The Role of the Extracorporeal Circuit in the Trapping and Degranulation of Platelets

Oever, Mareille Gritters-van den; Schoorl, Marianne; Schoorl, Margreet; Bartels, P. C. M.; Grooteman, Muriël P.C.; Nubé, Menso J.

doi:10.1159/000232933

Cited by 21 publications

(16 citation statements)

References 35 publications

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“…Shear stress in the extracorporeal circuit may be an important trigger in sP-Selectin-mediated platelet aggregation. The finding in our study of a significant intra-dialytic reduction in MPV, PDW, and P-LCR, as demonstrated previously by Gritters-van den Oever et al, may be also be in line with platelet activation during the HD procedure [14]. MPV decreased during HD treatment and hence the MPV derived parameters P-LCR and PDW decreased as well.…”

Section: Discussionsupporting

confidence: 90%

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Effects of Ultrapure Hemodialysis and Low Molecular Weight Heparin on the Endothelial Surface Layer

et al. 2014

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Background: Chronic kidney disease patients show changes in the endothelial surface layer (ESL). Whether hemodialysis (HD) itself or low molecular weight heparins (LMWH) induce ESL alterations is unknown. Methods: We studied the ESL in 20 HD patients with Sidestream Dark Field Imaging [measuring perfused boundary region (PBR)] and measurement of ESL constituents in plasma during HD in 2 studies. LMWH was administered at the start of HD in study A, and 120 min after the start of HD in study B. Mean platelet volume (MPV) and platelet large cell ratio (P-LCR) were also measured. Results: Syndecan-1 increased significantly 30 min after LMWH administration. sP-Selectin increased 120 min after HD start, and MPV and P-LCR decreased significantly during HD. No significant changes of PBR, sE-Selectin, sICAM-1, or sVCAM-1 were perceived. Conclusions: HD caused a significant increase in Syndecan-1 without a change in PBR. The administration of LMWH appeared to precede the rise in Syndecan-1.

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Section: Discussionsupporting

confidence: 90%

“…Given the effects of hemodialysis (HD) on platelet activation, and due to the highly dynamic blood-ESL interaction, it can be hypothesized that HD may also have acute effects on the ESL [14,15,16]. However, it is unknown whether ESL damage is exacerbated even during the HD treatment in patients with end-stage renal disease (ESRD).…”

Section: Introductionmentioning

confidence: 99%

Effects of Ultrapure Hemodialysis and Low Molecular Weight Heparin on the Endothelial Surface Layer

et al. 2014

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“…Docci et al [11] found a significant platelet loss during cuprophan dialysis, but not with polyacrylonitrile membranes. However, Gritters-van den Oever et al [12] reported that platelet numbers markedly dropped after hemodialysis with low-flux PS dialyzers. As the drop over the extracorporeal circuit at the first passage amounted to approximately 15%, the combined activation and number of platelets suggest that a considerable number of activated platelets stick to the extracorporeal circuit, most probably the dialyzer membrane directly after the start of hemodialysis [13] .…”

Section: Discussionmentioning

confidence: 99%

Cellulose Triacetate Dialyzer Reduces Platelet Loss during Continuous Veno-Venous Hemofiltration

et al. 2010

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Thrombocytopenia is a common complication in patients receiving continuous veno-venous hemofiltration (CVVH) in the intensive care unit. The hemofilter itself plays an important role in the genesis of thrombocytopenia. The present study was undertaken to test whether there were differences in platelet loss and activation during CVVH with a polysulfone (PS) hemofilter or a cellulose triacetate (CTA) dialyzer. 96 patients with thrombocytopenia and acute kidney injury requiring CVVH were randomly assigned to four groups receiving low-molecular-weight heparin (LMWH) PS (n = 24), LMWH CTA (n = 24), no anticoagulation PS (n = 24), and no anticoagulation CTA (n = 24), respectively. We found a significant decrease in platelet counts, but an increased platelet activation with the PS hemofilter in patients who received no anticoagulation. There was no significant decrease in platelet counts and activation in the CTA group. The cellulose membranes could be an effective alternative to the standard synthetic membranes in patients at high risk for thrombocytopenia during CVVH.

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“…During HD treatment, blood constituents interact with the foreign surfaces within the extracorporeal circuit (ECC), including the wall of blood lines, the artificial dialyzer membrane and mechanical forces of the roller pump. Within the ECC endothelium is lacking and activation of PLTs and biomarkers inducing activation of coagulation are released by mechanical triggers [23]. In order to prevent clotting in the ECC during HD, a bolus of low molecular weight heparin or unfractionated heparin is supplied at the start of each HD session.…”

Section: Discussionmentioning

confidence: 99%

“…Increase of PLT activation and procoagulant activity is demonstrated in HD patients [24,25]. PLTs are activated within the ECC, as detected by increase in the expression of CD62p and release of β-tromboglobulin (β-TG) within the ECC [23]. PLT activation is associated with exposure of phosphatidylserine on the PLT exterior.…”

Section: Discussionmentioning

confidence: 99%

Coagulation activation, depletion of platelet granules and endothelial integrity in case of uraemia and haemodialysis treatment

Schoorl

Nubé

et al. 2013

BMC Nephrol

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BackgroundDuring haemodialysis (HD) treatment, increase of platelet (PLT) activation and induction of procoagulant activity is demonstrated. Although the role of the endothelium and its direct interaction with coagulation and homeostasis is known, it is not elucidated how PLT activation markers and activation of coagulation coincide with markers of endothelial integrity during HD treatment. In the present study uraemia and HD induced changes, with particular emphasis on PLT granules depletion, activation of coagulation and endothelial integrity were investigated.MethodsTo detect depletion of PLT granules, peripheral blood slide smears were screened by light microscopy for qualitative evaluation of PLT granule containing cytoplasm, as indicated by its granules staining density. Activation of coagulation was investigated by establishement of thrombin-antithrombin (TAT) and fibrinogen concentrations. To evaluate endothelial integrity proendothelin (proET-1) plasma concentrations were established.ResultsResults of our study demonstrate that proET-1 plasma concentrations were obviously increased in the subjects’ group with end-stage chronic kidney disease (CKD) and renal failure if compared with a group of apparently healthy subjects. The amount of depleted PLT granules was obviously increased in the subjects’ group with end-stage CKD if compared with the group with renal failure. Mean plasma concentrations of TAT and fibrinogen revealed results within the reference range.ConclusionsIt is demonstrated that uraemia is associated with endothelial damage and aberrations in PLT granules morphology in subjects with HD treatment. We hypothesize that increased proET-1 concentrations reflect ongoing stress on endothelial cells amongst others due to uraemia. Biomarkers like proET-1 and aberrations in PLT granules morphology assist in the early detection of procoagulant activity of the endothelium.

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The Role of the Extracorporeal Circuit in the Trapping and Degranulation of Platelets

Cited by 21 publications

References 35 publications

Effects of Ultrapure Hemodialysis and Low Molecular Weight Heparin on the Endothelial Surface Layer

Effects of Ultrapure Hemodialysis and Low Molecular Weight Heparin on the Endothelial Surface Layer

Cellulose Triacetate Dialyzer Reduces Platelet Loss during Continuous Veno-Venous Hemofiltration

Coagulation activation, depletion of platelet granules and endothelial integrity in case of uraemia and haemodialysis treatment

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