Platelet Function Analysis by Flowcytometry in Thrombocytopenic Trauma Patients
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ORIGINAL ARTICLE
Platelet Function Analysis by Flowcytometry in Thrombocytopenic Trauma Patients Tapasyapreeti Mukhopadhyay1 • Arulselvi Subramanian1 Anand Kumar1 • Shyam Prakash1 • Hara Prasad Pati2
•
Venencia Albert1
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Received: 1 June 2020 / Accepted: 31 August 2020 Ó Indian Society of Hematology and Blood Transfusion 2020
Abstract Hemostasis is dependent on sufficient quantity and quality of circulating functional platelets. Platelet function in trauma patients with thrombocytopenia and its impact on the clinical outcome is not adequately explored. Whether platelet dysfunction has a role in the pathogenesis of acute traumatic coagulopathy needs to be studied. Blood samples were collected from 70 thrombocytopenic trauma patients before transfusing platelets and assessed for platelet activation and platelet aggregation using flowcytometry. Primary outcome was in-hospital mortality. Platelet dysfunction was identified in 57.1% of thrombocytopenic trauma patients. A weak inverse correlation between percentage of activated platelets and APTT was observed (Spearman coefficient - 0.25, p = 0.03). A sensitivity and specificity of 66.6% was achieved for a cut off of B 6.5% of platelet activation post trauma with ROCAUC of 0.658 for identifying coagulopathy. No correlation with mortality however was observed (p [ 0.05). Platelet dysfunction had a weak association with coagulopathy suggesting limited contribution of platelet dysfunction in pathogenesis of acute traumatic coagulopathy and warrants further research. Keywords Hemostasis Platelet activation Platelet aggregation Platelet dysfunction
& Arulselvi Subramanian [email protected] Tapasyapreeti Mukhopadhyay [email protected] 1
Department of Laboratory Medicine, Jai Prakash Narayan Apex Trauma Centre, AIIMS, New Delhi, India
2
Department of Hematology (Retd), AIIMS, New Delhi, India
Introduction Platelets play a crucial role in maintaining hemostasis [1, 2]. Hemorrhage is a major preventable cause of death in trauma patients [3–5]. Thrombocytopenia coexisting with platelet dysfunction would exaggerate bleeding and thus require further exploration. Currently, the management practice is based on assessing the platelet counts and the coagulation profile. We also know that hemostasis is dependent on a sufficient quantity of circulating functional platelets. Yet platelet function in trauma patients, is not assessed in routine practice. Unavailability of a sensitive modality to assess platelet function in the settings of low platelet counts could be a probable reason. Whether platelet dysfunction has role in the pathogenesis of acute traumatic coagulopathy needs to be studied. The present paper is based on the research hypothesis that thrombocytopenic trauma patients develop platelet dysfunction and have poorer outcome. The primary objective of the study was to assess platelet function in thrombocytopenic trauma patients and to associate platelet function with outcome.
Method This prospective observational study was conducted in the Department
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