Prediction of haemorrhage in the early stage of acute myeloid leukaemia by flow cytometric analysis of platelet function

Abstract

Summary Haemorrhage is often responsible for the lethal course of acute myeloid leukaemia (AML). Previously, multiple platelet function defects were identified by flow cytometric analysis of platelet activation markers in AML. The role of flow cytometric analysis of platelet function in characterization of prognostic markers of haemorrhage in AML patients has not been well elucidated. The objective of this prospective study was to analyse platelet function in 50 AML patients at diagnosis and to compare results with clinical bleeding score, graded by common toxicity criteria. Platelet activation markers CD62P, CD42b, CD63 and PAC‐1 were analysed following in vitro activation by thrombin receptor activating peptide. The following plasma haemostasis parameters were measured: soluble P‐selectin, activated partial thromboplastin time, thrombin time, prothrombin time, d‐dimer, fibrinogen, and von Willebrand factor antigen. In a multivariate analysis, P‐selectin (CD62P) <36 molecules of equivalent soluble fluorochrome × 103 (P < 0·0015) and platelet count <40 × 109/l (P = 0·01) were significant predictors of haemorrhage at diagnosis. Haemorrhage at diagnosis predicted grade 3–4 haemorrhage in the first 28 d following diagnosis (P = 0·018). The presented results indicate that low P‐selectin is a prognostic marker of haemorrhage in AML.

Impaired mitochondrial activity explains platelet dysfunction in thrombocytopenic cancer patients undergoing chemotherapy

“…8–10 It was proposed that low expression of the a-granule glycoprotein, P-selectin, can be used as a prognostic marker for hemorrhage. 11 However, bleeding in combination with thrombocytopenia is more frequently observed in cancer patients treated with chemotherapy. 12 The literature thus far only indicates that the anthracycline daunorubicin inhibits integrin a IIb β 3 activation, aggregation and secretion of platelets upon agonist stimulation.…”

Evaluation Of Platelet Function By Flow Cytometry

“…104 However, low levels of expression of platelet surface Pselectin, as determined by whole blood flow cytometry, have recently been reported to be a prognostic marker for hemorrhage in acute myeloid leukemia. 103 …”

“…103 The clinical decision to prophylactically transfuse platelets is therefore usually based solely on the platelet count. 104 However, low levels of expression of platelet surface Pselectin, as determined by whole blood flow cytometry, have recently been reported to be a prognostic marker for hemorrhage in acute myeloid leukemia.…”

Editorial–New heights from solid ground

“…Endothelial dysfunction with subsequent blood–brain barrier disruption is a proposed mechanism of PRES and may occur with induction treatment that utilizes repetitive systemic and intrathecal administration of chemotherapy 1,8–10,12. Endothelial dysfunction may also account for the increased incidence of hemorrhage in our patients being treated for AML 13. Although tumor lysis syndrome commonly occurs during induction therapy and has been reported to occur in patients with PRES 14, only one patient in the present study (Patient 5) had documented tumor lysis at the onset of PRES.…”