RESUMEN
The aim of this study was to investigate if thrombocytopenic haematology patients show signs of endothelial damage when transfused with platelets and if that damage correlates with platelet increment measured with corrected count increment (CCI). Endothelial damage secondary to radiation or chemotherapy may lead to consumption of transfused platelets but research in this field is scarce. Patients were divided into four groups: Group 1: Acute leukaemia; Group 2: Autologous stem cell transplantation (SCT); Group 3: Allogenic SCT; and Group 4: patients receiving platelets prior to interventions. Blood was sampled before (baseline) and immediately after (0 h) transfusion and then at 1, 4, 8, 16 and 24 h after transfusion. The biomarkers syndecan-1, soluble thrombomodulin (sTM) and vascular endothelial growth factor (VEGF) were analysed. The plasma concentration differences between baseline and later sampling times were referred to as delta (Δ). Fifty-four platelet transfusion events were studied. All biomarkers were within the normal ranges both before and after the transfusions. The Δsyndecan-1 increased at 0 h (p = .02), but there was no significant correlation between Δsyndecan-1 and CCI. There was no change in any of the other biomarkers after transfusion compared to before. There were no differences between the groups and no correlations were found between CCI and C-reactive protein, Δsyndecan-1, ΔsTM or ΔVEGF. There were no signs of endothelial damage before or after platelet transfusions. A transient significant change in syndecan-1 immediately after platelet transfusion did not influence platelet count or platelet CCI.
Asunto(s)
Endotelio Vascular/fisiología , Transfusión de Plaquetas/efectos adversos , Plaquetas , Proteína C-Reactiva/metabolismo , Humanos , Recuento de Plaquetas , Estudios Prospectivos , Sindecano-1/sangre , Trombomodulina/sangre , Trasplante Autólogo , Factor A de Crecimiento Endotelial Vascular/sangreRESUMEN
BACKGROUND: Low platelet count on admission to an intensive care unit (ICU) is associated with increased mortality and is thus included in some severity scoring systems such as the simplified acute physiologic score 3 (SAPS 3); however it is unclear whether other routine coagulation tests also predict mortality. The purpose of this retrospective single-centre study was to investigate whether activated partial thromboplastin time (APTT) or prothrombin time - international normalized ratio (PT-INR) measured on admission to the ICU in patients with severe sepsis or septic shock may be associated with mortality independent of SAPS 3 score. METHODS: All patients admitted to a tertiary general ICU from 2007 to 2014 diagnosed with severe sepsis or septic shock were eligible. Results from APTT and PT-INR within 1.5 h of admission as well as SAPS 3 were used as independent variables in a Cox regression. RESULTS: Of total 5485 ICU admissions during the study period we identified 647 unique patients with severe sepsis or septic shock. APTT and PT-INR were found to correlate significantly with mortality with a hazard ratio (HR) of 1.014 [95% confidence interval of HR (1.006-1.023)] for APTT and 1.422 (1.117-1.811) for PT-INR. HR for SAPS 3 was 1.036 (1.028-1.044). CONCLUSION: Activated partial thromboplastin time prolongation and raised PT-INR on ICU admission in patients with severe sepsis or septic shock is associated with increased mortality independent of SAPS 3 score. This indicates that APTT prolongation and PT-INR increase represents morbidity that is not accounted for in SAPS 3.
Asunto(s)
Pruebas de Coagulación Sanguínea/estadística & datos numéricos , Cuidados Críticos/métodos , Hospitalización , Sepsis/sangre , Sepsis/mortalidad , Anciano , Coagulación Sanguínea , Pruebas de Coagulación Sanguínea/mortalidad , Estudios de Cohortes , Femenino , Mortalidad Hospitalaria , Humanos , Unidades de Cuidados Intensivos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Suecia/epidemiologíaRESUMEN
Polished enamel blocks with known surface areas were obtained from human mandibular incisors. Acidulated phosphate fluoride was applied for 4 min and washed off after additional contact times of 0, 2, 6 and 24 h, respectively. The enamel fluoride concentrations were determined in three successive etch depths before and after extraction in 1 M KOH for 24 h. The predominant reaction product was CaF2. The concentration of the fluoride bound as fluorapatite or fluorhydroxyapatite reached an optimal level after a 6-h contact time.