A defect in hemostasis has been repeatedly reported in patients with cirrhosis. However, the nature of this defect has not been fully characterized. We explored adhesive and cohesive functions of platelets from cirrhotic patients at different stages of disease development. The response of platelets to standard activating agents was tested by aggregometric procedures. The interaction of platelets with subendothelial components was explored in a perfusion system in which blood was exposed (shear rate, 800/s; 10 minutes) to denuded segments of rabbit aorta. Platelet interactions in these perfusions were analyzed morphometrically. Results were always compared with those obtained in similar studies using blood obtained from healthy subjects. Aggregation studies showed abnormal responses for single or several agonists. Abnormalities in aggregation were more evident in patients with severe disease (Child-Pugh class C), although they occasionally were abnormal for single agonists (ADP or U46619) in patients with less severe disease (Child-Pugh classes A or B). All the patient classes showed impaired platelet-subendothelial interactions (P < .01 vs. healthy subjects) that were not justified by the relative thrombocytopenia present in the more severely affected patients. Experimental increases in hematocrit in patients at stages B and C did not improve platelet-subendothelial interactions. Platelets from cirrhotic patients interact defectively with subendothelial components under flow conditions. The adhesion defect is more evident and consistent than the aggregation defects and may already be present in patients with mild liver failure. This adhesion defect may contribute to the defective hemostasis observed in cirrhotic patients.

A defect in hemostasis has been repeatedly reported in patients with cirrhosis. However, the nature of this defect has not been fully characterized. We explored adhesive and cohesive functions of platelets from cirrhotic patients at different stages of disease development. The response of platelets to standard activating agents was tested by aggregometric procedures. The interaction of platelets with subendothelial components was explored in a perfusion system in which blood was exposed (shear rate, 800/s; 10 minutes) to denuded segments of rabbit aorta. Platelet interactions in these perfusions were analyzed morphometrically. Results were always compared with those obtained in similar studies using blood obtained from healthy subjects. Aggregation studies showed abnormal responses for single or several agonists. Abnormalities in aggregation were more evident in patients with severe disease (Child-Pugh class C), although they occasionally were abnormal for single agonists (ADP or U46619) in patients with less severe disease (Child-Pugh classes A or B). All the patient classes showed impaired platelet-subendothelial interactions (P < .01 vs. healthy subjects) that were not justified by the relative thrombocytopenia present in the more severely affected patients. Experimental increases in hematocrit in patients at stages B and C did not improve platelet-subendothelial interactions. Platelets from cirrhotic patients interact defectively with subendothelial components under flow conditions. The adhesion defect is more evident and consistent than the aggregation defects and may already be present in patients with mild liver failure. This adhesion defect may contribute to the defective hemostasis observed in cirrhotic patients.

To describe transscleral ultrasonography as a novel alternative approach for visualising the optic nerve sheath and measuring its diameter and to analyse the linear regressions of the optic nerve sheath diameter value with the weights and morphometric measurements of the globe in dogs. Forty healthy dogs admitted for routine sterilisation were examined. Under general anaesthesia, a B-mode ultrasonography with a linear probe (9–18 MHz) was applied transscleral in the dorso-temporal quadrant. The optic nerve sheath diameter was measured 3 mm behind the caudal aspect of the globe. The morphometric measurements, including the axial globe, lens thickness and vitreous chamber, were estimated by two observers using the direct corneal approach. Univariate and multivariate multiple linear regression analyses were performed to explore the associations of the independent predictors with dependent variables. The optic nerve sheath diameter intraclass correlation coefficient (ICC) analyses revealed interobserver 0.91 (ICC = 0.83–0.95) and intraobserver 0.93 (ICC = 0.87–0.96) reliability. The multiple regression analysis revealed that the optic nerve sheath diameter was associated with the weight (R² = 0.60, P &lt; 0.0001) but not with the axial globe (P = 0.48), the lens thickness (P = 0.73) or the vitreous chamber (P = 0.99). The findings of this study suggest that transscleral ultrasonography may be a valid alternative approach for the optic nerve visualisation and optic nerve sheath diameter measurements with excellent intra- and interobserver repeatability. The optic nerve sheath diameter was associated with the body weight, but not with the morphometric measurements of the globe.

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