Does Reactive Thrombocytosis Observed in Iron Deficiency Anemia Affect Plasma Viscosity?

Data on 225 Japanese patients with primary or essential thrombocythemia (ET) were analyzed in an attempt to characterize the clinical and laboratory features in subgroups with thrombosis (T), hemorrhages (H), thrombohemorrhagic events (TH) or a non-thrombohemorrhagic (O) group, and in order to examine survival and the incidence of blastic transformation in the entire group and in the different subgroups. Higher platelet and leukocyte counts were related to hemorrhage (H and TH), prolonged activated partial thromboplastin times and high LDH levels to H while elevated FDP levels were more frequently linked to T. Increased spontaneous platelet aggregation (SPA) was noted in 80.3% of the entire group, independent of whether there was a tendency for thrombohemorrhagic events or not. Bleeding time, as measured by the Duke method, and hemoglobin levels were not different in the various subgroups. Transformation occurred in 11 patients (1.9% per year); seven developed acute leukemia (myeloblastic 4, lymphoblastic 2, megakaryoblastic 1) at a rate of 1.2% per year; and 4 developed other types of chronic myeloproliferative disorders. Nineteen patients died (3.3% per year), six from leukemia (32%), 4 from bleeding (21%) and 9 from unrelated diseases (47%). Survival was estimated to be 65% at ten years, and was significantly longer in females, younger individuals, and the groups with lower leukocyte counts, but did not differ between the subgroups when platelet count and hemoglobin level were considered. Survival was similar in patients with platelet counts between 700-1000 × 10(9)/L and in those with an even higher platelet count. These findings suggest that (1) young female patients with low leukocyte counts may survive longer, (2) SPA is not indicative of either a thrombotic or an hemorrhagic tendency and (3) the limit of the platelet count for establishing the diagnosis of this disorder could perhaps be lowered to 700 × 10(9)/L.

Introduction: Single Donor Platelets (SDP) is crucial in managing thrombocytopenia and other platelet-related disorders. Compared with random donor platelets, SDPs minimise donor exposure and reduce the risk of alloimmunisation. Although SDPs are preferred over random donor platelets, their quality deteriorates during storage due to metabolic, biochemical, and morphological changes. These changes can influence post-transfusion platelet recovery and clinical efficacy. Moreover, the risk of bacterial contamination increases with longer storage duration despite leucoreduction and improved storage conditions. Therefore, continuous evaluation of in-vitro quality parameters and post-transfusion outcomes is essential to ensure that stored SDP units remain effective and safe for patient use. Aim: To assess changes in platelet and White Blood Cell (WBC) counts and the risk of bacterial contamination during storage of SDP, and to evaluate post-transfusion platelet count increment in recipients. Materials and Methods: The present prospective observational cross-sectional study was conducted in the Department of Immunohematology and Blood Transfusion (IHBT), Nizam’s Institute of Medical Sciences, Hyderabad, Telangana State, India, from April 2023 to March 2024. One hundred SDP donors and 100 transfusion recipients were included (patients). The collected platelets were stored in sterile, oxygen permeable polyvinyl chloride bags. A 5 mL sample was drawn on day 0 (day of collection) for WBC and platelet count estimation and for bacterial culture using BACT/ALERT PF+ culture bottles. Comparisons of WBC and platelet counts between day 0 and subsequent storage days (days 1-5) were performed using the paired t-test. Bacterial contamination was assessed by sterility testing (culture reports) from samples collected on each storage day. For evaluating platelet count increments in patients, mean pretransfusion and post-transfusion platelet counts were calculated and compared using the paired t-test. Microsoft Excel was used for data entry, and statistical analysis was performed with IBM Statistical Package for Social Sciences (SPSS) software, version 2022. Results: The mean donor age was 29.7 years, with an average height of 168.9 cm and weight of 75.5 kg. The most common patient diagnoses were AML (18 cases), followed by CML (14 cases) and lymphoma (15 cases); refractory ITP and cholangitis with severe anaemia were least common (1 case each). Platelet counts showed no significant change on days 0 and 3, but significant reductions were observed on days 1, 2, 4, and 5. Bacterial contamination was detected in some units by day 3 and day 5. There was a significant increase in the patient platelet count (p<0.05). Conclusion: Platelet counts in SDP units decline with longer storage, and patients transfused earlier experience better count recovery. Bacterial contamination risk increases after day 3.

Fibrinogen, plasma viscocity, and the white blood cell count predict ischaemic heart disease, but there is less certainty for their predictive power for ischaemic stroke. Studying stroke and ischaemic heart disease in the same cohort prospectively allows comparison of predictive strengths. The Caerphilly and Speedwell cohorts consist of a population sample of 4,860 men aged 45-59 years at recruitment who had baseline measurements of fibrinogen, plasma viscosity, and white blood cell counts. After 15-19 years of follow-up, men in the two cohorts experienced 312 ischaemic strokes and 557 ischaemic heart disease events. Mean fibrinogen, plasma viscosity and white blood cell counts differed significantly after adjustment for confounding factors between men with and without ischaemic heart disease, 0.25 g/l (95% CIs 0.1 8-0.32); 0.036 cp (95% CIs 0.027-0.044); 0.67 x 10(9)/l (95% CIs 0.50-0.84) respectively. The same measurements showed no significant differences after adjustment for the same confounding factors for men with and without ischaemic stroke, 0.05 g/l (95% CIs -0.04-0.14); 0.008 cp (95% CIs -0.003-0.019); 0.16 x 10(9)/l (95% CIs -0.06-0.38) respectively.

Objective Lusutrombopag is a thrombopoietin receptor agonist approved to treat thrombocytopenia in patients with chronic liver disease (CLD). This post hoc analysis of the Japanese L-PLUS 1 and global L-PLUS 2 trials aimed to clarify factors related to platelet count increase after lusutrombopag treatment. Methods In L-PLUS 1, Pearson’s correlation coefficients were used to evaluate correlations between platelet count and spleen index, thrombopoietin concentration, white blood cell (WBC) counts, and red blood cell counts (intent-to-treat [ITT] population). Associations between platelet count increase after lusutrombopag treatment and each parameter were assessed by regression analysis and mixed-effect model for repeated measures (MMRM). Associations between time-dependent changes in platelet count increase and each parameter were also examined in the L-PLUS 2 lusutrombopag ITT population by MMRM. Results In L-PLUS 1, the baseline platelet count was correlated with pretreatment spleen index (r = −0.23, 95% confidence interval [CI] −0.41 to −0.03) and WBC count (r = 0.26, 95% CI 0.06 to 0.43). No selected parameters were associated with the maximum platelet count increase from baseline. Patients with WBC counts below the normal range showed smaller platelet count increases after lusutrombopag treatment than patients with WBC counts within the normal range (p = .0028). In L-PLUS 2 (p = .0533), findings were similar and confirmed by larger pooled data of L-PLUS 1/L-PLUS 2 (p = .0021). Conclusions This post hoc analysis revealed a possible association between baseline WBC count and platelet count increase after lusutrombopag treatment. WBC count could be a relevant factor for lusutrombopag efficacy.

The Janus kinase 2 (JAK2) V617F mutation (JAK2 V617F), JAK2 exon 12 mutations and myeloproliferative leukemia virus oncogene W515L/K mutation (MPL W515L/K) have become three major molecular diagnosis criteria for myeloproliferative neoplasms (MPNs) including polycythemia vera (PV), essential thrombocythemia (ET), and primary myelofibrosis (PMF) from 2005. 1 However, diagnosing MPNs with non-mutated JAK2 and MPL remains a major diagnostic challenge. 2-4 6] Here, we report our data on CALR mutation in wild-type (wt) JAK2 MPN on patients. It should also be mentioned that this is undoubtedly the first report regarding CALR mutations in Chinese MPN patients.

Treatment of severe hypertriglyceridemia lowers plasma viscosity

I-009 RARS-T: Molecular and clinical features of refractory anemia with ringed sideroblasts associated with marked thrombocytosis

Adequate vitamin B12 levels in infancy are crucial for normal psychomotor and cognitive development of infants. Our aim was to examine serum vitamin B12, folate and ferritin levels in exclusively breastfed healthy full-term infants (age group: 1-6months), and also investigate their correlation with maternal markers. A cross-sectional study was conducted on 100 exclusively breastfed healthy full-term infants (age group: 1-6months) along with their lactating mothers. Serum vitamin B12, folate and ferritin levels were determined for each mother-infant dyad using enzyme-linked immunosorbent assay. The mean serum vitamin B12, folate and ferritin levels were 512 vs. 535 pg/mL, 15 vs. 12 ng/mL and 313 vs. 114 ng/mL in infants and mothers, respectively. Among 100 infants, 26 (26%) had lower vitamin B12 levels and 5 (5%) had inadequate folate levels. In addition, 22 (22%) of 100 lactating mothers were deficient in vitamin B12 levels and 14 (14%) had inadequate folate levels. We found a statistically significant positive correlation between infant and maternal vitamin B12 (r=0.659, P < 0.001) and folate levels (r=0.51, P < 0.001). Vitamin B12 deficiency was observed in 26% of infants and 22% of lactating mothers. Vitamin B12 and folate levels of infants were positively correlated with maternal levels in the state of Punjab, North-West India. Our findings support that maternal vitamin B12 status can be used as a valuable predictor of infant vitamin B12 status.

Comparison tests for plasma viscosity measurements

To determine the association between several obesity indices (BMI, waist circumference, waist-to-hip and waist-to-height ratios, and abdominal height) and hematologic parameters [white blood cell (WBC) and platelet counts] among police officers. The authors conducted this cross-sectional study among 104 randomly selected officers (41 women and 63 men) from the Buffalo, NY, Police Department. Anthropometric measures were performed by clinic staff, and fasting blood samples were drawn for complete blood counts. Pearson's correlation, Student's t tests, ANOVA, analysis of covariance, and linear regression were used to assess the associations. Officers ranged in age from 26 to 61 years old and were predominantly white. Among women, current smokers had significantly higher WBC counts (7.4 x 10(3) cells/microL +/- 1.4) than former (5.2 x 10(3) cells/microL +/- 1.4) or never smokers (5.6 x 10(3) cells/microL +/- 1.5) (p = 0.002). Women had similar WBC counts but higher mean platelet counts than men (p = 0.005). Among women, abdominal height was positively associated with platelet count after adjustment for depression (p for trend = 0.039). Among women and men, a non-significant step-wise trend was observed between abdominal height and mean WBC counts before and after adjustment for smoking, race, and physical activity. No association was observed between obesity and platelet count among men. Abdominal height was significantly associated with increased platelet counts among female officers. No significant associations were observed between obesity and WBC or platelet counts among male officers.

To determine the relationship between mean platelet volume (MPV) and treatment response of iron deficiency anaemia (IDA) with normal platelet count. Study further aimed to determine changing of platelet parameters treatment response of IDA. IDA patients (n = 124) and the control group (CG) (n = 124) who fulfilled the inclusion criteria were compared for MPV and platelet parameters. Patients with IDA were divided into two groups as partial and complete response. The partial response to treatment group (PRG) was accepted as haemoglobin level between 10 and 12g/dL, mean corpuscular volume (MCV) below 80 fL, and ferritin below 15ng/ml (n = 60). Complete response to treatment group (CRG) was the patients whose haemoglobin was above 12g/dL, MCV is above 80 fL, and ferritin is above 15ng/ml (n = 64). The MPV levels of CG (8.81 ± 0.99), PRG (8.80 ± 1.09), and CRG (8.96 ± 0.96) were similar at the beginning of the study. In addition, MPV levels of PRG (8.84 ± 1.08) and CRG (8.96 ± 1.11) with IDA therapy were similar at the end of the study (p > 0.05). When IDA was treated, there was a decrease in plateletcrit, platelet distribution width (PDW), and platelet count from platelet parameters. There was a correlation between MPV level and platelet count in both PRG and CRG (r = - 0.506; p < 0.001), (r = - 0.499; p < 0.001). There is no change in MPV levels before and after treatment when normal platelet count IDA is treated, but there is a decrease in platelet count and an increase in PDW.

Reply to: Clinical impact of high platelet count and high hematocrit, by Marc Sorigue

Background: Iron deficiency is the most common cause of anemia worldwide. In premenopausal women, iron deficiency anemia is commonly caused by chronic heavy vaginal bleeding (menorrhagia). Iron deficiency anemia is usually associated with either normal or high platelet counts. However, it is rarely reported with low platelet counts. The presentation of menorrhagia, iron deficiency anemia, and thrombocytopenia has been rarely reported in the literature. The present report discusses the management and outcome of the unusual presentation of menorrhagia, iron deficiency, and thrombocytopenia. Case presentation: A 20-year-old female presented with a history of menorrhagia for two months, severe anemia, and thrombocytopenia. The laboratory investigations confirmed a severe iron deficiency anemia which was secondary to menorrhagia. After excluding other causes of thrombocytopenia, it was attributed to iron deficiency anemia. She was treated with packed red blood cell transfusion and oral iron therapy. Surprisingly, she had a further decline in platelet count then the count improved. Two weeks later, she had a further rebound thrombocytosis. During follow-up, and then the patient recovered completely, and all her hematological parameters returned to normal values. Conclusion: Iron deficiency anemia-associated thrombocytopenia is an underrepresented cause of thrombocytopenia. This case highlights the importance of considering iron deficiency-associated thrombocytopenia in the differential diagnosis to avoid the use of unnecessary investigations and treatment. Menorrhagia can cause iron deficiency anemia which can be associated with thrombocytopenia. Iron therapy can help to treat menorrhagia, iron deficiency anemia, and thrombocytopenia and it should be considered in the management of such patients.

Iron deficiency anaemia (IDA) and anaemia of chronic disease (ACD) are common causes of anaemia with similar clinical and laboratory features. IDA is caused by low iron stores while ACD is due to iron-restricted erythropoiesis occurring in inflammatory states. Differential diagnosis requires analysis of multiple biochemical and haematological parameters. IDA can occur simultaneously to ACD (mixed aetiology). It is essential that true iron deficiency is identified, as these patients will require iron therapy. This preliminary study investigated whether hepcidin, the master regulator of iron homeostasis, in conjunction with reticulocyte haemoglobin equivalent (RetHe) has the potential to differentiate IDA from ACD, and to exclude IDA in patients with mixed aetiology. Hepcidin concentration (measured using a commercially available ELISA method), RetHe, and iron parameters along with C-reactive protein (CRP) were analysed in 77 Gastroenterology patients with anaemia in a secondary care setting. Receiver operator characteristic (ROC) analysis showed that hepcidin at an optimal cut-off concentration of <6ng/ml could identify IDA with a sensitivity and specificity of 88.9% and 90.6% respectively and could distinguish ACD from IDA with both a sensitivity and specificity of 100% at a cut-off of >46ng/ml. Identifying true IDA in mixed aetiology patients could be achieved by RetHe analysis and applying an optimal cut-off of <30pg. Hepcidin, in conjunction with RetHe, offers a new simplified diagnostic pathway for differential diagnosis of IDA and ACD, thereby reducing the diagnostic turnaround time and allowing appropriate treatment of patients with a true iron deficiency.

Acute pouchitis (AP) after ileal pouch-anal anastomosis (IPAA) is common and easily treated. However, chronic pouchitis (CP) remains a difficult management problem and may represent a form of Crohn disease (CD) of the ileal pouch. Because CD patients have higher platelet counts than ulcerative colotis (UC) patients, we prospectively evaluated the association between preoperative platelet count and pouchitis development in 159 patients undergoing IPAA. Reactive thrombocytosis (RT) was defined as a platelet count > 450 x 10(9)/L. Median preoperative platelet count was 312 x 10(9)/L (range, 103 x 10(9)/L to 886 x 10(9)/L). One hundred twenty-five patients (79%) had a normal (150 x 10(9)/L to 450 x 10(9)/L) platelet count (-RT patient group). Twenty-eight patients (18%) had RT. Six patients (3%) had a platelet count below 150 x 10(9)/L. After a median follow-up of 13 months, 45 patients (28%) developed pouchitis. Pouchitis developed in 33 +RT patients (26%) versus 9 -RT patients (32%) (P = NS). UC patients who had +RT had a 25 per cent incidence of CP compared to only 7 per cent of those UC patients who had -RT (P = 0.03). The incidence of CP was significantly higher after IPAA in UC patients having thrombocytosis before surgery compared to UC patients having a normal platelet count before surgery.