Platelet function tests predict bleeding in patients with acute myeloid leukemia and thrombocytopenia

Abstract

Bleeding is frequent among patients with thrombocytopenia. We studied whether in vitro platelet function predicts future bleeding in patients with acute myeloid leukemia (AML), and thrombocytopenia. Adult AML patients with platelet count <5.0 × 1010/L were included. Detailed bleeding history and blood samples were collected at inclusion and every 7 days. We analyzed hematology and coagulation parameters. With flow cytometry we evaluated platelet activation (activated GPIIb/IIIa, P‐selectin, and CD63 expression), and platelet aggregation. Agonists were thrombin‐receptor activating peptide (TRAP) and collagen‐related peptide (CRP‐XL). During 18 months, sixty participants were enrolled and followed for a total of 114 weeks. Bleeding occurred in 52 weeks, and was not associated with clinical, hematology or coagulation parameters. Predictors of bleeding were assessed using multivariate logistic regression, adjusted for platelet count, sex, and age. Bleeding history and receiver operating curves were compared using c‐index. Reduced TRAP‐induced platelet aggregation had Odds ratio 3.00 (95% confidence interval [CI] 1.38‐6.60). Reduced CRP‐XL‐induced platelet aggregation had Odds ratio 4.00 (95%‐CI 1.70‐9.20) for bleeding. Overall, C‐index was 0.71 for the models including platelet aggregation results, 0.72 for activated GPIIb/IIIa‐positive platelets after stimulation with TRAP, 0.68 for percent P‐selectin positive platelets with TRAP and 0.63 for the platelet count. Among patients receiving no platelet transfusion, C‐index was 0.83–0.91 for bleeding; highest for models using platelet aggregation. Change in platelet aggregation did not correlate with the number of platelet concentrates administered. In conclusion, platelet aggregation and platelet activation results predict bleeding better than platelet count alone, among AML patients with thrombocytopenia.

Expert consensus on the diagnosis and treatment of thrombocytopenia in adult critical care patients in China

“…Trauma patients with prolonged use of oral antiplatelet drugs are particularly prone to adverse prognosis due to platelet dysfunction [67,68]. For acute myeloid leukemia (AML) patients with thrombocytopenia, platelet aggregation and activation tests are superior to platelet count in predicting the risk of bleeding [69]. Therefore, platelet function should be evaluated in case of thrombocytopenia.…”

The effect of mycophenolate mofetil on platelet function

“…Previously, the effect of antiplatelet drugs on platelet aggregation in spiked samples from healthy individuals showed dose-response curves in agreement with LTA results. Further, results obtained by the flow cytometric aggregation assay is highly clinically relevant and have been shown to identify bleeding risk in a clinical setting [28,39].…”

Patient blood management in oncology in the Russian Federation: resolution to improve oncology care.

“…В противовес этому сведения, касающиеся пациентов с солидными опухолями, крайне ограничены, хотя известно, что риск возникновения кровотечений увеличивается при количестве тромбоцитов ≤10×10 9 /л [110]. Тесты вязкости и анализ функции тромбоцитов могут быть более точными, если оценивается число тромбоцитов для определения рисков развития кровотечения у онкологических больных [110,112], как было установлено для других групп пациентов [113,114]. Здесь также следует упомянуть, что сведения о профилактических переливаниях тромбоцитов являются недостаточно качественными для пациентов с тромбоцитопенией, вызванной химиотерапией, и пациентов с солидными опухолями, равно как и для пациентов с низким дооперационным числом тромбоцитов [111,115].…”