特发性血小板减少性紫癜患者血小板相关抗体及网织血小板检测的临床意义

目的探讨血小板相关抗体(PAIgG)和网织血小板(RP)检测在特发性血小板减少性紫癜(ITP)治疗中的临床意义。方法收集常州市第一人民医院2003-06～2004-10住院的ITP患者48例,根据疗效分为两组,其中临床有效组40例,临床无效组8例,以50例健康人为正常对照。应用流式细胞仪(FCM)测定其治疗前后血浆和(或)血清PAIgG及RP%,并常规血小板计数。结果ITP患者临床有效组治疗后较治疗前血小板计数明显升高、PAIgG和RP%显著降低(P<0.01)。临床无效组治疗前后血小板计数、PAIgG和RP均无明显变化(P>0.05)。两组治疗前3项指标与对照组比较差异有显著性意义(P<0.01)。结论PAIgG和RP动态检测将是ITP患者血小板治疗效果的预测指标之一。     

老年血小板减少患者网织血小板测定及意义

血小板减少症为血液系统常见疾病 ,多见于儿童及中青年 ,老年人相对较少。我们应用流式细胞仪测定了 41例老年血小板减少患者及 50例正常老年人外周血网织血小板 (RP) ,研究其对老年人血小板减少性疾病的诊断价值和意义。1　材料和方法1.1　对象　 41例老年血小板减少患者均来自本院血液科门诊及住院病人 ,根据张之南主编的《血液病诊断及疗效标准》[1],其中特发性血小板减少性紫癜(ITP) 2 6例 ,男 10例 ,女 16例 ,年龄 60～76岁 ,平均 (68 7± 4 7)岁 ;再生障碍性贫血 (AA) 6例 ,男 4例 ,女 2例 ,年龄 61～ 72岁 ,平均 (66 5± 2 6)岁 …     

特发性血小板减少性紫癜患者血小板抗体等四项参数测定的价值

目的　探讨特发性血小板减少性紫癜 (ITP)患者血小板抗体 (PAIgG)、血小板膜蛋白(CD62P)、网织血小板 (RP)及淋巴细胞亚群变化及意义。方法　应用流式细胞术检测 5 8例ITP组及 2 0例正常对照组外周PAIgG、血CD62P、RP、淋巴细胞亚群的表达。结果　ITP组的血小板数明显低于正常对照组 (P <0 .0 1) ,PAIgG、CD62P、RP均明显高于正常对照组 (P <0 .0 1)。在淋巴细胞亚群中 ,ITP组CD3、CD4、CD4/CD8比值明显低于正常对照组 (P <0 .0 1) ,CD8、CD19细胞则显著高于正常对照组 ,而CD16+ 5 6与正常对照组无明显差异。结论　PAIgG、CD62P、RP及淋巴细胞亚群的变化可较好地反映ITP这一病理过程 ,对提高诊断水平及指导临床有一定实用价值。     

网织血小板检测在特发性血小板减少性紫癜中的临床价值

特发性血小板减少性紫癜(ITP)是一种因为产生抗自身血小板抗体促使血小板减少而使机体器官受损的特异性自身免疫性疾病。血小板减少引起的出血是ITP较常见的表现之一。血小板减少的主要原因大致为两类：血小板生成减少和血小板破坏加速。网织血小板(RP)是新释放入血液循环的血小板，是富含RNA类似于网织红细胞(Ret)的最年轻的血小板。RP的数目反映了人体血小板的更新速度、血小板增生情况。2002年11月～2003年4月我们检测了50例健康人、48例ITP患者、35例急性白血病、25例再生障碍性贫血外周血的RP，旨在探讨RP在特发性血小板减少性紫癜诊断和治疗中的临床价值，以便更好为临床上诊治ITP提供一种新的手段。     

网织血小板测定对血小板减少疾病诊断价值的探讨

目的　探讨外周血网织血小板 (RP)数值的变化对各型血小板减少疾病的诊断价值 ;外周血RP与骨髓中巨核细胞 (MK)增生程度的关系。方法　以噻唑橙作为RNA的荧光染料 ,利用流式细胞仪测定外周血中含有RNA的RP ,并计算RP(% )及RP绝对值。结果　 (1)正常对照组 :RP(8 4±2 5 ) % ,RP绝对值为 (16 8± 6 8)× 10 9/L。 (2 )原发性血小板减少性紫癜 (ITP)和脾功能亢进症患者RP(% )显著高于正常对照组 ,而RP绝对值显著低于正常对照组 (P <0 0 1) ,在不同MK增生级别的ITP患者中 ,RP(% )、RP绝对值在各组之间均无差异 ;再生障碍性贫血患者RP(% )及绝对值均低于正常对照组 (P <0 0 5 ,P <0 0 1) ;而急性白血病、骨髓增生异常综合征患者RP(% )与正常对照组无明显差异 (P >0 0 5 ) ,但其RP绝对值明显低于正常对照组 (P <0 0 1)。 (3)上述疾病患者 ,经治疗有效者RP(% )恢复正常 ,而无效或疗效欠佳者 ,则RP(% )几无变化。结论　外周血RP测定 ,有助于血小板减少疾病的病因学诊断 ,是血小板减少疾病一有价值的诊断依据 ,也是疗效判断的监控指标。外周血RP与骨髓中MK增生的程度无相关性     

环孢菌素Ａ治难性特发性血小板养活性紫癜的疗效

特发性血小板减少性紫癜 ( ITP)是常见的出血性疾病 ,传统的治疗方法能使大多数患者缓解 ,经治疗无效的即所谓“难治性 ITP”。有文献报告用环孢菌素 ( Cs A)治疗难治性 ITP取得良好效果〔1〕。我院自 1 990年以来采用 Cs A治疗难治性 ITP 1 5例 ,并随访 1年 ,现将疗效报告如下。1　资料与方法1 .1　临床资料1 5例均为住院患者 ,男 4例 ,女 1 1例 ,年龄 1 7～ 47岁 ,平均 31 .5岁。其诊断均符合 1 986年 1 2月首届全国血栓与止血学术会议所制定的诊断标1山东东营市人民医院血液科 (山东东营 ,2 5 70 91)2山东东营市东营区机关门诊部…     

山莨菪碱联合血浆置换对老年血栓性血小板减少性紫癜患者网织红细胞计数的影响

<正>据流行病学调查显示血栓性血小板减少性紫癜(TTP)患病率约为3.7/100万〔1〕,TTP以微血管病性溶血性贫血主要特征,常伴有神经精神异常、肾脏损害、发热、出血等症状和体征的血栓性微血管病。老年TTP患者因红细胞变形能力差,红细胞容易破碎,微血管溶血性贫血尤其突出。本文观察山莨菪碱联合血浆置换(PE)对TTP患者细胞百分数(Ret%)的影响。     

特发性血小板减少性紫癜的治疗

特发性血小板减少性紫癜(idiopathic thrombo—cytopenic purpura,ITP)是一种由自体免疫介导的血小板破坏,导致血小板数量减少,该病是临床上最常见的一种血小板减少性疾病。成人ITP多见于18～40岁的女性患者,国外资料显示,男：女比例为1．7：1～1．2：1,诊断时的平均年龄为56～60岁。     

网织血小板在血小板减少性疾病中的临床意义

网织血小板;血小板减少症特发性血小板减少性紫癜（rrP）是因免疫机制使血小板破坏增多的临床综合征。血小板减少原因归为两类：血小板生成减少和血小板消耗或破坏过多。网织血小板（RP）是新近从骨髓中释放入外周血中的血小板,RP数目反映了人体血小板的更新速度、血小板生成能力。2002年11月-2004年6月我们检测50例健康人、48例ITP病人和其中30例获完全缓解ITP及35例急性白血病（AL）、25例慢性再生障碍性贫血（CAA）外周血的RP％和绝对计数,旨在初步探讨RP在血小板减少性疾病中的临床意义。     

妊娠合并特发性血小板减少性紫癜

特发性血小板减少性紫癜（ITP）是一种以外周血小板数目持续减少为特征的自身免疫性疾病。在成人中好发于40岁以下育龄女性,且不影响生育功能,所以妊娠合并ITP是临床医生经常遇到的问题,其机率报道不一,约为1～2／1000名妊娠妇女,     

Measurement of reticulated platelets by simple flow cytometry: An indirect thrombocytopoietic marker

BACKGROUND: The aim of this study was to determine whether measurement of reticulated platelets (RP) by flow cytometry directly from whole blood, with no fixation or manipulation, is as useful a thrombocytopoietic marker as other more complex techniques. METHODS: RP percentage was prospectively assessed in thrombocytopenic patients (platelets <100x10(9)/L) and non-thrombocytopenic controls using a direct, whole-blood, dual-labelling flow cytometric method. Direct, whole-blood double coverage was achieved using a monoclonal antiglycoprotein (GP)-III antibody (CD61-PerCP(R)) for platelet identification and thiazol orange (Retic-count(R)) as platelet mARN stain. After establishing thrombocytopenia etiology, patients were grouped according to whether their rate of thrombopoiesis was increased or decreased. RESULTS: RP were measured in 53 thrombocytopenic patients with several etiologies and in 53 non-thrombocytopenic controls. The mean RP in 14 thrombocytopenic patients with no increased thrombopoietic activity was 4.8% (95% CI: 3.2-6.4) and the RP absolute number was 1.98x10(9)/L (95% CI: 1.3-2.6). The mean RP in 17 thrombocytopenic patients with increased thrombopoietic activity was 29.4% (95% CI: 24.7-34.1) and the RP absolute number was 7.24x10(9)/L (95% CI: 4.9-9.5). CONCLUSIONS: RP measurement by flow cytometry, directly from whole blood without manipulation, is a useful screening test to differentiate thrombocytopenia with high or low thrombopoietic activity.     

Acute idiopathic thrombocytopenic purpura in children

Acute idiopathic thrombocytopenic purpura (ITP) characteristically follows a viral illness in preschool children. The exact role of viruses in the pathogenesis of this disorder remains uncertain, but the finding of markedly elevated levels of platelet-associated IgG serves to distinguish it from the chronic form of the disease and permits speculation on the mechanisms of platelet destruction. Although the spleen is important in both antibody production and platelet destruction, bone marrow synthesis of IgG has also been shown to be increased. The clinical course may be alarming, but mortality is low and prognosis excellent. Controversy has surrounded the role of steroids in the management of acute childhood ITP in retrospective studies. Controlled studies, however, indicate that thrombocytopenia is reversed sooner in treated patients. New assays for platelet-associated IgG offer new insights into this disorder and will allow delineation of acute and chronic disease at the time of diagnosis.     

Studies of a patient with recurring thrombotic thrombocytopenic purpura

A young woman with recurring bouts of thrombotic thrombocytopenic purpura presented an opportunity to study a single patient serially and in depth. This patient underwent 12 remissions in response to fresh frozen plasma, and as little as 250 ml of plasma or plasma from which cryoprecipitate had been extracted was efficacious. Neither the Lian factor nor alterations in either cold-insoluble globulin or protein C could be demonstrated. Evidence in support of the concept of “exhausted” platelets was generated, in that immediately before a thrombocytopenic relapse, platelet function was altered as manifested by bruising, prolongation of the bleeding time, and decreased platelet aggregation. The in vitro addition of normal plasma to such platelets did not improve aggregation. The antiplatelet agent sulfinpyrazone did not seem to add efficacy. Serial observations support the hypothesis that the progression of pathophysiologic events in this patient is: exhausted platelets, thrombocytopenia, hemolysis, renal perturbations, and central nervous system dysfunction.     

Usefulness of measurement of reticulated platelets for diagnosis of idiopathic thrombocytopenic purpura.

Reticulated platelets (RP) and large platelets (LP) were measured by an automated hematology analyzer (modified R-2000) in 287 healthy volunteers and 131 patients with thrombocytopenia or thrombocytosis. RP was significantly higher in patients with idiopathic thrombocytopenic purpura (ITP), especially in active phase, while RP was markedly lower in patients with essential thrombocytosis (ET) or chronic myelocytic leukemia (CML). LP was significantly higher in patients with ITP, especially in active phase, while LP was markedly lower in patients with aplastic anemia (AA), ET, or CML. In ITP, RP and LP were significantly higher in patients positive for anti-glycoprotein (Gp) IIb/IIIa antibody. RP and LP were poorly correlated with platelet-associated IgG (PAIgG). RP and LP were poorly correlated with plasma thrombopoietin levels, and negatively correlated with platelet count. These results show that RP reflects the pathology of thrombocytopenic disorders, and that measurement of RP is useful for the differential diagnosis and analysis of platelet kinetics.     

Automated measurement of reticulated platelets in estimating thrombopoiesis

Abstract: We described a fully automated measurement of reticulated platelets using a fluorescent dye, auramine O, and a reticulocyte counter, the R-3000, equipped with special software. Reproducibility and linearity were shown to be good. In the normal subjects studied (n = 60), the mean value for reticulated platelets was 0.98% ± 0.41% and the mean absolute count was 2.12 ± 0.69 × 10⁹/l. The absolute count for reticulated platelets was significantly lower (p < 0.05) in patients with reduced thrombopoiesis as seen in acute myeloblastic leukemia, aplastic anemia or chemotherapy-induced thrombocytopenia and it was elevated (p < 0.05) in essential thrombocythemia and in chronic myelocytic leukemia with thrombocytosis. All 20 patients with chronic idiopathic thrombocytopenic purpura had a high percentage of reticulated platelets. The percentage of reticulated platelets was significantly increased (p < 0.05) in patients with impaired thrombopoiesis despite the reduction in the absolute count. In 2 leukemic patients, an apparent rise was noticed in the percentage of reticulated platelets which preceded by several days a progressive increase in the platelet count at the recovery phase of thrombocytopenia. The results suggest that an automated measurement of reticulated platelets can be applied to routine laboratories for clinical use.     

细胞凋亡和增殖在特发性血小板减少性紫癜中的作用

目的为了探讨特发性血小板减少性紫癜(ITP)患者外周血淋巴细胞凋亡的特征和抗凋亡的bcl-xl蛋白及p65的变化情况以及肾上腺糖皮质激素治疗对其的影响.方法采用肾上腺糖皮质激素治疗的ITP患者,取静脉血标本,用原位细胞凋亡(TUNEL染色)来检测外周血淋巴细胞凋亡情况;免疫组化方法检测bcl-xl蛋白、p65,检测淋巴细胞抗凋亡的增殖能力.结果 ITP患者,肾上腺糖皮质激素治疗前外周血淋巴细胞凋亡明显减少,凋亡指数下降;治疗达到缓解后,淋巴细胞凋亡明显增多,凋亡指数上升,TUNEL染色阳性细胞明显增多;bcl-xl蛋白、p65在DEX治疗前是升高的,治疗后显著下降(P<0.05);凋亡指数与bcl-xl、p65呈负相关.结论 ITP患者淋巴细胞凋亡和增殖的异常是ITP发病的重要机制.     

Clinical significance of serum cytokine levels and thrombopoietic markers in childhood idiopathic thrombocytopenic purpura

Background

Biological markers useful for defining children with newly diagnosed immune thrombocytopenic purpura (ITP) who are likely to develop the chronic form of the disease are partially lacking. The purpose of this study was to assess the clinical role of both immunological and thrombopoietic markers in children with ITP and correlate their levels with different disease stages.

Materials and methods

We enrolled 28 children with ITP at the onset of their disease, who were followed-up for a whole year and divided according to whether their disease resolved within the 12 months (n=13) or became chronic (n=15), 11 subjects with chronic ITP off therapy for at least 1 month at the time of enrolment, and 30 healthy matched controls. Serum levels of T helper type 1 and 2 and T regulatory-associated cytokines, such as interferon γ, tumour necrosis factor α, interleukin (IL) 2, IL6, IL10, and thrombopoietin were measured in all children using quantitative immunoenzymatic assays, while reticulated platelets were evaluated by flow cytometric analysis.

Results

Serum IL10 levels were significantly higher in patients with an acute evolution of ITP than in either healthy controls (p<0.001) or patients with chronic progression of ITP (p<0.05). Reticulated platelet count and thrombopoietin levels were significantly higher in ITP patients at the onset of their disease, whether with acute resolution or chronic progression, than in healthy subjects (p<0.01; p<0.001), but did not differ between the groups of patients.

Conclusion

IL-10 seems to predict the clinical course of ITP, as it is significantly higher at the onset of disease in patients who obtain disease remission in less than 1 year.