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Platelets and platelet function in patients with chronic uremia on maintenance hemodialysis.

In 20 chronic uremic patients on maintenance hemodialysis, who were not taking any medication known to affect platelet function, the following investigations were carried out: platelet count, fibrin/fibrinogen degradation products, fibrinogen and plasminogen concentration, platelet adhesiveness, clot retraction and platelet aggregation induced by ADP, ristocetin, fibrinogen, collagen and epinephrine. The only significant abnormal result was a decreased clot retraction. We consider many cases of so-called uremic bleeding to be caused by the medication taken and conclude that on well-controlled hemodialysis treatment, bleeding tendency should not be a major problem.

Blood Coagulation Disorders↗

Haemorrhagic smallpox. I. Preliminary haematological studies.

In an investigation of specific haematological defects that might account for the haemorrhagic diathesis in certain smallpox patients, 93 patients with haemorrhagic and non-haemorrhagic forms of the disease were subjected to a variety of bleeding and coagulation studies. The findings indicate that smallpox patients with no clinical evidence of haemorrhage have no significant clotting defects although many have decreased platelets and clot retraction abnormality. Patients with the late haemorrhagic form of smallpox consistently show thrombocytopenia and associated abnormalities in the bleeding time, tourniquet test and clot retraction; some also have slightly depressed specific prothrombin activity.Patients with the severe, and uniformly fatal, early haemorrhagic form have severe thrombocytopenia, a marked decrease in specific prothrombin activity and prolongation of the prothrombin complex times. They also have a marked prolongation of the thrombin time, suggesting the presence of a circulating antithrombin.Both early and late haemorrhagic smallpox patients also have a marked abnormality of prothrombin consumption, indicating impaired plasma thromboplastin production. This finding could be explained by the thrombocytopenia present in all haemorrhagic cases.

Blood Coagulation Disorders↗

[Effects of frostbite on some factors of blood coagulation system in rats under hypoxia].

The changes of some factors of blood coagulation system in rats following frost-bite of both hind feet under hypoxia were investigated. Male Wistar rats weighed 200 +/- 20g were divided into four groups: normal control (C); frostbite at normoxia (FN); frostbite during acute hypoxia (FAH) and frostbite during hypoxia after altitude acclimation (FHAC). Bleeding time and clotting time, rate of clot-retraction, plasma content of 6-keto-PGF1 alpha and TXB2 were determined following exposure to cold. The results showed that bleeding time and clotting time were shortened, and rate of clot-retraction was decreased, plasma content of 6-keto-PGF1 alpha and TXB2, T/P ratio were increased significantly after exposure to cold in all frostbite groups, but these changes were more prominent in FHAC than those in FN and FAH. The results demonstrated that there were changes in blood coagulation system following cold injury, blood coagulability was increased. These changes were closely related to the degree of frostbite. In addition, the degree of cold injury was aggravated by altitude acclimation and this may play an important role in the pathological process of dysfunction leading to necrosis of local frostbite tissue.

Acclimatization↗

Chitosan-glycerol phosphate/blood implants elicit hyaline cartilage repair integrated with porous subchondral bone in microdrilled rabbit defects.

OBJECTIVE: We have previously shown that microfractured ovine defects are repaired with more hyaline cartilage when the defect is treated with in situ-solidified implants of chitosan-glycerol phosphate (chitosan-GP) mixed with autologous whole blood. The objectives of this study were (1) to characterize chitosan-GP/blood clots in vitro, and (2) to develop a rabbit marrow stimulation model in order to determine the effects of the chitosan-GP/blood implant and of debridement on the formation of incipient cartilage repair tissue. METHODS: Blood clots were characterized by histology and in vitro clot retraction tests. Bilateral 3.5 x 4 mm trochlear defects debrided into the calcified layer were pierced with four microdrill holes and filled with a chitosan-GP/blood implant or allowed to bleed freely as a control. At 1 day post-surgery, initial defects were characterized by histomorphometry (n=3). After 8 weeks of repair, osteochondral repair tissues between or through the drill holes were evaluated by histology, histomorphometry, collagen type II expression, and stereology (n=16). RESULTS: Chitosan-GP solutions structurally stabilized the blood clots by inhibiting clot retraction. Treatment of drilled defects with chitosan-GP/blood clots led to the formation of a more integrated and hyaline repair tissue above a more porous and vascularized subchondral bone plate compared to drilling alone. Correlation analysis of repair tissue between the drill holes revealed that the absence of calcified cartilage and the presence of a porous subchondral bone plate were predictors of greater repair tissue integration with subchondral bone (P<0.005), and of a higher total O'Driscoll score (P<0.005 and P<0.01, respectively). CONCLUSIONS: Chitosan-GP/blood implants applied in conjunction with drilling, compared to drilling alone, elicited a more hyaline and integrated repair tissue associated with a porous subchondral bone replete with blood vessels. Concomitant regeneration of a vascularized bone plate during cartilage repair could provide progenitors, anabolic factors and nutrients that aid in the formation of hyaline cartilage.

Animals↗

A monoclonal antibody to the fibrinogen gamma-chain alters fibrin clot structure and its properties by producing short, thin fibers arranged in bundles.

BACKGROUND: We previously reported that hamster monoclonal antibody 7E9, which reacts with the C-terminus of the gamma-chain of mouse fibrinogen, inhibits factor (F)XIIIa-mediated cross-linking, platelet adhesion to fibrinogen, and platelet-mediated clot retraction; in addition, it facilitates thrombolysis. OBJECTIVES: To understand the mechanism(s) by which 7E9 acts, we have now studied the effect of 7E9 IgG, 7E9 F(ab')2, and 7E9 Fab on fibrin clot structure using electron microscopy and measurements of clot physical properties. RESULTS: By transmission electron microscopy, 7E9 IgG was found to bind primarily to the ends of the fibrinogen molecule. 7E9 IgG and 7E9 F(ab')2, both of which are bivalent, were capable of binding to two fibrinogen molecules simultaneously. Scanning electron microscopy of clots formed in the presence of equimolar concentrations of fibrinogen and 7E9 IgG demonstrated the presence of very short and thin fibers (63% reduction in fiber diameter) arranged in unusual bundles, surrounding large pores. Clots formed in the presence of 7E9 demonstrated a marked increase in permeation (approximately 25-fold increase in perfusion rate at constant pressure), an approximately 50% reduction in dynamic storage modulus (G'; a reflection of decreased clot stiffness), and an approximately 38% increase in loss tangent (tan delta; a reflection of the clot's ability to undergo irreversible deformation). These clots also showed decreased absorbance at 350 nm, reflecting the clot structure produced by 7E9 IgG. The effects of 7E9 IgG were not observed with control hamster IgG, 7E9 F(ab')2, or 7E9 Fab fragments, indicating requirements for both the binding properties and mass of 7E9 IgG. CONCLUSIONS: These data indicate that 7E9 antibody affects fibrin clot structure in a way that is consistent with the enhanced fibrinolysis we reported previously. Together with our previous observations, we conclude that 7E9 is directed at a strategically important region of fibrinogen with regard to platelet function, FXIIIa-mediated cross-linking, clot retraction, fibrin structure, and fibrinolysis. Thus targeting this region of fibrinogen may have antithrombotic therapeutic potential.

Animals↗

Comparative screening of plant essential oils: phenylpropanoid moiety as basic core for antiplatelet activity.

Essential oils extracted from different plants (Anthemis nobilis L., Artemisia dracunculus L., Cannabis sativa L., Cupressus sempervirens L., Cymbopogon citratus (DC.) Stapf., Curcuma longa L., Foeniculum vulgare L., Hypericum perforatum L., Hyssopus officinalis L., Mentha spicata L., Monarda didyma L., Ocimum basilicum L., Ocotea quixos Kosterm., Origanum vulgare L., Pinus nigra J.F. Arnold, Pinus silvestris L., Piper crassinervium Kunth., Rosmarinus officinalis L., Salvia officinalis L., Salvia sclarea L., Santolina chamaecyparissus L., Thymus vulgaris L., Zingiber officinaie L.) were screened in guinea pig and rat plasma in order to assess antiplatelet activity and inhibition of clot retraction. The oils were chemically analysed and a relationship between components and ability to affect hemostasis was evidenced. O. quixos, F. vulgaris, and A. dracunculus showed the highest antiplatelet activity against ADP, Arachidonic Acid and the Thromboxane A2 agonist U46619 (IC50, 4-132 microg ml(-1)), and a good ability to destabilize clot retraction (IC50, 19-180 microg ml(-1)). For these oils a significant correlation between antiplatelet potency and phenylpropanoids content (54-86%) was evidenced thus suggesting a key role for this moiety in the prevention of clot formation. These findings provide the rationale to take in account the antiplatelet activity in the pharmacological screening of natural products containing phenylpropanoids.

Animals↗

Effect of clot formation and retraction on spin-echo MR images of blood: an in vitro study.

Phantoms were constructed that contained red blood cell (RBC)-free clots in varying stages of clot retraction. MR images of these samples were compared with those of retracted whole venous blood clots and a fresh rat brain standard. Images were obtained at 0.3 T, 0.5 T, 1.0 T, 1.5 T, and 2.4 T with T1-, spin-density- and T2-weighted spin-echo pulse sequences. The presence or absence of venous blood cells in the clot caused only minor differences in T2- and spin-density-weighted images of the clots at or below 1.5 T. On T2-weighted scans, the retraction of the RBC-free clot resulted in a progressive decrease in signal intensity at 2.4 T. Fully retracted RBC-free clots were markedly hypointense relative to serum and ranged from slightly hyperintense to isointense with brain and venous clots at 0.5-1.5 T. There were no striking concomitant signal intensity changes on the spin-density- or T1-weighted scans, which could have caused the changes seen on the T2-weighted images of the clots. Our results indicate that the physical basis of these MR effects in the RBC-free clots is the concentration of plasma protein. The combined concentration of plasma protein and the tightly packed RBC proteins in the venous clots causes the strikingly similar MR appearance of venous and RBC-free clots on clinical images. These results do not demonstrate the presence of the previously postulated selective T2 relaxation of intracellular paramagnetic deoxyhemoglobin in these in vitro venous clots.

Animals↗

Plateletpheresis by discontinuous centrifugation: effect of collecting methods on the in vitro function of platelets.

The in vitro function of platelets collected by two different methods during centrifugal plateletpheresis was compared. The RBC method involves collecting platelets with red cells followed by a supplementary spin to remove them, whereas the no-RBC method requires collecting platelets only from the buffy coat without red cells. Platelet response to adenosine diphosphate (ADP), epinephrine and collagen was slightly reduced in platelet-rich plasma (PRP) prepared by no-RBC technique and was markedly decreased in samples obtained by the RBC technique when compared to prepheresis controls. The decrease in platelet response to ADP, epinephrine and collagen was apparent in three testing systems: aggregation, release of serotonin and reptilase clot retraction. Both plasma and platelets appeared to be affected by the pheresis procedure. Platelet preparations obtained by both RBC and no-RBC techniques showed an increase of platelet factor 3 activity and an enhancement of aggregation, release of serotonin and clot retraction induced by thrombin as compared to prepheresis controls. Postpheresis platelet-poor plasma contains platelet membrane fragments which exhibit a high platelet factor 3 activity. The results showed that the RBC method, although providing a higher platelet yield, caused more qualitative alterations in platelets than in those obtained by no-RBC method, and that both methods of collecting platelets activated the procoagulant activity of platelets.

Blood Platelets↗

Pathophysiologic roles of the fibrinogen gamma chain.

PURPOSE OF REVIEW: Fibrinogen binds through its gamma chains to cell surface receptors, growth factors, and coagulation factors to perform its key roles in fibrin clot formation, platelet aggregation, and wound healing. However, these binding interactions can also contribute to pathophysiologic processes, including inflammation and thrombosis. This review summarizes the latest findings on the role of the fibrinogen gamma chain in these processes, and illustrates the potential for therapeutic intervention. RECENT FINDINGS: Novel gamma chain epitopes that bind platelet integrin alpha IIbbeta3 and leukocyte integrin alphaMbeta2 have been characterized, leading to the revision of former dogma regarding the processes of platelet aggregation, clot retraction, inflammation, and thrombosis. A series of studies has shown that the gamma chain serves as a depot for fibroblast growth factor-2 (FGF-2), which is likely to play an important role in wound healing. Inhibition of gamma chain function with the monoclonal antibody 7E9 has been shown to interfere with multiple fibrinogen activities, including factor XIIIa crosslinking, platelet adhesion, and platelet-mediated clot retraction. The role of the enigmatic variant fibrinogen gamma chain has also become clearer. Studies have shown that gamma chain binding to thrombin and factor XIII results in clots that are mechanically stiffer and resistant to fibrinolysis, which may explain the association between gammaA/gamma' fibrinogen levels and cardiovascular disease. SUMMARY: The identification of new interactions with gamma chains has revealed novel targets for the treatment of inflammation and thrombosis. In addition, several exciting studies have shown new functions for the variant gamma chain that may contribute to cardiovascular disease.

Animals↗

An overview of platelet structural physiology.

Marion Barnhart and her colleagues used light, phase contrast and scanning electron microscopy to provide a clear picture of platelet surface changes developing in response to aggregating agents. This review, in honor of Marion and her work, has sought to expand the horizon provided through study of surface alterations by peeling back the membrane of the platelet to reveal the dynamic world within. A cytoskeleton consisting of a circumferential microtubule and submembrane actin filaments supports the discoid shape of the resting cell. Following exposure to aggregating agents in suspension, to foreign surfaces or denuded blood vessels and to fibrin strands during clot retraction, the state of assembly and organization of actin and location of the microtubule undergo dramatic alterations. There are differences in the cytoskeletal organization of platelets activated in suspension or on surfaces, during spreading on damaged blood vessels or in the process of clot retraction; yet, the similarities are far more impressive than the differences. The ability to assemble its cytoskeleton and adapt it to a variety of conditions requiring the exercise of contractile force makes the platelet a unique form of muscle cell.

Blood Platelets↗

In vitro effects of different medium molecular hydroxyethyl starch solutions and lactated Ringer's solution on coagulation using SONOCLOT.

UNLABELLED: Hydroxyethyl starch (HES) solutions are widely used to replace intravascular volume. HES solutions differ from each other with regard to molecular weight and mode of hydroxyl substitution (degree of hydroxylation, C2:C6 hydroxyethyl ratio, concentration), factors which may have varying effects on coagulation. We studied, in vitro, three different HES preparations (molecular weight/degree of hydroxylation/concentration/C2:C6 ratio of substitution 70.000/0. 5/6%/3.2; Pharmacia & Upjohn Co., Erlangen, Germany; 130.000/0. 4/6%/11.2 and 200.000/0.5/6%/4.6; Fresenius Co., Bad Homburg, Germany) and, for comparison, lactated Ringer's solution (RL) at 33% and 66% dilution with whole blood. The influence of hemodilution was measured by using routine laboratory variables and SONOCLOT (Sonoclot II Coagulation and Platelet Function Analyzer, Sienco Co.) analysis, using a viscoelastic test, on the cellular as well as on the plasmatic hemostatic system. For statistical analysis of quantitative data, we used nonparametric analysis of variance and adequate post hoc tests. Qualitative data were analyzed by using the nonparametric Kruskal-Wallis test. A P value below 0.05 was considered significant. In contrast to the control group with RL, the liquid phase of coagulation (activated clotting time) was slightly affected by the 33% diluted HES solutions. HES 70.000, 130. 000, and 200.000 interfered significantly with the early stage of coagulation as expressed by the clot rate (gel/fibrin formation). Clot maturation and speed of maturation (time to peak) were strongly affected by HES 70.000 at all grades of dilution. HES 130.000 showed a faster clot formation process compared with the other HES solutions. HES 130.000 diluted 33% showed a better clot retraction as compared with the other HES solutions. In conclusion, in vitro hemodilution comparing different medium molecular weight HES solutions reveals that HES 130.000 seems preferable regarding some aspects of clot formation and retraction. RL affected clot formation only minimally, except for the early activation of clotting, which was measured by a shortened activated clotting time. IMPLICATIONS: We investigated the effect of different hydroxyethyl starch (HES) solutions (70.000, 130.000, 200.000) on coagulation. Regarding clot formation and retraction, HES 130.000 had some advantages over the other tested HES solutions. Lactated Ringer's solution affected coagulation only minimally, except for the early stage of clot formation.

Blood Coagulation↗

Platelet disintegration during clotting.

Sequential alterations in the ultrastructure of blood platelets observed during the clotting of human platelet-rich plasma are described, with emphasis on disintegration of the platelet. As the clotting reaction proceeds, aliquots of citrated and recalcified citrated plasma are fixed by adding buffered OsO(4). After recalcification a lag period of about 10 minutes is followed by an interval of rapidly occurring changes which include reorientation of cytoplasmic contents, progressive central degeneration, and disruption of the platelet limiting membrane. Shortly thereafter vesicular platelet remains are seen at the peripheries of loosely arranged and widely spaced masses of granular material. As clot retraction proceeds, these masses gradually come closer together, become more and more compact, and finally disappear. At the same time the vesicles undergo progressive disintegration until at the end of the experiment, 2 hours after recalcification, only a few are found randomly distributed in a dense clot. The significance of progressive disintegration and the origin of the vesicles observed in the later stages of the experiment are discussed in relation to clot formation and clot retraction.

Blood Coagulation↗

Platelet-mediated collagen and fibrin retraction: effect of prostaglandins, cyclic AMP, calcium antagonists and N-ethylmaleimide.

Collagen gel retraction (CGR) and thrombin-induced fibrin clot retraction (FCR) could be abolished by EGTA and EDTA, trifluoperazine - a calmodulin inhibitor - and by NEM. Both processes appeared insensitive to hydrocortisone (up to 100 microM), indomethacin (up to 60 microM), PGI2 and its stable analogue 6-keto-PGE1 alpha (10 microM). A slight inhibitory effect on both CGR and FCR was provoked by dibutyryl-cAMP and PGD2. PGE1 1 microM strongly inhibited CGR and FCR. Possible interference of the inhibitors with anchorage of collagen and fibrin on platelet surface and with platelet contractile system is discussed.

Blood Platelets↗

Platelet functions in patients with meningococcal meningitis at the Kenyatta National Hospital, Nairobi.

OBJECTIVE: To determine platelet abnormalities in patients with menigococcal meningitis. DESIGN: Case control study. SUBJECTS: Fifty seven cases of mennigococcal meningitis based on a cerebrospinal fluid gram stain for gram negative diplococcus or positive culture were recruited. Fifty-seven controls matched for age and sex were also recruited. The following platelet functions tests were performed; platelet counts, platelet adhesiveness, platelet aggregation and clot retraction. RESULTS: Fifty seven patients (41 males and 16 females) with meningococcal meningitis were studied. Their mean age was 25.5 +/- 8.32 years with a range of 15 to 45 years. Five patients had purpura, four peripheral gangrene, eight conjunctival haemorrhages and one was in shock. There was a statistical significant difference in the platelet aggregation and clot retraction between the patients and controls at p-values of 0.0001 and 0.0002 respectively. There was no significant difference in the platelet count and adhesiveness between the patients and the controls at a p-value of 0.203 and 0.22 respectively. No association was found between the platelet functions and the clinical presentations. CONCLUSION: Patients with meningococcal meningitis have abnormalities in the platelet functions mainly in aggregation and adhesiveness.

Adolescent↗

Tyrosine phosphorylation of the beta3 cytoplasmic domain mediates integrin-cytoskeletal interactions.

Tyrosine phosphorylation of the beta3 subunit of the major platelet integrin alphaIIb beta3 has been shown to occur during thrombin-induced platelet aggregation (1). We now show that a wide variety of platelet stimuli induced beta3 tyrosine phosphorylation, but that this phosphorylation occurred only following platelet aggregation. Several lines of evidence suggest that the beta3 cytoplasmic domain tyrosine residues and/or their phosphorylation function to mediate interactions between beta3 integrins and cytoskeletal proteins. First, phospho-beta3 was retained preferentially in a Triton X-100 insoluble cytoskeletal fraction of thrombin-aggregated platelets. Second, in vitro experiments show that the cytoskeletal protein, myosin, associated in a phosphotyrosine-dependent manner with a diphosphorylated peptide corresponding to residues 740-762 of beta3. Third, mutation of both tyrosines in the beta3 cytoplasmic domain to phenylalanines markedly reduced beta3-dependent fibrin clot retraction. Thus, our data indicate that platelet aggregation is both necessary and sufficient for beta3 tyrosine phosphorylation, and this phosphorylation results in the physical linkage of alphaIIb beta3 to the cytoskeleton. We hypothesize that this linkage may involve direct binding of the phosphorylated integrin to the contractile protein myosin in order to mediate transmission of force to the fibrin clot during the process of clot retraction.

Amino Acid Sequence↗

Platelet function in acute leukemias.

Bleeding time, clot retraction, platelet factor 3 availability and platelet aggregation in response to ADP, epinephrine, collagen and ristocetin were studied in 13 cases of acute leukemia which included 5 cases of acute myeloid leukemia, 2 of chronic myeloid leukemia in blast crisis and 6 of acute lymphoblastic leukemia. More than one abnormality was seen in all the patients. Defects in bleeding time, clot retraction and platelet factor 3 availability were encountered in 43% of cases. Platelet aggregation responses to all the reagents were significantly impaired. There was, however, no consistency in the pattern of the defects.

Blast Crisis↗

Blood clotting: the force of retraction.

The force of blood clot retraction was measured and found to be at least 104 dyne/cm(2); this is sufficient to deform many soft tissues and to allow clots to retract in vivo.

Blood Coagulation↗

Beta3 tyrosine phosphorylation in alphaIIbbeta3 (platelet membrane GP IIb-IIIa) outside-in integrin signaling.

The platelet integrin alphaIIbbeta3 not only binds fibrinogen and von Willebrand factor to mediate platelet aggregation and adhesion, it also serves as a signaling receptor. Platelet agonists such as ADP, thrombin and collagen induce "inside-out" signaling which activates the receptor function of alphaIIbbeta3 for soluble fibrinogen. Subsequent platelet aggregation leads to "outside-in" signaling, inducing platelet aggregate stabilization and triggering a variety of functions important to platelet physiology. This review focuses on the role of beta3 tyrosine phosphorylation in alphaIIbbeta3 outside-in signaling. Tyrosine phosphorylation of beta3 in platelets is a dynamic process which is initiated upon platelet aggregation and also by adhesion of platelets to immobilized fibrinogen. Tyrosine phosphorylation occurs on the beta3 integrin cytoplasmic tyrosine (ICY) domain, a conserved motif found in the beta subunits of several integrins. Beta3 ICY domain tyrosine phosphorylation induces the recruitment of two proteins to the cytoplasmic domains of alphaIIbbeta3: the cytoskeletal protein myosin, important to clot retraction; and the signaling adapter protein Shc, important to platelet stimulation, The critical role of beta3 tyrosine phosphorylation to platelet function was established by the diYF mouse, a novel strain which expresses an alphaIIbbeta3 in which the two beta3 ICY domain tyrosines have been mutated to phenylalanine. These mice are selectively impaired in outside-in alphaIIbbeta3 signaling, with defective aggregation and clot-retraction responses in vitro, and an in vivo bleeding defect which is characterized by a pronounced tendency to rebleed. Taken together, the data suggest that the beta3 tyrosine phosphorylation signaling mechanism is important to alphaIIbbeta3 function and might be applicable to a wide variety of integrin-mediated events.

Amino Acid Motifs↗