Reliability of a Single β-Thromboglobulin Measurement in a Diabetic Population : Importance of PGE₁ in Anticoagulant Mixture

Summary

During the collection of samples for plasma β-thromboglobulin (β-TG) determination, it is well established that artificially high values can be observed due to in-vitro release. To estimate the reliability of a single β-TG measurement, blood samples were collected simultaneously from both arms on two separate occasions in 56 diabetic patients selected for a clinical trial. From each arm, blood was taken into two tubes containing an anticoagulant mixture with (tube A) and without (tube B) PGE!. The overall mean value of B-TG in tube B was 1.14 times higher than in tube A (p <0.01). The markedly large between-arms variation accounted for the most part of within-subject variation in both tubes and was significantly greater in tube B than in tube A. Based on the difference between B-TG values from both arms, the number of subjects with artifically high B-TG values was significantly higher in tube B than in tube A on each occasion (overall rate: 28% and 14% respectively). Estimate of between-occasions variation showed that B-TG levels were relatively stable for each subject between two occasions in each tube. It is concluded that the use of PGEi decreases falsely high B-TG levels, but a single measurement of B-TG does not provide a reliable estimate of the true B-TG value in vivo.

Keywords

β-thromboglobulin - Reliability - Anticoagulant mixture - PGE₁ - Diabetes

• References

• 1 Ludlam CA, Moore S, Bolton AE, Pepper DD, Cash JD. The release of a human platelet specific protein measured by a radioimmunoassay. Thromb Res 1975; 6: 543-548
• 2 Kaplan KL, Owen J. Plasma levels of β-thromboglobulin and platelet factor 4 as indices of platelet activation in vivo. Blood 1981; 57: 199-202
• 3 Ludlam CA. Evidence for the platelet specific of β-thromboglobulin and studies on its plasma concentration in healthy individuals. Br J Haematol 1979; 41: 271-278
• 4 Zahavi J, Kakkar VV. Beta-thromboglobulin - a specific marker of in vivo platelet release reaction. Thromb Haemostas 1980; 44: 23-29
• 5 Ludlam CA, Cash JD. Studies on the liberation of β-thromboglobulin from human platelets in vitro. Br J Haematol 1976; 33: 239-247
• 6 Passa P, Eschwege E. Essai contrôlé de l’aspirine et de l’association Aspirine-Dipyridamole sur l’évolution de la rétinopathie diabétique. I - Présentation du protocole général Diab Metab 1982; 2: 91-96
• 7 Verstraete M. Registry of prospective clinical trials. Fourth report. Thromb Haemostas 1980; 42: 176-181
• 8 Bolton AE, Ludlam CA, Moore S, Pepper DS, Cash JD. Three approaches to the radioimmunoassay of human β-thromboglobulin. Br J Haematol 1976; 33: 233-238
• 9 Snedecor GW, Cochran WG. Statistical methods. Iowa Stat; Univers. Press: 1967
• 10 Franchi F, Canciani MT, Mannucci PM. The β-thromboglobulin test. Thromb Haemostas 1980; 44: 107
• 11 Randi ML, Fabris F, Casonato A, Girolami A. The effect of anticoagulant mixtures on BTG and PF4 levels. Thromb Haemostas 1981; 46: 569
• 12 Levine SP, Suarez AJ, Sorenzon RR, Knieriem LK, Raymond NM. The importance of blood collection methods for assessment of platelet activation. Thromb Res 1981; 24: 433-443
• 13 Burrows AW, Chavin SI, Hockaday T DR. Plasma-thromboglobulin concentrations in diabetes mellitus. Lancet 1978; 1: 235-237
• 14 Preston FE, Ward JD, Marcola BH, Porta NR, Timperley WR, O’Malley BC. Elevated β-thromboglobulin levels and circulating platelet aggregates in diabetic microangiopathy. Lancet 1978; 1: 238-240
• 15 Campbell IW, Dawes J, Fraser DM, Pepper DD, Clarke BF, Duncan L JP, Cash JD. Plasma β-thromboglobulin in diabetes mellitus. Diabetes 1977; 26: 1175-1177
• 16 Borsey DQ, Dawes J, Fraser DM, Prowse CC, Elton RA, Clarke BF. Plasma β-thromboglobulin in diabetes mellitus. Diabetologia 1980; 18: 353-357
• 17 Edit. Platelets, beta-thromboglobulin, and diabetes mellitus. Lancet 1978; 1: 250-251