Effect of erythropoietin use on mean platelet volume in children undergoing chronic dialysis

Yıl 2014, Cilt: 5 Sayı: 3, 415 - 419, 01.09.2014

Kadriye Özdemir Orhan Deniz Kara Nida Dinçel İpek Kaplan Bulut Ebru Yılmaz Sevgi Mir

https://doi.org/10.5799/ahinjs.01.2014.03.0430

Cited By: 1

Öz

Objective: In this study, it was aimed to determine the relationship between erythropoietin (EPO) use and mean platelet volume (MPV) in the children undergoing dialysis. Methods: MPV values before and after EPO use in 36 patients (16 hemodialysis - HD, 20 peritoneal dialysis - PD) were retrospectively evaluated. Patients were divided into two groups according to weekly EPO need as; given less than 150 U/kg defined as low EPO and more than 150 U/kg as high EPO groups. The age, weight, primary cause of chronic renal failure, dialysis methods and EPO dosages of patients were recorded. Blood samples were taken before and 4 weeks after EPO usage and MPV values were noted from complete blood counts. Results: While significant increase was seen in the MPV values after EPO in comparison to MPV values before EPO in the HD group (8.18±1.52 fL vs. 9.20±1.46 fL; p=0.046); near significant difference was found in the MPV levels after EPO (8.28±1.80 fL vs. 9.39±1.50 fL; p=0,051) in PD group. In HD patients when high dose of EPO was given, MPV levels were found to be significantly elevated (7.81 ± 1.04 vs 9.61 ± 1.05; p=0.06) after EPO. However, no difference was seen with the lowe dose EPO subgroup (8.64 ± 1.97 ve 8.67 ± 1.81; p>0,05). No effect of EPO dose was found on MPV values in PD patients (9.57 ± 1.58 ve 9.1 ± 1.42; p>0.05). Conclusion: It was observed that EPO influenced MPV values in children undergoing HD, while no effect of erythropoietin was found on MPV values of PD patients. Physicians should be careful while using high dose erythropoietin in children with high thrombosis risk. J Clin Exp Invest 2014; 5 (3): 415-419

Anahtar Kelimeler

Mean platelet volume, erythropoietin, hemodialysis, child

Kronik diyaliz tedavisi alan çocuklarda eritropoetin kullanımının ortalama trombosit hacmine etkisi

Öz

Amaç: Bu çalışmada diyaliz uygulanan çocuklarda ortalama trombosit hacmi (OTH) ve eritropoetin (EPO) kullanımı arasındaki ilişkinin incelenmesi amaçlanmıştır. Yöntemler: Çalışmada 16 hemodiyaliz (HD), 20 periton diyalizi (PD) olmak üzere 36 hastanın eritropoetin öncesi ve sonrası OTH değerleri retrospektif olarak incelendi. Hastalar haftalık eritropoetin alımı 150 Ü/kg\'ın altında (düşük EPO) ve 150 Ü/kg üzerinde (yüksek EPO) olmak üzere 2 gruba ayrıldı. Hastaların yaşları, vücut ağırlıkları, kronik böbrek yetmezliğine neden olan primer hastalıkları, uygulanan diyaliz tedavi yöntemleri, EPO dozları kaydedildi. EPO başlanmadan önce ve başlandıktan 4 hafta sonra alınan kan örneklerinde tam kan sayımı (hemogram) yapılarak OTH değerleri kaydedildi.. Bulgular: Hemodiyaliz grubunun EPO sonrası OTH değerlerinde EPO öncesi OTH değerlerine göre anlamlı yükselme (8,18±1,52 fL ve 9,20±1,46 fL, p=0,046) saptanırken, PD grubunda ise EPO sonrası değerlerde yükselme olmasına rağmen, fark istatistiksel anlamlılık sınırına çok yakın bulundu (8,28±1,80 fL ve 9,39±1,50 fL, p=0,051). Yüksek dozda EPO alan HD hastalarında EPO sonrası OTH değerleri artmış olarak bulundu (7,81 ± 1,04 ve 9,61 ± 1,05 fL; p=0,06). Düşük doz EPO kullananlarda ise farklılık görülmedi (8,64 ± 1,97 ve 8,67 ± 1,81 fL; p>0,05). PD hastalarında ise EPO dozu OTH değerleri üzerinde etkili bulunmadı (9,57 ± 1,58 ve 9,10 ± 1,42 fL; p>0,05). Sonuç: HD uygulanan çocuklarda EPO\'nun OTH düzeylerini etkilediği, ancak PD hastalarında OTH düzeylerinin EPO tedavisinden etkilenmediği görüldü. Hekimler tromboz riski yüksek hastalarda yüksek doz EPO kullanırken dikkatli olmalıdır.

Anahtar Kelimeler

Ortalama trombosit hacmi, eritropoetin, hemodiyaliz, çocuk

Kaynakça

• Soyoral YU, Demir C, Begenik H, et al. Skin bleed- ing time for the evaluation of uremic platelet dysfunc- tion and effect of dialysis. Clin Appl Thromb Hemost 2012;18:185-188.
• Viron B, Chamma F, Jaar B, et al. Thrombosis of angio- access in haemodialysed patients treated with human recombinant erythropoietin. Nephrol Dial Transplant 1997;12:368–370.
• Tang WW, Stead RA, Goodkin DA. Effects of epoetin alfa on prohemostasis in chronic renal failure. Am J Nephrol 1998;18:263–273.
• Taylor JE, McLaren M, Henderson IS, et al. Prothrom- botic effect of erythropoietin in dialysis patients. Nephrol Dial Transplant 1992;7:235–239.
• Cases A, Escolar G, Reverter JC, et al. Recombinant human erythropoietin treatment improves platelet function in uremic patients. Kidney Int 1992;42:668– 672.
• Zhou XJ, Vaziri ND. Defective calcium signaling in uraemic platelets and its amelioration with long term erythropoietin therapy. Nephrol Dial Transplant 2002;17:992–997.
• Diaz-Ricart M, Etebanell E, Cases A, et al. Erythropoi- etin improves signaling through tyrosine phosphory- lation in platelets from uremic patients. Thromb Hae- most 1999;82:1312–1317.
• Thompson CB, Jakubowski JA, Quinn PG, et al. Plate- let size as a determinant of platelet function. J Lab Clin Med 1983;101:205-213.
• Thompson CB, Monroy RL, Skelly RR, et al. The bi- ology of platelet volume heterogeneity. In: Martin JF, Trowbridge EA, eds. Platelet heterogeneity: biology and pathology. London: Springer-Verlag; 1990:25–35.
• Endler G, Klimesch A, Sunder-Plassmann H, et al. Mean platelet volume is an independent risk factor for myocardial infarction but not for coronary artery dis- ease. Br J Haematol 2002;117:399-404.
• Kılıçlı N, Demirtunç R, Konuralp C, et al. Could mean platelet volume be a predictive marker for acute myo- cardial infarction? Med Sci Monit 2005;11:387-392.
• Şen HS, Abakay Ö, Taylan M, et al. The importance of mean platelet volume in early mortality of pulmonary embolism. J Clin Exp Invest 2013;4:298-301.
• Yılmaz N, Özkan OV, Büyükbaş S, et al. Mean platelet volume in patients with acute pancreatitis. J Clin Exp Invest 2011;2:362-365.
• Sharpe PC, Desai ZR, Morris TCM. Increase in mean platelet volume in patients with chronic renal failure treated with erythropoietin. J Clin Pathol 1994;47:159- 161.
• Erçoban HS. Kronik böbrek yetmezliğinde ortalama trombosit hacmini etkileyen faktörler ve klinik önemi. Yan dal uzmanlık tezi. Başkent Üniversitesi Pediatrik Nefroloji Bilim Dalı, 2008.
• Dow RB. The clinical and laboratory utility of platelet volume parameters. Aust J Med Sci 1994;15:12-15.
• Kaw D, Mahotra D. Platelet dysfunction and end- stage renal disease. Semin Dial 2006;19:317-322.
• Boccardo P, Remuzzi G, Galbusera M. Platelet dysfunction in renal failure. Semin Thromb Hemost 2004;30:579-589.
• Ishibashi T, Koziol JA, Burstein SA. Human recombi- nant erythropoietin promotes differentiation of murine megakaryocytes in vitro. J Clin Invest 1987;79:286- 289.
• Berridge MV, Fraser JK, Carter JM, Lin FK. Effects of recombinant human erythropoietin on megakaryo- cytes and on platelet production in the rat. Blood 1988;72:970-977.
• Fraser JK, Tan AS, Lin FR, Berridge MV. Expression of specific high-affinity binding sites for erythropoietin on rat and mouse megakaryocytes. Exp Haematol 1989;17:10-16.
• Van Geet C, Hauglustaine D, Verresen L, et al. Hae- mostatic effects of recombinant human erythropoietin in chronic haemodialysis patients. Thromb Haemostat 1989;61:117-121.
• Akizawa T, Kingusa E, Kitoaka T, Koshikawa S. Ef- fects of recombinant human erythropoietin and cor- rection of anaemia on platelet function in haemodialy- sis patients. Nephron 1991;58:400-406.
• Tang YD, Hasan F, Giordano JF, et al. Effects of re- combinant human erythropoietin on platelet activation in acute myocardial infarction: results of a double- blind, placebo-controlled randomized trial. Am Heart J 2009;158:941–947
• Salvati F, Liani M. Role of platelet surface receptor abnormalities in the bleeding and thrombotic diathesis of uremic patients on hemodialysis and peritoneal di- alysis. Int J Artif Organs 2001;24:131-135.
• Burstein SA, Meir J, Friese P, Turner K. Recombinant human leukaemia inhibitory factors (LIF) and inter- leukin-1 1 (IL-i1l) promote murine and human mega- karyocytopoiesis in vitro. Blood 1990;76:450a.
• Burstein SA, Henthorn J, Mei R, Williams DE. Mast cell growth factor (MGF) promotes human and murine megakaryocytic (MK) differentiation in vitro. Blood 1991;78:160a.
• Van Geet C, Hauglustaine D, Verresen L, et al. Hae- mostatic effects of recombinant human erythropoietin in chronic haemodialysis patients. Thromb Haemo- stas 1989;61:117-121.
• Carter JM, Lin FK. Effects of recombinant human erythropoietin on megakaryocytes and a platelet pro- duction in the rat. Blood 1988;72:970-977.
• Ishibashi T, Kimura H, Uchida T, et al. Human interleu- kin 6 is a direct promoter of maturation of megakaryo- cytes in vitro. Proc Nad Acad Sci USA 1989;86:5953- 5957.