Reduced Platelet Aggregation in Hemolytic-Uremic Syndrome

Summary

Platelet aggregation was studied in three patients during the course of the hemolytic-uremic syndrome (HUS) when the platelet count was below 100,000/mm³ and after the platelet count had normalized. Platelet aggregation was examined in response to epinephrine, adenosine diphosphate (ADP) and collagen. Aggregation did not occur in response to epinephrine when the patients were thrombocytopenic but normal tracings were obtained when the platelet counts had returned to normal. In contrast, platelet-rich plasma from normal subjects diluted with platelet-poor plasma from patients to comparable platelet counts, showed normal aggregation responses. This study demonstrates that platelet aggregation is reduced in the early phase of the HUS.

Keywords

Platelets aggregation - Hemolytic-uremic syndrome

• References

• 1 Avalos JS, Vitacco M, Penalver J, Gianantonio CA. Coagulation studies in the hemolytic-uremic syndrome. J Pediatr 1970; 76: 538-548
• 2 Piel CF, Phibbs RH. The hemolytic-uremic syndrome. Pediatr Clin North Am 1966; 13: 295-314
• 3 Gilchrist GS, Lieberman E, Ekart H, Fine RN. Heparin therapy in the haemolytic-uraemic syndrome. Lancet 1979; 1: 1123
• 4 Courtecuisse V, Habib R, Monnier C. Nonlethal haemolytic and uraemic syndromes in children: an eledctron-microscopic study of renal biopsies from six cases. Experimental and Molecular Pathology 1969; 7: 327-347
• 5 Brain MC. The haemolytic-uraemic syndrome. Seminars in Hematology 1969; 6: 162-180
• 6 Katz J, Krawitz S, Sacks PV, Levin SE, Thomson P, Levin J, Metz J. Platelet, erythrocyte, and fibrinogen kinectics in the hemolytic-uremic syndrome of infancy. J Pediatr 1973; 83: 739-748
• 7 van Wieringen PM V. Het haemolytisch-uraemisch syndroom op de kinderleeftijd. M D Thesis, Catholic University of Nijmegen, van Mameren B. V. – Nijmegen 1977
• 8 Kass L. Megakaryocyte abnormalities in thrombotic thrombocytopenic purpura. Am J Clin Pathol 1974; 61: 639-644
• 9 Fong JS C, White JG, Godd RA. Inhibition of endotoxic lipopolysaccharide-mediated platelet aggregation by cobra venom anticomplementary factor. Blood 1974; 44: 399-409
• 10 Hovig T. Aggregation of rabbit blood platelets produced in vitro by saline "extract" of tendons. Thromb Diath Haemorrh 1963; 9: 248-263
• 11 Horowitz HT, Stein IM, Cohen BD, et al. Further studies on the platelet inhibitory effect of guaridinosuccinic acid and its role in uremic bleeding. Amer J Med 1970; 49: 336-345
• 12 Rabiner SF, Molinas F. The role of phenol and phenolic acids on the thrombocytopathy and defective platelet aggregation of patients with renal failure. Am J Med 1970; 49: 346-351
• 13 Levine PH. The effect of thrombocytopenia on the determination of platelet aggregation. Am J Clin Pathol 1976; 65: 79-82
• 14 Eknoyan G, Wacksman SJ, Glueck HI, Will JJ. Platelet function in renal failure. New Eng J Med 1969; 280: 677-681
• 15 Cameron JS. Platelets and glomerulonephritis. Nephron 1977; 18: 253-8
• 16 George CR, Clark WF, Cameron JS. Role of platelets in glomerulonephritis. Adv Nephrol 1975; 5: 19-65
• 17 Arkel YS. Evaluation of platelet aggregation in disorders of hemostasis. Med Clin North Am 1976; 60: 881-911
• 18 Arenson EB, August CS. Preliminary report: Treatment of the hemolytic-uremic syndrome with aspirin and dipyridamole. J Pediatr 1975; 86: 957-961
• 19 Mandal BK, McNulty M. Treatment of heamolytic-uraemic syndrome with phenformin and enthyloestrenol. Lancet 1971; 2: 1036
• 20 Ponticelli C, Maestri O, Imbasciati E, Brancaccio D, Rossi E. Late recovery of renal function in a woman with the hemolytic uremic syndrome. Clin Nephrol 1977; 8 (2): 367-370
• 21 Powell HR, Ekert H. Streptokinase and anti-thrombotic therapy in the hemolytic-uremic syndrome. J Pediatr 1974; 84: 345-9
• 22 Stuart J, Winterborn MH, White RH R, Flinn RM. Thrombolytic therapy in haemolytic-uraemic syndrome. Br Med. J 1974; 3: 217-221
• 23 Sutor AH, Schindera F, Jacobi H, Kunzer WM. Haemolyticuraemic syndrome: thrombocyturia after treatment with streptokinase and aspirin. Lancet 1972; 2: 762
• 24 Thorsen CA, Rossi EC, Green D, Carone FA. The treatment of the hemolytic-uremic syndrome with inhibitors of platelet function. Am J Med 1979; 66: 711-16
• 25 Wehinger H, Sutor HA, Schindera F, Kunzer W. Zur Therapie des hämolytisch-urämischen Syndroms. Dtsch. Med. Wochenschr. 1974; 99: 840-1
• 26 O'Brien JR. "Exhausted" platelets continue to circulate. Lancet 1978; 2: 1316
• 27 Editorial Platelets, endothelium, and renal disease. Lancet 1979; 2: 890
• 28 Hladovec J. Is the antithrombotic activity of "antiplatelet" drugs based on protection of endothelium?. Thromb Hemost 1979; 41: 774-8