Platelet Kinetics and Laboratory Evaluation of Thrombocytopenia

Wasserkrug‐Naor, Adi

doi:10.1002/9781119500537.ch78

Cited by 8 publications

(19 citation statements)

References 96 publications

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“…The platelet change was defined as the difference between the pre‐ and posttransfusion platelet counts; the value was positive if the patient's platelet count increased posttransfusion and negative if the platelet count decreased posttransfusion. All platelet counts were measured with a hematology analyzer a or estimated via blood smear evaluation by the primary clinician or the reference laboratory 7 . For automated platelet counts, a blood smear was reviewed to assess for platelet clumping and the presence of macroplatelets.…”

Section: Methodsmentioning

confidence: 99%

“…All canine PC transfusions performed at the William R. Pritchard with a hematology analyzer a or estimated via blood smear evaluation by the primary clinician or the reference laboratory. 7 For automated platelet counts, a blood smear was reviewed to assess for platelet clumping and the presence of macroplatelets. If clumps were present, the value recorded represents the lowest potential platelet count.…”

Section: Data Collectionmentioning

confidence: 99%

“…Thrombocytopenia was defined as a platelet count <150 × 10 9 /L (150,000/µL), 8 and severe thrombocytopenia was defined as a platelet count of ≤50 × 10 9 /L (50,000/µL). 7 Additional data retrieved from the medical record included sites of hemorrhage, based on patient examination, noted on diagnostic tests, or observed on necropsy. Patients with documented hemorrhage at any point during their visit were included in the following categories:…”

Section: Data Collectionmentioning

confidence: 99%

“…Large volumes of FWB are required to increase the platelet count significantly, and patients who do not require red blood cells and plasma may be at risk for polycythemia, circulatory overload, and additional transfusion reactions. 7 PC offers the benefit of containing a higher concentration of platelets as compared to FWB; however, this product is not widely accessible and has a short shelf life. Cryopreserved and lyophilized platelet products offer longer storage times and immediate availability, but the duration of survival and function of transfused platelets may not equal those observed with PC, which remains the product of choice for use in people.…”

Section: Introductionmentioning

confidence: 99%

“…Platelet‐containing products available for dogs include fresh whole blood (FWB), fresh platelet products such as platelet‐rich plasma and platelet concentrate (PC), cryopreserved platelets, and lyophilized platelets. Large volumes of FWB are required to increase the platelet count significantly, and patients who do not require red blood cells and plasma may be at risk for polycythemia, circulatory overload, and additional transfusion reactions 7 . PC offers the benefit of containing a higher concentration of platelets as compared to FWB; however, this product is not widely accessible and has a short shelf life.…”

Section: Introductionmentioning

confidence: 99%

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Retrospective evaluation of fresh platelet concentrate administration in dogs: Patient characteristics, outcomes, and transfusion practices in 189 transfusion episodes (2008–2019)

Saint-Pierre

Farrell

Hopper

et al. 2023

J Vet Emergen Crit Care

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Objective To describe patient characteristics, underlying disease processes, clinical outcomes, transfusion dose and type (therapeutic or prophylactic), platelet count changes, and adverse events associated with platelet concentrate (PC) administration in dogs. Design Retrospective study. Setting University teaching hospital. Animals A total of 149 dogs, representing 189 PC transfusion episodes. Interventions None. Measurements and Main Results In this population, 39 of 149 dogs (26.2%) were diagnosed with primary immune‐mediated thrombocytopenia, 22 of 149 (14.8%) had decreased bone marrow production, 12 of 149 (8.0%) received PC during a massive transfusion, 3 of 149 (2.0%) had congenital thrombocytopathia, 59 of 149 (39.6%) had severe thrombocytopenia of other causes, and 14 of 149 (9.4%) underwent transfusion for miscellaneous causes without a documented severe thrombocytopenia. In 117 of 149 dogs (78.5%), >1 site of hemorrhage was noted. The most common sites of hemorrhage were the gastrointestinal (GI) tract in 89 of 149 (59.7%) and the skin in 78 of 149 (52.3%). Overall survival to discharge was 59.1% (88/149). The median PC dose was 0.8 units per 10 kg of body weight per transfusion episode (range: 0.2–6.7). Of 189 episodes, 29 of 189 (15.7%) were prophylactic, and 158 of 189 (83.6%) were therapeutic. For 99 of 189 transfusion episodes, paired pre‐ and postplatelet counts were available within 24 hours. The median platelet count change was 5.0 × 109/L (5000/μL; range: –115 × 109/L to 158 × 109/L [–115,000 to 158,000/μL]); the posttransfusion platelet count was significantly higher than pretransfusion (P < 0.0001). The increase in platelet count after transfusion was greater in the prophylactic group than the therapeutic group (P = 0.0167). Transfusion reactions were suspected during 2 of 168 episodes (1.2%). Conclusions Immune‐mediated thrombocytopenia was the most common disease process that resulted in PC transfusion. PC was more frequently administered to animals with active hemorrhage rather than prophylactically, and most dogs had evidence of hemorrhage in multiple organ systems, particularly the GI tract and skin. PC transfusions typically appeared safe, and the median platelet count increased after transfusion.

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Section: Methodsmentioning

confidence: 99%

Section: Data Collectionmentioning

confidence: 99%

Section: Data Collectionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Retrospective evaluation of fresh platelet concentrate administration in dogs: Patient characteristics, outcomes, and transfusion practices in 189 transfusion episodes (2008–2019)

Saint-Pierre

Farrell

Hopper

et al. 2023

J Vet Emergen Crit Care

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ACVIM consensus statement on the diagnosis of immune thrombocytopenia in dogs and cats

LeVine,

Kidd,

Garden

et al. 2024

Veterinary Internal Medicne

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Immune thrombocytopenia (ITP) is the most common acquired primary hemostatic disorder in dogs. Immune thrombocytopenia less commonly affects cats but is an important cause of mortality and treatment‐associated morbidity in both species. Immune thrombocytopenia remains a diagnosis of exclusion for which diagnostic guidelines are lacking. Primary, or non‐associative, ITP refers to autoimmune platelet destruction. Secondary, or associative, ITP arises in response to an underlying disease trigger. However, evidence for which comorbidities serve as ITP triggers has not been systematically evaluated. To identify key diagnostic steps for ITP and important comorbidities associated with secondary ITP, we developed 12 Population Evaluation/Exposure Comparison Outcome (PECO) format questions. These questions were addressed by evidence evaluators utilizing a literature pool of 287 articles identified by the panelists using a structured search strategy. Evidence evaluators, using panel‐designed templates and data extraction tools, summarized evidence and created guideline recommendations that then were integrated by diagnosis and comorbidity domain chairs. The revised PECO responses underwent a Delphi survey process to reach consensus on final guidelines. A combination of panel expertise and PECO responses were employed to develop algorithms for diagnosis of ITP in dogs and cats, which also underwent 4 iterations of Delphi review. Comorbidity evidence evaluators employed an integrated measure of evidence (IME) tool to determine evidence quality for each comorbidity; IME values combined with evidence summaries for each comorbidity were integrated to develop ITP screening recommendations, which also were subjected to Delphi review. Commentary was solicited from multiple relevant professional organizations before finalizing the consensus. The final consensus statement provides clinical guidelines for the diagnosis of, and underlying disease screening for, ITP in dogs and cats. The systematic consensus process identified numerous knowledge gaps that should guide future studies. This statement is a companion manuscript to the ACVIM Consensus Statement on the Treatment of Immune Thrombocytopenia.

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Utility of immature platelet fraction in the Sysmex XN‐1000V for the differential diagnosis of central and peripheral thrombocytopenia in dogs and cats

Perez‐Ecija,

Martinez,

Fernandez‐Castañer

et al. 2024

Veterinary Internal Medicne

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BackgroundThe immature platelet fraction (IPF), a parameter obtained by the Sysmex XN‐1000V analyzer, is used in humans to differentiate between central (CEN) and peripheral (PER) thrombocytopenia (TP) but has not been evaluated in small animals.ObjectivesCompare IPF between healthy, clinical non‐TP and TP dogs and cats, study IPF in different causes of TP in dogs and cats and, establish IPF reference intervals (RIs), and study the effect of age and sex on IPF in healthy dogs and cats.AnimalsA total of 3281 dogs and 726 cats.MethodsRetrospective review of medical records. Animals were classified as nonthrombocytopenic (healthy group and group of clinical patients without TP [NTP]) or TP. These latter animals were subclassified as pseudothrombocytopenia (PSE), CEN and PER, based on evaluation of platelet clumps, estimated platelet count in blood smears and final diagnosis. Blood samples were evaluated using a Sysmex XN‐1000V with a specific platelet channel (PLT‐F).ResultsThe IPF was significantly different between each subtype of TP in both species. Immature platelet fractions <6.9% in dogs or 13.6% in cats, once PSE has been eliminated by review of blood smears, are indicative of CEN. Reference intervals for IPF were 0.5%‐8% in healthy dogs and 1%‐40.3% in healthy cats.Conclusions and Clinical ImportanceWe determined that IPF can differentiate between CEN and PER in dogs and cats, guiding additional testing and avoiding more invasive procedures (bone marrow sampling). A blood smear always should be evaluated to rule out platelet clumping.

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Platelet Kinetics and Laboratory Evaluation of Thrombocytopenia

Cited by 8 publications

References 96 publications

Retrospective evaluation of fresh platelet concentrate administration in dogs: Patient characteristics, outcomes, and transfusion practices in 189 transfusion episodes (2008–2019)

Retrospective evaluation of fresh platelet concentrate administration in dogs: Patient characteristics, outcomes, and transfusion practices in 189 transfusion episodes (2008–2019)

ACVIM consensus statement on the diagnosis of immune thrombocytopenia in dogs and cats

Utility of immature platelet fraction in the Sysmex XN‐1000V for the differential diagnosis of central and peripheral thrombocytopenia in dogs and cats

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