title: Haemostatic function and biomarkers of endothelial damage before and after platelet transfusion in patients with acute myeloid leukaemia.
abstract: OBJECTIVE
  The beneficial effect of platelet transfusion on haemostasis is well established, but there is emerging evidence that platelet transfusion induces an inflammatory response in vascular endothelial cells.
  
  
  BACKGROUND
  We investigated haemostatic function and endothelial biomarkers before and after platelet transfusion in patients with acute myeloid leukaemia.
  
  
  METHODS
  Blood was sampled before, 1 and 24 h after platelet transfusion. Primary and secondary haemostasis was evaluated by whole blood aggregometry (Multiplate) and thromboelastography (TEG). Endothelial biomarkers (sICAM-1, syndecan-1, sThrombomodulin, sVE-Cadherin) and platelet activation biomarkers (sCD40L, TGF-beta) were investigated along with haematology/biochemistry analyses.
  
  
  RESULTS
  Twenty-two patients were included. Despite continued low platelet counts, platelet transfusion normalised the median values of most TEG parameters and slightly increased platelet aggregation (all P < 0·05). Endothelial biomarkers were not significantly affected by transfusion. The 1 h sCD40L level correlated positively with Syndecan-1 and soluble thrombomodulin delta values, biomarkers of endothelial damage (both P = 0·005).
  
  
  CONCLUSIONS
  Platelet transfusion improved haemostasis, whereas post-transfusion increases in sCD40L were associated with endothelial damage, indicating that transfused platelets and platelet-derived pro-inflammatory mediators may have opposite effects on the endothelium.
authors.affiliation: Department of Haematology, Copenhagen University Hospital, Herlev, Denmark.
authors.forename: A M
authors.initials: AM
authors.lastname: Larsen
authors.affiliation: Department of Haematology, Copenhagen University Hospital, Rigshospitalet, Denmark.
authors.forename: E B
authors.initials: EB
authors.lastname: Leinøe
authors.affiliation: Section for Transfusion Medicine, Capital Region Blood Bank, Copenhagen University Hospital, Rigshospitalet, Denmark.
authors.forename: P I
authors.initials: PI
authors.lastname: Johansson
authors.affiliation: Department of Clinical Immunology, Nordsjaellands Hospital, Copenhagen University Hospital, Hillerød, Denmark.
authors.forename: R
authors.initials: R
authors.lastname: Larsen
authors.affiliation: Department of Clinical Immunology, Copenhagen University Hospital, Herlev, Denmark.
authors.forename: P
authors.initials: P
authors.lastname: Wantzin
authors.affiliation: Department of Haematology, Copenhagen University Hospital, Herlev, Denmark.
authors.forename: H
authors.initials: H
authors.lastname: Birgens
authors.affiliation: Section for Transfusion Medicine, Capital Region Blood Bank, Copenhagen University Hospital, Rigshospitalet, Denmark.
authors.forename: S R
authors.initials: SR
authors.lastname: Ostrowski
mesh_terms: D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood*; D023201:CD40 Ligand / Q000097:blood*; D004730:Endothelium, Vascular / Q000293:injuries / Q000378:metabolism; D005260:Female; D006487:Hemostasis; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000097:blood / Q000628:therapy; D008297:Male; D008875:Middle Aged; D017713:Platelet Transfusion
chemical_list: D014408:Biomarkers, Tumor; D023201:CD40 Ligand
keywords: acute myeloid leukaemia; endothelium; haemostasis; platelet transfusion