How I approach new onset thrombocytopenia

Swain, Fiona; Bird, Robert

doi:10.1080/09537104.2019.1637835

Cited by 18 publications

(17 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…However, to the best of our knowledge, this is the first intervention study to date to describe the protective effect of a healthy diet on the development of low platelet count and their associated mortality. Our main hypothesis to explain the decrease in the risk of developing thrombocytopenia and some of its potential complications was the improvement in the general nutritional status of the participants in the MedDiet intervention groups, which may subsequently lead to an improved production of platelets in those participants at risk of presenting low platelet count, since platelet production and thrombocytopenia risk appear to be highly dependent on the nutritional status of the individuals [15].…”

Section: Discussionmentioning

confidence: 99%

“…Of the 4381 PREDIMED participants with blood count available, we excluded 28 individuals without baseline data on MedDiet adherence or intake of alcohol, folate, and iron. To exclusively determine the effects on platelet levels of the dietary intervention, we also excluded those participants with any condition potentially related to alterations in platelet count at any point of the study [15,18], including the following: (1) any cancer of the immune system (17 individuals); (2) an autoimmune disease (28 individuals, determined as the use of immunosuppressant medications); (3) alcohol abuse (26 individuals, determined as a cumulative average of alcohol intake throughout the study of ≥4 drinks/day in men or ≥3 drinks/day in women); (4) viral infections (9 participants, determined as the use of oral antiviral medication); and (5) users of medications associated with platelet count alterations (10 users of heparins, 31 users of certain anticonvulsants (carbamazepine, phenytoin, and valproate), 32 users of L-dopa, 8 users of certain antibiotics (sulfamethoxazole, sulfa antibiotics, and vancomycin), and 3 fluconazole users). No participants with health outcomes related to altered platelet count (aplastic anemia, myelodysplastic syndromes, paroxysmal nocturnal hemoglobinuria, thrombotic thrombocytopenic purpura, disseminated intravascular coagulation syndrome, hemolytic uremic syndrome, Wiskott-Aldrich syndrome, May-Hegglin anomaly, etc.)…”

Section: Study Populationmentioning

confidence: 99%

“…High adherence to a MedDiet has only been associated with decreased platelet count in a cross-sectional study [13] and in a small-scale, short-term intervention trial [14]. However, no study has assessed the effects of this dietary pattern on thrombocytosis in the long term and in larger populations, or on other platelet count-related alterations, such as thrombocytopenia, likely to appear in individuals with poor nutritional status [15]. We also do not know whether a possible improvement in platelet count could partially mediate the beneficial effects of MedDiet on chronic diseases and their associated mortality [16].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Mediterranean Diet Maintained Platelet Count within a Healthy Range and Decreased Thrombocytopenia-Related Mortality Risk: A Randomized Controlled Trial

et al. 2021

View full text Add to dashboard Cite

There is little information on the dietary modulation of thrombosis-related risk factors such as platelet count. We aimed to assess the effects of Mediterranean diet (MedDiet) on platelet count and related outcomes in an older population at high cardiovascular risk. In participants of the PREDIMED (PREvención con DIeta MEDiterránea) study, we assessed whether an intervention with a MedDiet enriched with extra-virgin olive oil or nuts, relative to a low-fat control diet, modulated platelet count (n = 4189), the risk of developing thrombocytosis and thrombocytopenia (n = 3086), and the association between these alterations and all-cause mortality (median follow-up time: 3.0 years). Although platelet count increased over time (+0.98·109 units/L·year [95% confidence interval: 0.12; 1.84]), MedDiet interventions moderated this increase, particularly in individuals with near-high baseline count (both MedDiets combined: −3.20·109 units/L·year [−5.81; −0.59]). Thrombocytopenia incidence was lower in the MedDiet interventions (incidence rates: 2.23% in control diet, 0.91% in MedDiets combined; hazard ratio: 0.44 [0.23; 0.83]). Finally, thrombocytopenia was associated with a higher risk of all-cause mortality (hazard ratio: 4.71 [2.69; 8.24]), but this relationship was attenuated in those allocated to MedDiet (p-interaction = 0.018). In brief, MedDiet maintained platelet counts within a healthy range and attenuated platelet-related mortality in older adults at high cardiovascular risk.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Study Populationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Mediterranean Diet Maintained Platelet Count within a Healthy Range and Decreased Thrombocytopenia-Related Mortality Risk: A Randomized Controlled Trial

et al. 2021

View full text Add to dashboard Cite

show abstract

“…Although the PT-INR has a high AUC and NPV, it reflects the liver function and anticoagulation therapy [14]. Although the platelet count is the most common parameter assessed DIC and has a high AUC, it was found to have a low NPV in this study, suggesting that thrombocytopenia is frequently observed in patients without DIC [15]. Finally, there are no perfect parameters for diagnosing DIC.…”

Section: Discussionmentioning

confidence: 68%

Proposal of Quick Diagnostic Criteria for Disseminated Intravascular Coagulation

Wada

Yamamoto

Tomida

et al. 2022

JCM

View full text Add to dashboard Cite

Background. The diagnostic criteria for disseminated intravascular coagulation (DIC) vary and are complicated and the cut-off values are different. Simple and quick diagnostic criteria for DIC are required in physicians for critical care. Material and methods. Platelet counts, prothrombin time–international normalized ratio (PT-INR) and D-dimer levels were examined in 1293 critical ill patients. Adequate cut-off values of these parameters were determined and a quick DIC score using these biomarkers was proposed. The quick DIC score was evaluated using a receiver operating characteristic (ROC) analysis. Results. Using the Japanese Ministry of Health, Labor and Welfare diagnostic criteria, 70 and 109 patients were diagnosed with DIC and pre-DIC, respectively. The ROC analysis of factors difference between DIC and non-DIC, revealed the following cut-off values: PT-INR, 1.20; platelet count, 12.0 × 1010/L and D-dimer, 10.0 μg/mL. Based on the above results, the quick DIC score system was proposed. All patients with DIC had a quick DIC score of 3, 4 or 5, and 85.3% of the patients with pre-DIC had a quick DIC score of ≥3 points. All patients with pre-DIC had a score of ≥2 points. In the ROC analysis, the area under the curve was 0.997 for DIC vs. non-DIC, and 0.984 for pre-DIC + DIC vs. non-DIC, and the cut-off value was 3 points for DIC and 2 points for DIC + pre-DIC. The quick DIC scores of non-survivors were significantly higher than those of survivors. Conclusions. The Quick DIC score system is a simple and useful tool that can be used for the diagnosis of DIC and pre-DIC. Further evaluation of the quick DIC score system in a large-scale study is required.

show abstract

“…As people with ITP often present with fatigue and unexplained mild bleeding, the platelet count in association with blood and bone marrow smears remain the major clinical tools to evaluate an isolated thrombocytopenia. Secondary causes for ITP need to be excluded with screening for autoimmune diseases, serology for hepatitis C virus, human immunodeficiency virus and in some regions Helicobacter pylori testing [16,17]. Factors that lead to a low platelet count.A low platelet count can result from one or more main elements; reduced production of platelets by megakaryocytes in the bone marrow, increased consumption of platelets in hemostatic processes and accelerated clearance of platelets.…”

Section: Current Means To Diagnose Itpmentioning

confidence: 99%

Novel scientific approaches and future research directions in understanding ITP

et al. 2020

View full text Add to dashboard Cite

Diagnosis of immune thrombocytopenia (ITP) and prediction of response to therapy remain significant and constant challenges in hematology. In patients who present with ITP, the platelet count is frequently used as a surrogate marker for disease severity, and so often determines the need for therapy. Although there is a clear link between thrombocytopenia and hemostasis, a direct correlation between the extent of thrombocytopenia and bleeding symptoms, especially at lower platelet counts is lacking. Thus, bleeding in ITP is heterogeneous, unpredictable, and nearly always based on a multitude of risk factors, beyond the platelet count. The development of an evidence-based, validated risk stratification model for ITP treatment is a major goal in the ITP community and this review discusses new laboratory approaches to evaluate the various pathobiologies of ITP that may inform such a model.

show abstract

How I approach new onset thrombocytopenia

Cited by 18 publications

References 39 publications

Mediterranean Diet Maintained Platelet Count within a Healthy Range and Decreased Thrombocytopenia-Related Mortality Risk: A Randomized Controlled Trial

Mediterranean Diet Maintained Platelet Count within a Healthy Range and Decreased Thrombocytopenia-Related Mortality Risk: A Randomized Controlled Trial

Proposal of Quick Diagnostic Criteria for Disseminated Intravascular Coagulation

Novel scientific approaches and future research directions in understanding ITP

Contact Info

Product

Resources

About