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Post-Transplant Complications

Prolonged thrombocytopenia after allogeneic hematopoietic stem cell transplantation: associations with impaired platelet production and increased platelet turnover

Bone Marrow Transplantation volume 38, pages 377–384 (2006)Cite this article

Abstract

To evaluate the mechanisms underlying prolonged thrombocytopenia after allogeneic hematopoietic stem cell transplantation (SCT), an index for plasma glycocalicin normalized for the individual platelet count (GCI), plasma thrombopoietin (TPO), and circulating B cells producing anti-GPIIb-IIIa antibodies were measured in 50 SCT recipients with or without prolonged thrombocytopenia, 42 patients with idiopathic thrombocytopenic purpura, nine patients with aplastic anemia, and 22 healthy individuals. All three indices were significantly higher in the SCT recipients with thrombocytopenia than in those without (P<0.01 for all comparisons), and were significantly correlated with the platelet count in SCT recipients. Stepwise multiple regression analysis of the samples from the SCT recipients revealed that GCI and TPO independently pointed to specific mechanisms of thrombocytopenia. The GCI and TPO status in SCT recipients with thrombocytopenia had a pattern similar to that seen in aplastic anemia, suggesting a major role for impaired thrombopoiesis. An antiplatelet antibody response was frequently detected in SCT recipients, but the development of thrombocytopenia is likely to depend on additional factors, such as reticuloendothelial function. In summary, post transplant prolonged thrombocytopenia is associated with complex mechanisms, including impaired thrombopoiesis and increased platelet turnover.

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Acknowledgements

This work was supported by the Japanese Ministry of Health, Labour and Welfare. We thank the staff of the Keio BMT program.

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Authors and Affiliations

  1. Division of Hematology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan

    R Yamazaki, T Mori, Y Ikeda & S Okamoto

  2. Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan

    M Kuwana & Y Okazaki

  3. Institute for Advanced Medical Research, Keio University School of Medicine, Tokyo, Japan

    R Yamazaki, M Kuwana & Y Kawakami

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  1. R Yamazaki
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  2. M Kuwana
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  7. S Okamoto
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Correspondence to M Kuwana.

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Yamazaki, R., Kuwana, M., Mori, T. et al. Prolonged thrombocytopenia after allogeneic hematopoietic stem cell transplantation: associations with impaired platelet production and increased platelet turnover. Bone Marrow Transplant 38, 377–384 (2006). https://doi.org/10.1038/sj.bmt.1705444

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