective of this study was to investigate the possible role of inflammation and atherothrombosis in sudden hearing loss patients through the neutrophil-to-lymphocyte ratio and mean platelet volume. Methods: Study design - retrospective cross-sectional historical cohort. This study was conducted on two groups: one with 59 individuals diagnosed with sudden hearing loss, and other with 59 healthy individuals with the same characteristics of gender and age distribution, neutrophil-to-lymphocyte ratio and mean platelet volume levels were measured in patients diagnosed with sudden hearing loss as well as in the control group, and it was verified whether these results interfered for a better or worse prognosis with treatment of sudden deafness. Results: Neutrophil-to-lymphocyte ratio levels are much higher in patients diagnosed with sudden hearing loss compared to the control group. Similarly, mean levels of neutrophil-to-lymphocyte ratio are higher in non-recovered versus recovered patients (p= 0.001). However, we could not find a correlation with mean platelet volume levels (p>. 0.05). Conclusion: Neutrophil-to-lymphocyte ratio is a quick and reliable indicator regarding diagnosis and prognosis of sudden hearing loss; on the other hand, mean platelet volume may be considered a less important indicator in this aspect. © 2015 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Introdução: Várias teorias tentam explicar a fisiopatologia da surdez súbita (SS).Objetivo: : O objetivo deste estudo foi investigar o possível papel da inflamação e da aterotrom-bose nos pacientes de SS através da relação neutrófilos/linfócitos (RNL) e volume plaquetáriomédio (VPM).Método: Forma de estudo --- coorte histórica com corte transversal (retrospectivo). Este estudofoi realizado com 59 indivíduos portadores de SS e 59 saudáveis, com as mesmas característi-cas em distribuição de gênero e idade. Os níveis de VPM e RNL foram medidos nos pacientesdiagnosticados com SS e no grupo controle, verificando-se se tais resultados implicavam em ummelhor ou pior prognóstico com o tratamento da surdez súbita.Resultados: Os níveis da RNL são muito mais altos em pacientes com SS, em comparação como grupo controle. De forma semelhante, níveis médios da RNL são mais altos nos pacientes nãorecuperados, em comparação com os recuperados (p = 0,001). Essas diferenças entretanto, nãoforam observadas em relação aos níveis de VPM (p > 0,05).Conclusão: RNL é um indicador rápido e confiável no que diz respeito ao diagnóstico e prognós-tico de SS; por outro lado, VPM pode ser um indicador menos importante neste aspecto.

Introduction: Platelets have a central role in the tissue response to injury, in hemostasis and clot formation. They also release rapidly and in orchestrated order bioactive molecules, important for angiogenesis and for tissue regeneration. Non-transfusional clinical use of platelet-derived products, such as Platelet Rich Plasma (PRP), is based on their ability to maximize cellular regeneration in lesions that have repair difficulties. Objectives: This review addresses the characteristics and the potential clinical use of platelets and their derivatives and discusses the legislative framework of their use in the Brazilian context. Method: The databases of PubMed, Brazilian Virtual Health Library, electronic pages of Anvisa and the Brazilian Ministry of Health were consulted between September 2017 and January 2018. Results: PRP is a platelet-derived product that cannot be chemically defined, and its proposed clinical uses are not orthologous applications. Conclusions: We can thus consider that the applications of PRP are Advanced Cell Therapies. Therefore, it is mandatory to standardize protocols and establish quality control criteria - such as traceability, efficacy and pharmacovigilance - so that their use can be properly controlled by the competent regulatory organs, guaranteeing safety in their use.

Under balanced conditions, hemostasis is maintained by a complex interaction between endothelium, platelets, and coagulation factors. Situations involving injury and discontinuation of the endothelial lining stimulate the adhesion, activation, and aggregation of platelets, culminating in the formation of arterial or venous thrombi. In this context, antiplatelet therapy occupies a prominent role in the management of pathologies arising from this process, notably acute coronary syndromes. The increased conceptual understanding of receptors, agonists, and antagonists of the pathophysiological cascades involved in this process has allowed the development of new drugs and refinement of the current therapy, demanding a complete knowledge of the arsenal of antiplatelet agents with respect to their indication, dosage, moment of administration, and duration of treatment. The objective of this review is to define the role of antiplatelet drugs in the management of acute coronary syndrome, revisiting aspects that have been already consolidated and addressing current and still controversial topics on the subject. Resumo Em condições de equilíbrio, a hemostasia é mantida através de uma complexa interação entre endotélio, plaquetas e fatores de coagulação. Situações que cursam com injúria e descontinuidade do revestimento endotelial estimulam a adesão, ativação e agregação de plaquetas, culminando com a formação de trombos arteriais ou venosos. Neste contexto, a terapia antiplaquetária ocupa um papel de destaque no manejo das patologias advindas deste processo, notadamente as síndromes coronarianas agudas.O maior domínio conceitual dos receptores, agonistas e antagonistas das cascatas fisiopatológicas envolvidasneste processo possibilitou o desenvolvimento de novos fármacos e o refinamento da terapêutica atual, tornando necessário o pleno conhecimento do arsenal antiplaquetário no que tange à sua indicação, posologia, momento de administração e duração do tratamento. O objetivo desta revisão é definir o papel dos fármacos antiplaquetários no manuseio da síndrome coronariana aguda, revisitando aspectos já consolidados e abordando tópicos atuais e ainda controversos acerca do tema.

Background: Cell-derived microvesicles (MVs) are vesicles released from activated or apoptotic cells. However, the levels of MVs in myocardial infarction have been found inconsistent in researches. Objective: To assess the association between MVs and myocardial infarction by conducting a meta-analysis. Methods: A systematic literature search on PubMed, Embase, Cochran, Google Scholar electronic database was conducted. Comparison of the MVs levels between myocardial infarction patients and healthy persons were included in our study. Standard Mean Difference (SMD) and 95% confidence interval (CI) in groups were calculated and meta-analyzed. Results: 11 studies with a total of 436 participants were included. Compared with the health persons, AMVs [SMD = 3.65, 95% CI (1.03, 6.27)], PMVs [SMD = 2.88, 95% CI (1.82, 3.93),] and EMVs [SMD = 2.73, 95% CI (1.13, 4.34)], levels were higher in patients with myocardial infarction. However, LMVs levels [SMD = 0.73, 95% CI (-0.57, 2.03)] were not changed significantly in patients with myocardial infarction. Conclusions: AMVs, PMVs and EMVs might be potential biomarkers for myocardial infarction. Resumo Fundamentos: As microvesículas derivadas de células (MVs) são vesículas liberadas de células ativadas ou apoptóticas. No entanto, os níveis de MVs no infarto do miocárdio foram encontrados inconsistentes nas pesquisas. Objetivo: Avaliar a associação entre MV e infarto do miocárdio por meio de uma meta-análise. Métodos: Foi realizada uma pesquisa sistemática na literatura em PubMed, Embase, Cochran e no banco de dados eletrônico do Google Scholar. Uma comparação dos níveis de MV entre pacientes com infarto do miocárdio e pessoas saudáveis foi incluída no nosso estudo. A Diferença Média Padrão (DMP) e o intervalo de confiança (IC) de 95% nos grupos foram calculadas e meta-analisadas. Resultados: Foram incluídos 11 estudos com um total de 436 participantes. Em comparação com as pessoas saudáveis, as MVA [DMP = 3,65, IC 95% (1,03, 6,27)], MVPs [DMP = 2,88, IC 95% (1,82, 3,93)] e MVEs [DMP = 2,73, IC 95% (1,13, 4.34)], foram maiores em pacientes com infarto do miocárdio. No entanto, os níveis de MVL [DMP = 0,73, IC 95% (-0,57, 2,03)] não foram alterados significativamente em pacientes com infarto do miocárdio. Conclusões: MVAs, MVPs e MVEs podem ser biomarcadores potenciais para o infarto do miocárdio.

Purpose: The aim of this study was to investigate the mean platelet volume (MPV) of patients with retinal artery occlusion (RAO). Methods: Thirty-seven patients diagnosed with RAO and 32 control subjects were included in this retrospective study. Retinal artery occlusion was diagnosed on the basis of clinical examination and fundus fluorescein angiography. All participants underwent complete ocular examination, and MPV, hematocrit, hemoglobin, and platelet counts were recorded. RAO patient data were compared with those of the control subjects. Results: Patients with RAO had significantly higher MPV values (7.96 ± 1.2 fL) compared with control subjects (7.33 ± 0.7 fL, p

Neonatal alloimmune thrombocytopenia is a serious disease, in which the mother produces antibodies against fetal platelet antigens inherited from the father; it is still an underdiagnosed disease. This disease is considered the platelet counterpart of the RhD hemolytic disease of the fetus and newborn, yet in neonatal alloimmune thrombocytopenia the first child is affected with fetal and/or neonatal thrombocytopenia. There is a significant risk of intracranial hemorrhage and severe neurological impairment, with a tendency for earlier and more severe thrombocytopenia in subsequent pregnancies. This article reports a case of neonatal alloimmune thrombocytopenia in the second pregnancy affected and discusses diagnosis, management and the clinical importance of this disease.

Objetivo: El infarto de miocardio es la causa más común de fallo cardíaco congestivo. El objetivo de este trabajo es evaluar, en el animal de experimentación, los efectos morfológicos e histológicos de la implantación de plasma autógeno rico en plaquetas en el corazón de ovejas previamente infartadas. Métodos: Se utilizaron 24 ovejas lacha hembras, en las que se produjo quirúrgicamente un infarto agudo de miocardio, mediante toracotomía izquierda y ligadura permanente de 2 arterias coronarias (primera y segunda diagonal). Tras la ligadura de las arterias coronarias 3 ovejas fallecieron por fibrilación ventricular. Pasadas 3 semanas de la ligadura coronaria, las ovejas fueron reoperadas por esternotomía media vertical. En 6 de ellas (grupo control) se inyectó suero fisiológico en la zona del infarto. En 15 se inyectó gel plaquetario. Todas las ovejas fueron sacrificadas a las 9 semanas de evolución de la segunda cirugía. Resultados: En los corazones tratados con plasma rico en factores de crecimiento (PRGF) destaca la neoformación vascular en los cortes de hematoxilina-eosina y de factor VIII, a diferencia de los no tratados. Conclusiones: La inyección de factores de crecimiento plaquetarios, PRGF, en el corazón de ovejas previamente infartadas favorece la mitogénesis y la angiogénesis. El uso de PRGF autógeno es sencillo y seguro, no provocando toxicidad ni desencadenando reacciones inmunológicas ni inflamatorias.

Evaluar el volumen de edema y el recuento leucocitario, plaquetario y de fibrinógenos de quemadura periférica en un modelo animal. Se introdujo en agua a 60 °C y durante 60 s, la pata posterior izquierda de Rattus rovergicus (grupo experimental) o a temperatura ambiente (grupo control). Se realizó el análisis antes y después de la quemadura inducida (a las 4, 8, 12 y 24 h). El volumen del edema se determinó por fotografía ortogonal, los leucocitos y el recuento plaquetario, en un equipo automatizado, y el fibrinógeno por el método gravimétrico. El valor máximo del edema se obtuvo a las 4 h, y de leucocitos a las 24 h. El recuento plaquetario no varió a los diferentes intervalos de tiempo posinflamación. El fibrinógeno se incrementó a las 4 h y 24 h. Este modelo animal induce inflamación sistémica caracterizada por leucocitosis, nivel elevado de fibrinógeno y edema localizado en la zona de inducción. To evaluate the edema volume and leukocyte, platelet, and fibrinogen count of peripheral burn in an animal model. The back left leg of Rattus norvegicus (experimental group) was placed in water at 60 °C for 60 seconds or at room temperature (control group). An analysis was carried out before and after the induced burn (at 4, 8, 12, and 24 h). The edema volume was determined by an orthogonal photo, the leukocyte and platelet counts were determined using automated equipment, and the fibrinogen count was determined using the gravimetric method. The maximum value of the edema was recorded at 4 h and leukocytes at 24 h. The platelet count did not vary at different post-edema time intervals. The fibrinogen level increased at 4 h and 24 h. In this animal model we induced systemic inflammation characterized by leukocytosis and elevated fibrinogen levels, combined with edema located at the induction area.

El láser de baja potencia se ha implementado dentro del campo médico, como una alternativa segura para influir en el comportamiento de las células del organismo humano. Se ha sugerido que la radiación de baja potencia reduce agentes patógenos, actúa como protector ante radiación ionizante e incrementa la población de plaquetas en sangre. Este trabajo tiene como objetivo analizar la tasa de crecimiento de las plaquetas humanas luego de aplicar radiación láser de baja potencia. The low-power laser has been implemented within the medical field as a safe alternative for influencing the behavior of cells of the human body. It has been suggested that low power radiation reduces pathogens and acts as a shield against ionizing radiation and increases the platelets population in blood. This study aims to analyze the rate of growth of human platelets after applying low power laser radiation.

Objective: To identify antiplatelet antibodies by flow cytometry (direct method) in patients with thrombocytopenia. Methods: Between January 1997 and March 2004 a total of 15100 patients were referred to the Centro de Hematologia de São Paulo for hematological investigation of several diagnoses (anemia, leukopenia, thrombocytopenia, coagulation abnormalities, adenomegaly, leukemia and others). Of those, 1057 were referred because of thrombocytopenia and were divided into two groups: Group Idiopathic thrombocytopenic purpura, with no identifiable cause; and Group Other thrombocytopenia, which included low normal platelet counts cause to be established, hepatitis C and HIV infection, hypersplenism, EDTA-induced artifacts, laboratory error, and other causes. Flow cytometry immunophenotyping was done in 115 cases to identify platelet autoantibodies (direct method). Results: Of the total number of patients, 1057 (7%) presented low platelet counts, 670 were females (63.4%) and age range of one to 75 years. Of the 115 cases (9.7%) submitted to immunophenotyping, the results were positive in 40% and the test was inconclusive in 5%. Idiopathic thrombocytopenic purpura was found in 52% of patients, more often in women. Hepatitis C virus infection was found in 7% and HIV infection in 1%. Low normal platelet counts were found in 17%, laboratory errors in 6%, and laboratory artifacts in 1% of cases. Platelet autoantibodies were found in 76.9% of all idiopathic thrombocytopenic purpura cases. It was negative in 83.3% of the low normal counts. Conclusion: antiplatelet autoantibodies when present help to diagnose idiopathic thrombocytopenic purpura. When absent, suggest other causes of thrombocytopenia. Objetivo: Identificar anticorpos antiplaquetas por citometria de fluxo (método direto) em pacientes com plaquetopenia. Métodos: No período de Janeiro de 1997 a Março de 2004, foram encaminhados ao Centro de Hematologia de São Paulo 15.100 pacientes para investigação hematológica, com vários diagnósticos (anemia, leucopenia, plaquetopenia, alteração da coagulação, adenomegalias, leucemia e outros) dos quais 1.057 apresentavam plaquetopenia. Esses pacientes, conforme diagnóstico, foram separados em dois grupos: Grupo Púrpura Trombocitopênica Idiopática, quando não foi descoberta a etiologia da plaquetopenia; e Grupo Outra Trombocitopenia, que incluía faixa de normalidade a esclarecer, infecção pelo vírus da hepatite C, HIV, hiperesplenismo, artefato EDTA, erro laboratorial e outras. Em 115 casos, foi realizada imunofenotipagem, para identificação de anticorpo antiplaquetas (método direto), por citometria de fluxo. Resultados: Dos 1.057 casos (7%) encaminhados por plaquetopenia, 670 casos (63,4%) eram do sexo feminino. As idades variavam entre 1 e 75 anos. Dos 115 casos (9,7%) em que foi realizada imunofenotipagem, houve positividade em 40% e o exame foi duvidoso em 5%. A púrpura trombocitopênica idiopática foi encontrada em 52% dos casos, sendo mais frequente no sexo feminino, em crianças e adultos jovens. A prevalência do vírus da hepatite C foi encontrada em 7% dos casos e HIV em 1% dos casos. Faixa de normalidade foi encontrada em 17%; erro laboratorial em 6% e artefato laboratorial em 1% dos casos. Conclusão: O anticorpo antiplaquetas é um exame útil, quando positivo, para confirmar o diagnóstico de púrpura trombocitopênica idiopática e, quando negativo, sugere outras causas de trombocitopenia.

Objetivos - Investigar o significado prognóstico da trombocitose nos pacientes com câncer colorretal. Método - Trata-se de estudo retrospectivo, com análise de 243 prontuários de pacientes submetidos a operações por câncer colorretal. Foram comparados os dados do estadiamento, recidiva tumoral e óbitos por câncer com a ocorrência de trombocitose no pré-operatório. O grupo controle foi composto de 50 pacientes submetidos à herniorrafia. A média da contagem de plaquetas no pré-operatório destes pacientes foi utilizada para dividir os pacientes em dois grupos: grupo 1, pacientes com contagem de plaquetas abaixo dessa média e grupo 2, pacientes com contagem de plaquetas acima dessa média. Resultados - A média da contagem plaquetária foi 317000/ìl entre os pacientes com câncer e de 267000 entre os pacientes do grupo controle. A prevalência da trombocitose no câncer colorretal foi 32,1%. Dentre os óbitos por câncer, 56,7% ocorreram em pacientes com trombocitose e 32% em pacientes com plaquetas normais (p=0,001). Utilizando a média do grupo controle, a diferença foi ainda mais significativa (p=0,0004). Quanto à recidiva tumoral, 40% dos pacientes do grupo 2 tiveram recidiva e 17,9% do grupo 1 (p=0,003). Com relação ao estadiamento T, no grupo 1, 14,1% eram T1 e 8,4% T4. No grupo 2, 2,2% eram T1 e 19,5% T4 (p=0.0005). Metástases à distância foram encontradas em 9,4% dos pacientes do grupo 1 contra 21,8% do grupo 2 (p=0.02). No que diz respeito ao estadiamento TNM, no grupo 1, 24,6% eram estadio 1 e 11% estadio 4. No grupo 2, 9,6% eram estadio 1 e 22,8% estadio 4 (p=0,02). Conclusão - A contagem de plaquetas no pré-operatório parece ser útil em identificar pacientes com prognóstico desfavorável.

Desde siempre los episodios de sangrado muco-cutáneos, al ser tan evidentes, causan mucha preocupación y zozobra, más aún si ocurren sin causa aparente. La púrpura trombocitopénica suele ser la responsable de estos desagradables sucesos. Esta revisión tiene por objetivo actualizar los conocimientos acerca de la fisiopatología, el diagnóstico y el tratamiento de la púrpura trombocitopénica inmunológica (PTI), una patología hematológica que afecta tanto niños como a adultos y que se ve con relativa frecuencia en la actividad diaria de un hospital general. Thrombocytopenic purpura is mostly responsible for episodes of muco-cutaneous bleeding. This review updates topics on the pathophysiology, diagnosis and treatment of immunologic thrombocytopenic purpura (IPT), an hematologic condition that afects both childern and adults, which is seen relatively frequent in daily practice in a general hospital.

OBJETIVO: Detectar alterações nos índices plaquetários em indivíduos com doença hepática alcoólica crónica e trombocitopenia e determinar o seu grau de correlação com outros parâmetros hematológicos. MÉTODOS: Foram estudados um total de 65 indivíduos, divididos em dois grupos: controlos (n = 35) e com doença hepática alcoólica crónica e trombocitopenia (n = 30). O grupo controlo foi emparelhado por idade e sexo com o grupo de doentes. A todos eles, foi efectuado hemograma completo, incluindo índices plaquetários. RESULTADOS: Os doentes com doença hepática alcoólica crónica apresentaram contagem de eritrócitos, leucócitos e plaquetas significativamente inferiores aos encontrados na população controlo. O mesmo se verificou com os valores de hemoglobina, hematócrito e valores absolutos de linfócitos e neutrófilos. O volume globular médio, a hemoglobina globular média e o RDW ("red cell distribution width") revelaram-se significativamente superiores no grupo de doentes. Relativamente aos índices plaquetários, foi encontrado aumento estatisticamente significativo do PDW ("platelet distribution width") e uma diminuição estatisticamente significativa no plaquetrócrito no grupo de doentes quando comparado com o grupo controlo. Em relação ao volume plaquetário médio não se encontraram diferenças estatisticamente significativas entre os dois grupos. Foi encontrada correlação estatisticamente significativa entre a contagem de plaquetas e os outros parâmetros hematológicos analisados. O plaquetrócito revelou-se o índice plaquetário que mais se relaciona com os restantes parâmetros hematológicos. CONCLUSÃO: Os doentes com doença hepática alcoólica crónica apresentam diminuição nas três linhas hematopoiéticas, possivelmente associada com o hiperesplenismo que estes doentes apresentam. Adicionalmente às alterações numéricas, encontraram-se alterações morfológicas a nível dos eritrócitos e plaquetas, demonstráveis pelos índices eritrocitários e plaquetários. AIM: To detect alterations in platelet indices in patients with chronic alcoholic liver disease and thrombocytopenia, and its correlation with other haematological parameters. METHODS: We studied 65 individuals separated in two groups: controls (n = 35) and chronic alcoholic liver disease patients with thrombocytopenia (n = 30). The control group was age and gender matched with patients group. In all, controls and patients, a haematological evaluation was done, including platelets indices. RESULTS: In the patients group we found a low number of erythrocytes, leucocytes and platelet when we compare with controls. The same is true when we compare haemoglobin, hematocrit and absolute count of lymphocyte and neutrophil. The mean globular volume, mean globular haemoglobin and red cell distribution width where significantly higher in patients group. Platelet indices showed a statistical significant increased in platelet distribution width and decreased in platelet crit in the patient group. No differences where found on mean platelet volume between the two groups. Correlation between platelet number and other haematological parameters was found. CONCLUSION: Chronic alcoholic liver disease patients showed a decrease in all haematopoietic cell lines, probably associated with hypersplenism found in those patients. Additionally to the numeric alterations the erythrocyte and platelets showed morphologic alteration revelled by respective indices.

Introducción y objetivoEl objetivo de esta investigación fue estudiar el daño en órganos y el efecto sobre las plaquetas de una nueva bomba pulsátil para circulación extracorpórea (CEC) con respecto a una bomba centrífuga Biomedicus.Materiales y métodosTrece cerdos, ocho en el grupo pulsátil (GP) y cinco en el grupo de centrífuga (GC) fueron sometidos a CEC durante 180 min, siendo sacrificados 180 min después (3 h post- CEC). Se realizó entonces un estudio morfológico de fragmentos de pared ventricular, hígado, pulmón y riñón. El estudio plaquetario fue tanto cuantitativo como cualitativo con un sistema PFA-100.Resultados y discusiónEl descenso en el número de plaquetas desde valores basales hasta 3 h post-CEC fue significativo sólo en GC (p=0,009). La función plaquetaria se alteró en ambos grupos, pero el valor col/ADP se incrementó significativamente sólo en el GC (p

PURPOSE: To compare the behavior of serum cortisol and ACTH levels and platelet kinetics after laparoscopic and open cholecystectomy. METHODS: In this prospective study, 31 patients with symptomatic cholelithiasis submitted to elective cholecystectomy, 17 by the laparoscopic route and 14 by the open route, were compared. Peripheral blood samples were collected on admission of the patient, during anesthetic induction, and 2, 6, 12, 24 and 48 hours after the surgical incision. Platelets were counted in hematoxylin-eosin-stained specimens under a light microscope at 100X magnification. Cortisol and ACTH were measured by chemiluminescence. RESULTS: Cortisol and ACTH levels showed a significant increase (p0.05) between the post- and preoperative periods was observed for either group. CONCLUSION: A hormonal response was observed for both procedures studied, but the surgical stress was higher and longer lasting in open surgery compared to the laparoscopic approach. However, no significant variation in platelet kinetics in response to tissue injury was observed between the two procedures. OBJETIVO: Comparar o comportamento dos níveis séricos de cortisol, ACTH e da cinética das plaquetas nas colecistectomias laparoscópica e aberta. MÉTODOS: Esse estudo prospectivo compara 31 pacientes portadores de colelitíase sintomática que se submeteram a colecistectomia eletiva, sendo que 17 por via laparoscópica e 14 por via aberta. Amostras de sangue periférico foram colhidas na internação do paciente, na indução anestésica, às 2, 6, 12, 24 e 48 horas da incisão cirúrgica. A contagem de plaquetas foi realizada no microscópio óptico- aumento de 100X- pela coloração de Hematoxilina- eosina . As dosagens de cortisol e ACTH foram realizadas através da técnica de quimioluminescência. RESULTADOS: Observou-se que as concentrações de cortisol e ACTH elevaram-se significativamente (p< 0.05) nas primeiras horas em relação aos valores do pré-operatório. Às 2 horas, houve elevação maior do nível de cortisol no grupo laparoscópico com diferença estatisticamente significante (p=0,0365;p

OBJETIVO: avaliar parâmetros do plaquetograma comparando os valores em gestantes normais e com pré-eclâmpsia. MÉTODOS: realizou-se estudo transversal controlado. Foram revisados os prontuários das mulheres internadas em hospital universitário, no período de 1 de janeiro de 2001 a 31 de julho de 2002. Foram pré-selecionadas aquelas que tinham plaquetograma realizado a partir da 28ª semana de gravidez. Foram analisados dois grupos de estudo: grupo PE (36 portadoras de pré-eclâmpsia) e grupo GN (58 gestantes normais). Os parâmetros plaquetários analisados pelo método automatizado foram: contagem de plaquetas, volume médio de plaquetas (MPV), largura de distribuição de plaquetas (PDW) e razão de células grandes de plaquetas (P-LCR). A análise estatística usou o teste t de Student e o teste do c² para comparar os grupos, e para avaliar o grau de dependência entre as variáveis utilizou-se o coeficiente de determinação (r²). Para todos os testes, o nível de significância considerado foi p < 0,05. RESULTADOS: a contagem de plaquetas não foi diferente entre os grupos, porém os demais parâmetros plaquetários estavam significativamente mais elevados no grupo PE. A gravidade da doença foi documentada em 91,7% das portadoras de pré-eclâmpsia, apesar de nenhuma das pacientes incluídas ter apresentado trombocitopenia como critério de gravidade. Detectaram-se correlações negativas entre a contagem das plaquetas e entre os demais parâmetros plaquetários analisados, e correlações positivas entre MPV e PDW, MPV e P-LCR e entre PDW e P-LCR. Observaram-se ainda correlações positivas entre MPV, PDW e P-LCR e as pressões sistólicas e diastólicas máximas. CONCLUSÕES: a pré-eclâmpsia esteve associada com estes novos parâmetros plaquetários, sugerindo alterações funcionais das plaquetas. A aplicabilidade clínica destes parâmetros, como marcadores mais precoces de gravidade da pré-eclâmpsia, exige mais estudos. OBJECTIVE: to evaluate platelet parameters in normal and pre-eclamptic pregnant women. METHODS: a controlled cross-sectional study was carried out. The medical records of the women who had delivered in the Hospital Universitário Júlio Müller-Cuiabá/MT, from January 1, 2001 to July 31, 2002, were reviewed. The pregnant women were pre-selected based on their platelet parameters analyses performed after the 28th week of gestation. Two groups of study were analyzed: PE group (36 pre-eclamptic women) and NP group (58 normal pregnant women). The platelet parameters analyzed by the automated method were: platelet counts, mean platelet volume (MPV), platelet distribution width (PDW) and platelet - large cells ratio (P-LCR). For statistical analysis the Student t-test and the chi-square test were used to compare the groups, and to evaluate the degree of dependence among the variables, the coefficient of determination was used (r²). For all these tests, the significance level considered was p < 0.05. RESULTS: the platelet counts did not show difference between the two groups. However, all other platelet indices (MPV, PDW and P-LCR) were significantly higher in the PE group. The severity of the disease was documented in 91.7% of the pre-eclamptic women, despite the fact that none of the patients included had shown thrombocytopenia as a criterion of severity. Negative correlation was detected between the platelet counts and the other platelet parameters analyzed and there was positive correlation between MPV and PDW, MPV and P-LCR, and PDW and P-LCR. Positive correlation was also observed between MPV, PDW and P-LCR, and the maximum systolic and diastolic blood pressures. CONCLUSIONS: pre-eclampsia was associated with these platelet parameters, suggesting alterations of the platelet functions. The clinical applicability of these parameters, as early markers of severity of pre-eclampsia, needs more studies.

Introdução: A Fibrina Rica em Plaquetas é um concentrado plaquetário, de preparo extemporâneo e uso autólogo, cuja proposta é promover uma melhor e mais rápida cicatrização e reparo das lesões cirúrgicas, tendo sido desenvolvida, inicialmente, para as cirurgias bucais. Objetivo: Analisar o preparo, controle de qualidade e uso clínico do PRF para compreender e discutir os aspectos práticos e regulatórios acerca da sua utilização. Método: Este trabalho foi elaborado como uma revisão integrativa, pelo levantamento de artigos científicos e legislação vigente sobre a utilização clínica do PRF. Resultados: O PRF constitui-se de uma matriz de fibrina, com grande quantidade de plaquetas, que liberam numerosos mediadores pró-regenerativos. A sua obtenção, preparo e uso ocorrem em centro cirúrgico ou consultório odontológico, cabendo ao cirurgião-dentista o compromisso com a garantia da qualidade, quanto aos procedimentos realizados. Além disso, os equipamentos e insumos utilizados devem ser compatíveis com as técnicas de preparo e uso do PRF. Conclusões: A utilização do PRF, pelos cirurgiões-dentistas, segue as determinações da Resolução do Conselho Federal de Odontologia – CFO nº 158/2015, de 08 de junho de 2015. Não há regulamentação para o uso de PRF pelo Conselho Federal de Medicina (CFM). A preparação e o uso do PRF não são considerados Terapia Avançada.

Brain-derived neurotrophic factor (BDNF) has several functions in the central nervous system, where it contributes to brain development and its functionality through affecting neuronal survival and activity and also modulating neurotransmitter levels. This neurotrophin is also found in the serum, but its origin and peripheral function remain unknown. Although the source of circulating BDNF is uncertain, it is stored in platelets and can be released through pharmacological treatment. Decreased levels of BDNF in the serum have been related to the pathophysiology of depression, and this relationship is reinforced by the reversal of this condition by treatment with antidepressants. Recently, riluzole has been proposed for the treatment of depression because it has the ability to lower extracellular glutamate levels and increase BDNF expression; and both mechanisms could be associated with its antidepressant action. Considering that riluzole enhances BDNF levels in the serum of patients, we investigated if treatment with this drug could stimulate the release of this neurotrophin from human platelets obtained from healthy subjects. When platelets were incubated with riluzole for 4 h, the basal value of BDNF (92.9±11.1 pg 10−6platelets) was significantly increased (P<0.05,n=27). This stimulatory effect was achieved at low concentrations of riluzole (from 10 µM) and was not observed when platelets were incubated with the drug for 24 h. The direct action of riluzole evoking BDNF release from human platelets at therapeutic concentrations is important and may contribute to the understanding of its mechanisms of action in the treatment of depression.

Abnormalities of platelet size are one of the distinguishing features of inherited thrombocytopenias (ITs), and evaluation of blood films is recommended as an essential step for differential diagnosis of these disorders. Nevertheless, what we presently know about this subject is derived mainly from anecdotal evidence. To improve knowledge in this field, we evaluated platelet size on blood films obtained from 376 patients with all 19 forms of IT identified so far and found that these conditions differ not only in mean platelet diameter, but also in platelet diameter distribution width and the percentage of platelets with increased or reduced diameters. On the basis of these findings, we propose a new classification of ITs according to platelet size. It distinguishes forms with giant platelets, with large platelets, with normal or slightly increased platelet size, and with normal or slightly decreased platelet size. We also measured platelet diameters in 87 patients with immune thrombocytopenia and identified cutoff values for mean platelet diameter and the percentage of platelets with increased or reduced size that have good diagnostic accuracy in differentiating ITs with giant platelets and with normal or slightly decreased platelet size from immune thrombocytopenia and all other forms of IT. Fil: Noris, Patrizia. University of Pavia; Italia Fil: Biino, Ginevra. Consiglio Nazionale Delle Ricerche. Istituto di Genetica Molecolare; Italia Fil: Pecci, Alessandro. University of Pavia; Italia Fil: Civaschi, Elisa. University of Pavia; Italia Fil: Savoia, Anna. Università degli Studi di Trieste; Italia. Istituto Di Ricovero e Cura a Carattere Scientifico Burlo Garofolo; Italia Fil: Seri, Marco. Università di Bologna; Italia Fil: Melazzini, Federica. University of Pavia; Italia Fil: Loffreddo, Giuseppe. Pausilipon Hospital; Italia Fil: Russo, Giovana. Università degli Studi di Catania; Italia Fil: Bozzi, Valeria. University of Pavia; Italia Fil: Notarangelo, Lucia Dora. Spedali Civili. Ospedale dei Bambini; Italia Fil: Gresele, Paolo. Università di Perugia; Italia Fil: Heller, Paula Graciela. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Médicas. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones Médicas; Argentina Fil: Pujol Moix, Nuria. Universitat Autònoma de Barcelona; España Fil: Kunishima, Shinji. National Hospital Organization Nagoya Medical Center; Japón Fil: Cattaneo, Marco. Università degli Studi di Milano; Italia Fil: Bussel, James. Cornell University; Estados Unidos Fil: de Candia, Erica. Universita Cattolica del Sacro Cuore; Italia Fil: Cagioni, Claudia. University of Pavia; Italia Fil: Ramenghi, Ugo. Università di Torino; Italia Fil: Barozzi, Serena. University of Pavia; Italia Fil: Fabris, Fabrizio. Università di Padova; Italia Fil: Balduini, Carlo L.. University of Pavia; Italia

12 p.-6 tab. Sánchez-Guiu et al., [Background] The diagnostic evaluation of inherited platelet disorders (IPDs) is complicated and time-consuming, resulting in a relevant number of undiagnosed and incorrectly classified patients. In order to evaluate the spectrum of IPDs in individuals with clinical suspicion of these disorders, and to provide a diagnostic tool to centers not having access to specific platelets studies, we established the project “Functional and Molecular Characterization of Patients with Inherited Platelet Disorders” under the scientific sponsorship of the Spanish Society of Thrombosis and Haemostasis., [Patients/methods] Subjects were patients from a prospective cohort of individuals referred for clinical suspicion of IPDs as well as healthy controls. Functional studies included light transmission aggregation, flow cytometry, and when indicated, Western-blot analysis of platelet glycoproteins, and clot retraction analysis. Genetic analysis was mainly performed by sequencing of coding regions and proximal regulatory regions of the genes of interest., [Results] Of the 70 cases referred for study, we functionally and molecularly characterized 12 patients with Glanzmann Thrombasthenia, 8 patients with Bernard Soulier syndrome, and 8 with other forms of IPDs. Twelve novel mutations were identified among these patients. The systematic study of patients revealed that almost one-third of patients had been previously misdiagnosed., [Conclusions] Our study provides a global picture of the current limitations and access to the diagnosis of IPDs, identifies and confirms new genetic variants that cause these disorders, and emphasizes the need of creating reference centers that can help health care providers in the recognition of these defects., Research of the authors’ group is supported by the Instituto de Salud Carlos III (ISCIII, PI10/02594), RECAVA RD12/0042/0050(ISCIII and FEDER), and Fundación Séneca (07703/GERM/07). ISG holds a fellowship from ISCIII (FI10/00535). CGM is supported by the Spanish Plan of Research & Development (BFU2010-15237).

Pregnancy in women with inherited thrombocytopenias is a major matter of concern as both the mothers and the newborns are potentially at risk of bleeding. However, medical management of this condition cannot be based on evidence because of the lack of consistent information in the literature. To advance knowledge on this matter, we performed a multicentric, retrospective study evaluating 339 pregnancies in 181 women with 13 different forms of inherited thrombocytopenia. Neither the degree of thrombocytopenia nor the severity of bleeding tendency worsened during pregnancy and the course of pregnancy did not differ from that of healthy subjects in terms of miscarriages, fetal bleeding and pre-term births. The degree of thrombocytopenia in the babies was similar to that in the mother. Only 7 of 156 affected newborns had delivery-related bleeding, but 2 of them died of cerebral hemorrhage. The frequency of delivery-related maternal bleeding ranged from 6.8% to 14.2% depending on the definition of abnormal blood loss, suggesting that the risk of abnormal blood loss was increased with respect to the general population. However, no mother died or had to undergo hysterectomy to arrest bleeding. The search for parameters predicting delivery-related bleeding in the mother suggested that hemorrhages requiring blood transfusion were more frequent in women with history of severe bleedings before pregnancy and with platelet count at delivery below 50 × 10(9)/L. Fil: Noris, Patrizia. Istituti di Ricovero e Cura a Carattere Scientifico. Policlinico San Matteo di Pavia; Italia. Università degli Studi di Pavia; Italia Fil: Schlegel, Nicole. Université Paris Diderot - Paris 7; Francia Fil: Klersy, Catherine. Istituti di Ricovero e Cura a Carattere Scientifico. Policlinico San Matteo di Pavia; Italia Fil: Heller, Paula Graciela. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Médicas. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones Médicas; Argentina Fil: Civaschi, Elisa. Università degli Studi di Pavia; Italia Fil: Pujol Moix, Nuria. Universitat Autònoma de Barcelona; España Fil: Fabris, Fabrizio. Università di Padova; Italia Fil: Favier, Remi. Inserm; Francia. Armand Trousseau Children’s Hospital; Francia. French Reference Center for Inherited Platelet disorders; Francia Fil: Gresele, Paolo. Università di Perugia; Italia Fil: Latger Cannard, Véronique. Centre Hospitalo-Universitaire. Service d’Hématologie Biologique; Francia. Reference French Centre. Centre de Compétence Nord-Est des Pathologies Plaquettaires; Francia Fil: Cuker, Adam. University of Pennsylvania; Estados Unidos Fil: Nurden, Paquita. Hôpital Xavier Arnozan; Francia Fil: Greinacher, Andreas. Institut für Immunologie und Transfusionsmedizin; Alemania Fil: Cattaneo, Marco. Università degli Studi di Milano; Italia Fil: De Candia, Erica. Università Cattolica del Sacro Cuore; Italia Fil: Pecci, Alessandro. Università degli Studi di Pavia; Italia Fil: Hurtaud Roux, Marie Françoise. Université Paris Diderot - Paris 7; Francia Fil: Glembotsky, Ana Claudia. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Médicas. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones Médicas; Argentina Fil: Muñiz Diaz, Eduardo. Banc de Sang i Teixits de Catalunya. Immunohematology Department; España Fil: Randi, Maria Luigia. Università di Padova; Italia Fil: Trillot, Nathalie. Centre Hospitalier Régional Universitaire de Lille. Pôle Biologie Pathologie Génétique. Institut d’Hématologie-Transfusion; Francia Fil: Bury, Loredana. Università di Perugia; Italia Fil: Lecompte, Thomas. Hôpitaux Universitaires de Genève; Suiza. Université de Genève. Faculté de Médecine; Suiza Fil: Marconi, Caterina. Università di Bologna; Italia Fil: Savoia, Anna. Università degli Studi di Trieste; Italia Fil: Balduini, Carlo L.. Istituti di Ricovero e Cura a Carattere Scientifico Burlo Garofolo. Institute for Maternal and Child Health; Italia. Università degli Studi di Pavia; Italia Fil: European Hematology Association Scientific Working Group on Thrombocytopenias and Platelet Function Disorders. No especifica

Resumen La hemorragia masiva es la principal causa de morbimortalidad en el paciente traumatizado, y una de las mas importantes en el paciente sometido a cirugia mayor. El tratamiento convencional se basaba en la reposicion inicial de la volemia con la infusion de grandes cantidades de fluidos y en la transfusion de hemoderivados, con objeto de asegurar la perfusion y oxigenacion tisular. Hipotermia, acidosis y coagulopatia se considera triada letal. En esta revision los autores abordan un enfoque terapeutico actualizado del manejo de la hemorragia masiva. Se preconiza infundir cristaloides de forma pautada (no masiva) para lograr una presion arterial sistolica de 85 mmHg. La administracion de hemoderivados debe ser precoz y con ratio 1:1:1 (cantidades equiparables de concentrados de hematies, plasma y plaquetas), y si es posible, guiada por tromboelastograma a la cabecera del paciente. La coagulopatia puede ser precoz y tardia. Salvo el acido tranexamico, se discute la relacion coste-beneficio de farmacos prohemostaticos, como fibrinogeno, complejo protrombinico, y FVII recombinante.

Para analisar a variação circadiana dos leucócitos, fibrinogênio e plaquetas, foram utilizados 20 cães machos, sem raça definida, os quais foram divididos em dois grupos de 10 animais. Os cães do grupo I foram tratados com 1,3mg/kg de escina de 12 em 12 horas e os do grupo II sem nenhum tratamento. Goletas de sangue foram feitas em todos os animais às 0 (zero), 4, 8, 12, 16, 20 e 24h do dia para exame dos leucócitos, fibrinogênio e plaquetas. A escina determinou eosinopenia às 8 e 12 horas, monocitopenia às 24h e linfocitose em relação aos animais sadios às 8, 16 e 20h. Na taxa de fibrinogênio houve aumento às 20 e 24h e nas plaquetas diminuição às 0 (zero), 8, 12, 16 e 20h. Pode-se concluir que a escina determina variações circadianas instáveis do número de alguns tipos de leucócitos, plaquetas e quantidade de fibrinogênio em cães sadios. Twenty mongrel male dogs were used to anlyse the circadian variations of leucocyte, fibrinogen and platelet values. They were divided into two groups of ten animals. The first group was treated with 1.3mg/kg of Aescin every 12 hours while the second group was left without treatment. Blood samples were collected in all animals at 0 (zero), 4am, 8am, 12am 4pm, 8pm and 12pm hours of the day to determine leucocyte and platelet count and to evaluate fibrinogen. Aescin produced: eosinopenia at 4am, 8am, 12am and 4pm hours; neutrophilia at 8am, 12am, 8pm, and 12pm hours; monocytopenia at 12pm hour and lymphopenia at 8am, 4am, 8pm an 12pm hours. There was an increase in fibrinogen level at 8pm and 12pm and a decrease in the platelet number at 0 (zero), 8am, 12am, 4pm and 8pm hours. Aescin determines unstable circadian variations in the number of leucocytes, platelets and in the amount of fibrinogen in health dogs.

La hemorragia masiva es la principal causa de morbimortalidad en el paciente traumatizado, y una de las más importantes en el paciente sometido a cirugía mayor. El tratamiento convencional se basaba en la reposición inicial de la volemia con la infusión de grandes cantidades de fluidos y en la transfusión de hemoderivados, con objeto de asegurar la perfusión y oxigenación tisular. Hipotermia, acidosis y coagulopatía se considera triada letal. En esta revisión los autores abordan un enfoque terapéutico actualizado del manejo de la hemorragia masiva. Se preconiza infundir cristaloides de forma pautada (no masiva) para lograr una presión arterial sistólica de 85mmHg. La administración de hemoderivados debe ser precoz y con ratio 1:1:1 (cantidades equiparables de concentrados de hematíes, plasma y plaquetas), y si es posible, guiada por tromboelastograma a la cabecera del paciente. La coagulopatía puede ser precoz y tardía. Salvo el ácido tranexámico, se discute la relación coste-beneficio de fármacos prohemostáticos, como fibrinógeno, complejo protrombínico, y FVII recombinante. Massive hemorrhage is the main cause of mortality and morbidity in trauma patients, and is one of the most important causes in any patient following major surgery. Conventional treatment consists of volume replacement, including the transfusion of blood products, so that tissue perfusion and oxygenation may be maintained. Associated hypothermia, acidosis and coagulopathy is a lethal triad. This review focuses on the latest therapeutic management of massive hemorrhage. The authors advocate the use of crystalloids as per protocol (controlled volumes) in order to achieve a systolic blood pressure of 85mmHg. The administration of the three blood products (red cells, plasma, and platelets) should be on a 1:1:1 basis. Where possible, this in turn should be guided by thromboelastography performed at point of care near the patient. Coagulopathy can occur early and late. With the exception of tranexamic acid, the cost-benefit relationships of the hemostatic agents, such as fibrinogen, prothrombin complex, and recombinant F VII, are subject to discussion.

RACIONAL: Sabe-se que tanto a leucopenia quanto a plaquetopenia têm relação direta com a esplenomegalia, mas não existem estudos correlacionando de forma direta ou precisa o tamanho do baço com o número de plaquetas. Ainda há controvérsia se a plaquetopenia observada em pacientes com doenças hepáticas crônicas está mais relacionada à esplenomegalia ou à própria hipertensão portal. OBJETIVO: Correlacionar o nível sérico das plaquetas nos períodos pré e pós-operatório imediato com peso e volume do baço em pacientes portadores da forma hepatoesplênica da esquistossomose com indicação para tratamento cirúrgico da hipertensão portal. MÉTODO: Foram analisados os prontuários de pacientes portadores da forma hepatoesplênica da esquistossomose mansônica submetidos a tratamento cirúrgico da hipertensão portal. Foram incluídos portadores com a doença confirmada pelo diagnóstico anatomopatológico da biópsia hepática realizada no período intra-operatório. Foram excluídos todos os doentes que apresentavam antecedentes de etilismo crônico, hepatite viral, evidências clínico-laboratoriais de insuficiência hepática ou alterações histopatológicas compatíveis com cirrose hepática. Foram avaliados: o tamanho e volume do baço; o nível sérico de plaquetas; o número de plaquetas. RESULTADOS: Foram identificados 141 pacientes que preenchiam os critérios de inclusão do total de 160 prontuários analisados. A idade média foi de 39,03 ± 12,74 anos (15 a 74 anos), sendo 84 homens (59,5%) e 57 mulheres (40,5%). O peso médio do baço foi de 966,27 ± 464,61 g (120 a 2700 g). O volume elíptico médio foi de 966,68 ± 499,12 cm3 (236,13 a 2782,36 cm³. Houve correlação estatisticamente significativa entre o peso e o volume elíptico do baço (p

OBJETIVO: Avaliação dos efeitos hemostáticos e plaquetários em crianças submetidas a correção de cardiopatias congênitas acianogênicas com circulação extracorpórea que receberam aprotinina. MÉTODOS: Estudo prospectivo randomizado em crianças de 30 dias a 4 anos de idade, submetidas a correção de cardiopatia congênita acianogênica, com circulação extracorpórea (CEC) e divididas em dois grupos, um denominado Controle (n=9) e o outro, Aprotinina (n=10). Neste, a droga foi administrada antes e durante a CEC. A disfunção hemostática foi analisada por marcadores clínicos e bioquímicos. Foram consideradas significantes as diferenças com P

La polución aérea es una mezcla heterogénea de gases, líquidos y material particulado (MP) presente en el mundo urbano moderno. El MP varía en tamaño, desde pocos nanómetros hasta 10 micras de diámetro. Se ha observado que la exposición a MP se asocia a un mayor riesgo de enfermedades cardiovasculares. Al respecto se ha planteado tres posibles mecanismos: inducción de inflamación sistémica y/o estrés oxidativo; alteraciones en el balance de autonomía cardiaca; y, acción directa sobre el sistema circulatorio, causando vasoconstricción aguda, disfunción endotelial y estado protrombótico. Hay evidencias que indican que la polución aérea se asocia con el acortamiento del tiempo de protrombina, disminución del activador del plasminógeno tisular, aumento de fibrinógeno, factor VIII y factor von Willebrand e hiperactividad plaquetaria., Air pollution is a heterogenic mixture of gases, liquids and particulate matter (PM) present in the urban modern world. PM rates vary in size from a few nanometers to 10 micra diameter. The exposure to PM is associated to a major risk of cardiovascular diseases as explained by three mechanisms: induction of systemic inflammation and/or oxidative stress, alteration in the cardiac autonomic balance and direct action on the circulatory system, causing acute vasoconstriction, endothelial dysfunction and prothrombotic state. There is evidence suggesting that air pollution is associated with shortened prothrombine time, decrease in tissue plasminogen activator, increase of fibrinogen, factor VIII and factor von Willebrand, and platelet hyperactivity.

Se evaluó el efecto clínico de la inyección intraarticular de un concentrado autólogo de plaquetas (APC) en 7 caballos con enfermedad articular grave (4 con osteoartritis y 3 con osteocondrosis). Se documentó el grado de cojera (GC) y distensión articular (DA). Se aplicaron tres inyecciones de APCs con un intervalo de dos semanas entre cada aplicación. Los caballos fueron evaluados antes de cada inyección y dos meses después del último tratamiento. Se realizó seguimiento clínico durante un año. Se determinaron los niveles de plaquetas y leucocitos y los niveles de factor de crecimiento transformante beta 1 (TGF-β1) por ml de APC. El APC preparado presentó un promedio de 250 (rango: 140-480) x 10(6) plaquetas y 8,68 (3,3-18) x 10(6) leucocitos por y 12,5 (3-15) ng de TGF-β1 La inyección de los APCs produjo una mejoría clínica en el GC y DA. La mejoría más marcada se observó dos meses después del último tratamiento y persistió durante ocho meses posinyección. No se observaron signos clínicos adversos significativos asociados al tratamiento. A pesar de los efectos aparentemente positivos del APC no se puede recomendar el uso de esa sustancia, hasta que no haya un suficiente número de casos clínicos preferiblemente evaluados mediante un estudio doble ciego controlado.

OBJETIVO: Avaliar a importância da interação entre a integrina Mac-1 dos leucócitos (a Mb 2) e a glicoproteína (GP) Iba das plaquetas para o recrutamento de leucócitos após a lesão vascular e o efeito da neutralização da interação Mac-1-GPIba sobre a proliferação celular e a hiperplasia neointimal desencadeadas por lesão vascular. MÉTODOS: Um peptídeo denominado M2 ou anticorpo anti-M2 foi desenvolvido para bloquear a interação Mac-1-GPIba . Esse peptídeo foi injetado e comparado com anticorpo-controle em camundongos C57B1/6J submetidos a lesão vascular da artéria femoral com corda-guia. Um, cinco ou 28 dias após a lesão vascular, as artérias femorais foram retiradas para a realização de morfometria e imuno-histoquímica. RESULTADOS: O bloqueio da interação Mac-1-GPIba promoveu uma redução estatisticamente significativa do número de leucócitos na camada média no primeiro dia após a lesão vascular (controle: 7,9±5,0% do total de células versus anti-M2: 2,0±1,6%, p=0,021), bem como determinou uma diminuição estatisticamente significativa do acúmulo de leucócitos na neoíntima em cinco e 28 dias (controle: 42,3±12,9% versus anti-M2: 24,6±10,8%, p=0,047 e controle: 7,9±3,0% versus anti-M2: 3,3±1,3%, p=0,012; respectivamente). A proliferação celular na camada média do vaso em cinco dias pós-lesão foi reduzida com o bloqueio da interação Mac-1-GPIba (controle: 5,0±2,9% do total de células versus anti-M2: 1,8±0,5%; p=0,043), assim como houve diminuição significativa da proliferação celular na camada íntima do vaso em 28 dias (controle: 3,8±1,7% versus anti-M2: 2,0±1,2%; p=0,047). O bloqueio da interação Mac-1-GPIba também determinou uma redução estatisticamente significativa do espessamento intimal em 28 dias pós-lesão (controle: 10.395±3.549 µm² versus anti-M2: 4.561±4.915 µm²; p=0,012). CONCLUSÃO: O recrutamento de leucócitos após a lesão vascular é dependente da interação Mac-1-GPIba e a neutralização dessa interação inibe a proliferação celular e a formação neointimal. OBJECTIVE: To assess the importance of the interaction between leukocyte integrin Mac-1 (a Mb 2) and platelet glycoprotein (GP) Ib-a for leukocyte recruitment after vascular injury and the effect of the neutralization of the Mac-1-GPIba interaction on cell proliferation and the neointimal hyperplasia triggered by the vascular injury. METHODS: A peptide called M2 or anti-M2 antibody was developed to block the Mac-1-GPIba interaction. This peptide was injected and compared to a control-peptide in C57B1/6J mice submitted to vascular injury of the femoral artery with a guide wire. One, five or 28 days after the vascular injury, the femoral arteries were removed for morphometric and immunohistochemical analyses. RESULTS: The blocking of the Mac-1-GPIba interaction promoted a statistically significant reduction in the number of leukocytes in the neointimal layer on the first day after the vascular injury (control: 7.9±5.0% of the cell total versus anti-M2: 2.0±1.6%, p=0.021), as well as determined a statistically significant decrease in leukocyte accumulation in the neointimal layer on days 5 and 28 (control: 42.3±12.9% versus anti-M2: 24.6±10.8%, p=0.047 and control: 7.9±3.0% versus anti-M2: 3.3±1.3%, p=0.012; respectively). Cell proliferation in the neointimal layer of the vessel five days post-injury was reduced with the blocking of the Mac-1-GPIba interaction (control: 5.0±2.9% of the cell total versus anti-M2: 1.8±0.5%; p=0.043), along with a significant decrease in cell proliferation in the vessel neointimal layer 28 days post-injury (control: 3.8±1.7% versus anti-M2: 2.0±1.2%; p=0.047). The blocking of the Mac-1-GPIba interaction also determined a statistically significant decrease of the intimal thickening 28 days post-injury (control: 10,395±3,549 µm² versus anti-M2: 4,561±4,915 µm²; p=0.012). CONCLUSION: Leukocyte recruitment after a vascular injury depends on the Mac-1-GPIba interaction and the neutralization of this interaction inhibits cell proliferation and neointimal formation.

espanolObjetivo: Se valoro la eficacia de la aplicacion subconjuntival de concentrado de plaquetas plasmaticas autologas en pacientes con quemaduras oculares. Metodo: Para ello se analizaron 10 ojos de 10 pacientes que sufrieron accidentes laborales por quemaduras oculares del mismo grado. Se establecieron dos tipos de tratamiento: al primer grupo, control, se le aplico tratamiento medico topico convencional; al segundo, se le anadio ademas, inyeccion subconjuntival de concentrado de plaquetas autologas. Se estudio la evolucion clinica, dias que le incapacitaron dicha patologia para su actividad laboral y seguimiento hasta su curacion final. Resultados: Se encontraron diferencias entre el grupo de los tratados con concentrado de plaquetas autologas subconjuntivales respecto al grupo con tratamiento medico topico convencional, siendo mas corto el tiempo de cicatrizacion de cornea (significativamente estadistico), conjuntiva, baja laboral y tiempo hasta curacion final. Conclusiones: Podemos considerar la autoplaquetoterapia subconjuntival (infiltracion subconjuntival de concentrado de plaquetas autologas) como un tratamiento sencillo y economico en el tratamiento de las alteraciones traumaticas (quemaduras) de la superficie ocular. Cuya eficacia debera ser confirmada por series mayores. EnglishPurpose: The efficiency of the subconjunctival application of autologous platelet concentrate in patients with ocular burns was assessed. Methods: This was carried out by analysing the effect of treatment in the eyes of 10 patients suffering from ocular burns as a result of work-related accidents. Two types of treatment were evaluated: the first group only received conventional topical medical treatment; and the second group, in addition, had subconjunctival injection of plasma platelet concentrate. The clinical condition of the patient and the period in which the disease prevented the patient from working were studied; monitoring was carried out until the burns had fully healed. Results: Statistically significant differences were found between the group treated with subconjunctival autologous platelet concentrate and the group treated with conventional topical medications, with a shorter period of time in corneal and conjunctival healing, time on sick leave and time needed for full healing. Conclusions: Subconjunctival infiltration of autologous platelet concentrate should be considered as a straightforward, economical and possibly effective form of treatment for traumatic accidents (burns) of the ocular surface

O objetivo deste estudo foi avaliar a ativação plaquetária através da P-selectina e o conteúdo de PDGF-AB e TGFbeta1, nos pacientes com esquistossomose que desenvolveram fibrose (F3), naqueles que não tiveram esta manifestação (F0) e nos controles (C). Os resultados mostraram que a percentagem de P-selectina nas plaquetas sem estímulo de agonistas foi de 10,6% nos F3; 11,1% nos FO, e 6,3% nos C e após a adição de ADP/adrenalina, foi de 44%; 25,3% e 42%, respectivamente. A dosagem do PDGF-AB e TGFbeta1 por plaquetas foi de 11,016ng/dL (F3); 3,172 ng/dL (F0) e 5,01ng/dL (C) e, (0,012ng/dL (F3); 5,27ng/dL (F0) e 4,66ng/dL (C), respectivamente. Em relação à P-selectina, concluímos que as plaquetas dos pacientes com esquistossomoses, apesar de estarem pré ativadas, mantiveram-se responsivas aos agonistas. O TFGbeta1 não apresentou diferença entre os três grupos, enquanto o PDGF-AB foi significantemente maior no grupo F3, sugerindo a participação deste no desenvolvimento da fibrose.