Reticulated platelets: a reliable measure to reduce prophylactic platelet transfusions after intensive chemotherapy

Chaoui, Driss; Chakroun, Tahar; Robert, Françoise; Rio, Bernard; Belhocine, Ramdane; Legrand, Ollivier; Salanoubat, Célia; Lecrubier, C; Casadevall, Nicole; Marie, Jean‐Pierre; Elalamy, Ismaı̈l

doi:10.1111/j.1537-2995.2005.04286.x

Cited by 43 publications

(45 citation statements)

References 35 publications

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“…This creates the opportunity to defer platelet transfusions that would be given when transfusion decisions are based on platelet counts only. Until present, limited clinical evidence supporting this concept has been reported and there is an evident need for randomized, controlled clinical studies in this field [82,97,98]. A highly interesting observation that also needs to be confirmed is that prophylactic transfusions with high IPF platelet concentrates seem to be more effective than low IPF platelets [99].…”

Section: Clinical Utility Of Reticulated/ Immature Plateletsmentioning

confidence: 99%

Reticulated platelets: analytical aspects and clinical utility

Hoffmann

2014

Clinical Chemistry and Laboratory Medicine (CCLM)

139

147

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Reticulated platelets are immature platelets circulating in blood; they reflect the activity of megakaryopoiesis in the bone marrow. Therefore, they can be used as a non-invasive test in patients with thrombocytopenia in various clinical conditions. The preferred method of analysis is by flow cytometry. However, there is an evident lack of analytical standardization, making it difficult to compare results obtained in different laboratories. Currently, two types of hematology analyzers are on the market offering fully automated measurement of reticulated or immature platelets: the high end analyzers manufactured by Sysmex (XE-and XN-series) and Abbott (CELL-DYN Sapphire). Although the methods are essentially different and cannot be used interchangeably, both have been proven to have clinical utility. Reticulated or immature platelet assays are useful for the differential diagnosis of thrombocytopenia and for monitoring bone marrow recovery after chemotherapy or stem cell transplantation. These assays may aid clinicians in platelet transfusion decisions when recovery from thrombocytopenia is imminent. In addition, preliminary findings indicate that there is a rationale for reticulated or immature platelets for risk stratification in acute coronary syndromes and for monitoring the effect of treatment with antiplatelet drugs in patients with coronary artery diseases. The aim of this paper is to present the present technology available for measuring reticulated platelets as well as an overview of the current status of clinical application. This overview also indicates that more research is needed before reticulated or immature platelet assays can be applied in other clinical conditions than thrombocytopenia and after transplantation.

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Section: Clinical Utility Of Reticulated/ Immature Plateletsmentioning

confidence: 99%

Reticulated platelets: analytical aspects and clinical utility

Hoffmann

2014

Clinical Chemistry and Laboratory Medicine (CCLM)

139

147

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“…Although an arbitrary cut point (a marker set to include 1% of the negative population), this was similar to other studies with this and other RP staining reagents. Previous studies have used cut points of 0.1%, 0.5%, 1%, and 5% (2,3,5,6,17,22) or even red cell autofluorescence (11) to determine the level at which RP begin. Small changes in the marker position (for example a gain of 0.1%) can have a large impact on the RP value, for these reasons strict adherence to the protocol is needed for this assay.…”

Section: Discussionmentioning

confidence: 99%

“…Subsequent studies showed RP were readily stained with nucleic acid dyes such as Thiazole Orange (TO) (2)(3)(4) and that RP have obvious potential as a sensitive early predictor of bone marrow engraftment (5,6). However difficulties with consistency of analysis have hampered wide-spread adoption.…”

Section: Introductionmentioning

confidence: 99%

“…We believe the relative simplicity of this combination method described here may encourage broader uptake by routine flow laboratories. The routine use of RP can be expected to yield economic, social, and clinical benefits in terms of reduced investigation and treatment costs, earlier interventions, more direct treatment, and better outcomes (6).…”

Section: Introductionmentioning

confidence: 99%

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Combined accurate platelet enumeration and reticulated platelet determination by flow cytometry

Hedley

Llewellyn-Smith

Lang

et al. 2015

Cytometry Part B Clinical

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Background: Diagnosing the cause of thrombocytopenia often requires a bone marrow aspiration or biopsy, an invasive procedure. Reticulated platelets (RP) are immature RNA containing platelets, accurate RP enumeration has yet to be achieved, partially due to the lack of a robust reference method. Goal: To refine previous work and gating strategies distinguishing RP from mature platelets while incorporating accurate platelet enumeration into the analysis. After reviewing previously published studies on Thiazole Orange (TO) staining of RP, we systematically evaluated CD41/CD61 in combination with a commercial source of TO (BDBiosciences). Previous RP methods have not taken advantage of platelet enumeration therefore our goal was to incorporate the ICSH platelet enumeration protocol into our method.Methods: TO concentration, incubation, and fixation method were determined to be 10% of stock concentration, 30 min, and 1% formaldehyde respectively. Gating strategy to determine RP fraction used an unstained control tube to set the limit of TO staining.Results: Normal range (n = 51) was 9.9 6 3.1%. Analysis of 40 patients with immunethrombocytopenia-purpura (ITP) showed a RP range from 4.3% to 81.2%. Platelet enumeration was consistent with our previous studies in this area. INTRODUCTIONReticulated platelets (RP), first recognized in 1969 (1), are young, RNA-containing platelets, freshly released from the bone-marrow into the peripheral circulation: RP are analogous to the reticulocytes of erythropoiesis. Subsequent studies showed RP were readily stained with nucleic acid dyes such as Thiazole Orange (TO) (2-4) and that RP have obvious potential as a sensitive early predictor of bone marrow engraftment (5,6). However difficulties with consistency of analysis have hampered wide-spread adoption. The nucleic acid dye based flow methods are problematic to control and these difficulties with specificity and reproducibility have prevented routine adoption of RP counts in the clinical setting. Though automated methods have been available on some Sysmex and Abbott hematology analyzers for some time, there are distinct methodological differences between them, which has further contributed to slow adoption of the assay by clinicians (7-10). The lack of consensus over the selection of dye (11-13), the temperature and duration of incubations (13-15) and the use of whole blood (16) versus platelet rich plasma (14) has further contributed to the slow adoption of this promising measurement. Previous studies determining RP have used various methods for gating this immature fraction of platelets. Work by Ault et al. (3) and Kienast and Schmitz (2) evaluated TO as a stain for RP, as the ability to enter cells without pretreatment and large increase in fluorescent emission upon binding made it ideal. Studies in murine and human samples demonstrated that this was predominately due to RNA content. However, TO fluorescence in platelets is not entirely due to binding of dye to mRNA: Robinson et al. (17) demonstrated a proportion of fluores...

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“…The assay is suitable to predict the time of platelet recovery and to optimise platelet transfusion decisions. In fact, reticulated platelets have been successfully employed to manage the platelet transfusion requirement during chemotherapy [23]. In addition, circulating reticulated platelets serve as prognostic markers in ischaemic vascular disease [24].…”

Section: Estimation Of Platelet Turnovermentioning

confidence: 99%

Diagnostic Methods for Platelet Function Analysis

Klouche¹

2007

Transfus Med Hemother

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Platelets play a key role in the regulation of haemostasis, clot stability and retraction, vascular repair, and exert an increasingly recognised function in host defence. Conversely, platelets are also implied in many pathophysiological processes, such as thrombosis, haemorrhage, inflammation, atherogenesis, tumour growth and metastasis. Thus quantitative and qualitative platelet alterations have been associated with distinct clinical diseases, including cardiovascular diseases, diabetes, tumour metastasis and sepsis, and consequently different diagnostic platelet markers are correlated with the prognosis and severity of these diseases. While primary platelet functional abnormalities are very rare diseases, acquired platelet function disorders are rather frequent and occur in the context of many diseases and in association with several drugs. Furthermore, the introduction of a great variety of different anti-platelet agents leads to iatrogenic states of therapeutically reduced platelet function. This review provides an overview of the methodological principles of platelet function analysis, the currently available diagnostic devices, the application and suitability for the diagnosis of different platelet function disorders and the restrictions of each method, to promote an optimal selection of diagnostic tests.

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Reticulated platelets: a reliable measure to reduce prophylactic platelet transfusions after intensive chemotherapy

Abstract: These encouraging results may allow us to reduce the prophylactic PLT transfusion according to patients RP% increase.

Cited by 43 publications

References 35 publications

Reticulated platelets: analytical aspects and clinical utility

Reticulated platelets: analytical aspects and clinical utility

Combined accurate platelet enumeration and reticulated platelet determination by flow cytometry

Diagnostic Methods for Platelet Function Analysis

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