T-TAS HD-Chip in patients with myeloid neoplasia and thrombocytopenia

Introduction Thrombocytopenia is frequent in patients with hematologic malignancies. Platelet count is commonly used to assess the need for platelet transfusion. However, this approach does not consider platelet function and other coagulation parameters such as von Willebrand factor (VWF), which may influence bleeding tendency. T-TAS is a flow chamber based system to evaluate the hemostatic function in whole blood samples. The HD-chip of T-TAS was developed for the analysis of samples from patients with thrombocytopenia [1]. The aim of this study was to investigate the T-TAS HD-chip in thrombocytopenic patients with myeloid neoplasia.

Method Whole blood samples from patients with acute myeloid leukemia, myelodysplastic and myeloproliferative neoplasias and thrombocytopenia were analyzed at the Leipzig University Hospital. The area under the curve (AUC), occlusion start time (OST) and occlusion time (OT) of T-TAS were determined in patients with and without platelet transfusion. VWF activity and VWF antigen were measured and spearman correlation coefficient (ρ) between T-TAS and VWF parameters determined.

Results A total of 67 samples were collected from 28 patients before (n=19), one hour after (n=8) and 12 to 24 hours after platelet transfusion (n=19), as well as 21 samples from patients without platelet transfusion. Median platelet count was 21 (range 3-63) Gpt/l. VWF antigen was determined in 57 and VWF activity in 47 samples, respectively.

Absence of occlusion in T-TAS was detected in samples with platelet counts<21 Gpt/l, but 17 of 35 samples with platelet counts≥21 Gpt/l showed occlusion, p<0.001. From the 35 samples with platelet counts≥21 Gpt/l, 19 were from patients receiving parenteral nutrition rich in lipids. Complete occlusion was seen in 5 (26.3%) samples from patients with parenteral nutrition compared to 12 (75.0%) in patients without parenteral nutrition, p=0.007.

In samples with occlusion, there was no correlation between platelet count and AUC (ρ=0.216), OST (ρ=-0,107) and OT (ρ=-0.306), but VWF antigen showed a significant positive correlation with AUC (ρ=0.685), a significant negative correlation with OST (ρ=-0.652) and OT (ρ=-0.718), while VWF activity was significantly correlated only with AUC (ρ=0.661) and OT (ρ=-0.673).

Conclusion Our preliminary data suggest that occlusion in T-TAS HD-Chip in patients with myeloid neoplasia does not occur in patients with platelet counts<21 Gpt/l. Parenteral nutrition seems to interfere with the occlusion of T-TAS HD chip. In patients with occlusion and a platelet count above 20 Gpt/l, VWF appears to have a greater impact on T-TAS than platelet count indicating that T-TAS reflects the interaction of von Willebrand factor with platelets in this cohort of patients.

 

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Conflict of Interest

The study was sponsored by an unrestricted grant from Fujimori Kogyo Co., Ltd. CP reports institutional grants and personal fees for lectures from Fujimori Kogyo Co., Ltd.

• References

• 1 Atari B, Ito T, Nagasato T. et al. A modified microchip-based flow chamber system for evaluating thrombogenicity in patients with thrombocytopenia. Thromb J 2020; 18 (01) 3

Publikationsverlauf

Artikel online veröffentlicht:
26. Februar 2024