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- Title
Role of platelets in thrombin generation amongst patients with non-transfusion-dependent thalassaemia.
- Authors
Tan, Chuen Wen; Wong, Wan Hui; Idros, Roserahayu; Chan, Yiong Huak; Kaur, Hartirathpal; Tng, Alvin Ren Kwang; Lee, Lai Heng; Ng, Heng Joo; Ang, Ai Leen
- Abstract
Non-transfusion-dependent thalassaemia (NTDT) is associated with a hypercoagulable state with thrombotic risk highest after splenectomy. Various mechanisms have been proposed. Although an antiplatelet agent is commonly recommended as thromboprophylaxis in NTDT, the role of platelets contributing to this hypercoagulable state is not well-defined. This study aims to evaluate the role of platelets contributing to hypercoagulability in NTDT patients using thrombin generation (TG). Platelet-rich (PRP) and platelet-poor plasma (PPP) were collected from NTDT patients (n = 30) and normal controls (n = 20) for TG measurement and compared. Controls had higher endogenous thrombin potential (ETP) in PPP (1204.97 nM.min vs 911.62 nM.min, p < 0.001) and PRP (1424.23 nM.min vs 983.99 nM.min, p < 0.001) than patients. Patients' mean normalized ETP ratio [{PRP ETP (patient)/PPP ETP (patient)}/{mean PPP ETP (controls)/mean PPP ETP (controls)}], demonstrated that the presence of platelet does not alter ETP (mean ratio 0.97, 95% CI 0.93-1.02, equivalence defined as 10%). Types of thalassaemia, splenectomy, and severity of liver iron overload did not significantly influence patients' ETP in PPP and PRP by multivariate analysis. Platelets did not increase the TG potential of NTDT patients. Instead of being hypercoagulable, our NTDT patients were hypocoagulable by ETP measurement, although this could not be conclusively demonstrated to correlate with their iron overloading state giving rise to reduced synthesis of coagulation factors. The guideline recommendations for thromboprophylaxis with antiplatelet agents in similar NTDT patients should be re-examined.
- Subjects
REPRODUCTION; BLOOD coagulation factors; BLOOD diseases; BLOOD plasma; BLOOD platelets; CLINICAL trials; COMPARATIVE studies; IRON in the body; RESEARCH methodology; MEDICAL cooperation; RESEARCH; SPLENECTOMY; THALASSEMIA; THROMBIN; EVALUATION research; ARTHRITIS Impact Measurement Scales
- Publication
Annals of Hematology, 2019, Vol 98, Issue 4, p861
- ISSN
0939-5555
- Publication type
journal article
- DOI
10.1007/s00277-018-3579-z