الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Platelets are essential in primary haemostasis and it is evident that a low platelet count is a significant risk factor for bleeding which is a frequently occurring complication and may be the cause of death in thrombocytopenic patients. However, not all patients with thrombocytopenia experience bleeding.
Several clinical studies have documented an association between haemostasis and platelet size as they found MPV to be an independent risk factor for thrombosis and large platelets are selectively consumed during massive bleeding. However, only few studies have investigated the relationship between MPV and spontaneous bleeding in thrombocytopenia, and no data on MPC, PDW or the fraction of large platelets have been published.
Most platelet function tests (PFT) have traditionally been used for the diagnosis and management of patients presenting with bleeding problems. In the last 2 decades, the clinical application of PFT has improved as it has increasingly come to be used for monitoring the antiplatelet treatment of cardiovascular patients at risk of arterial disease. However, the increasing number of patients on antiplatelet drugs, with a higher risk of bleeding, especially during trauma and surgical procedures, has also led to the emergence of PFT as a useful tool in presurgical/perioperative settings for the prediction of hemorrhage and for monitoring the efficacy of different prohemostatic therapies.
The aim of this study is to evaluate the different currently available platelet parameters on automated blood analyzers (platelet count, MPV, PDW, MPC and fraction of large platelet) and platelet aggregation function as predictors for bleeding tendencies in thrombocytopenic patients.
This study was conducted on a group of 30 thrombocytopenic patients randomly selected of both sexes admitted to Alexandria university hospitals including El Miri and the Medical Research Institute and compared to 30 healthy subjects of matched age and sex. Inclusion and exclusion criterion were strictly applied for all those who accepted to participate in the study.
All subjects enrolled in the study underwent full history taking including personal data, history of present illness, history of spontaneous bleeding, history of platelet and/or blood transfusion and drug history, in addition to thorough clinical examination and laboratory investigation.
Laboratory investigations included complete blood count, coagulation profile (prothombin time,INR and activated partial thromboplastin time), bleeding time test and platelet function testing using whole blood aggregometer.
Our results were; the mean platelet count among bleeders (75.24x109/L) was lower than that among non-bleeders, though statistically insignificant. Also, the highest percent of bleeders (47.1%) had platelet count between 50 and 100x109/L, similarly the highest percent of non-bleeders (53.8%) had platelet count within the same range. The different automated platelet parameters (MPV, PDW, PCT, MPC and LPlt) were directly proportional to platelet aggregation function testing using different agonists (ADP, collagen, ristocetin and A.A), furthermore, that was statistically significant where p values were less than or equal to 0.05.
We can conclude that the use of the different measured automated platelet parameters in the study collectively was a better predictor for spontaneous bleeding among the thrombocytopenic cases than the use of platelet aggregation function testing.
Thus our study recommended that measured automated platelet parameters could be incorporated in the investigations of thrombocytopenic patients and the follow up of these cases rather than the use of the tedious platelet function testing.