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      Platelet count and mean volume (MPV) in association with plasma HCO3- in regular hemodialysis patients Translated title: Parâmetros hematológicos associados ao HC0(3)- plasmático de pacientes em hemodiálise

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          Abstract

          End-stage renal failure often is associated with abnormal bleeding that may represent an important complication of this disorder. The hemorrhagic tendency currently is attributed to altered primary hemostasis, mainly platelet dysfunction. The aim of the present study was to elucidate whether and how in patients, with uremia on hemodialysis, the level of plasma HCO3- affects the mean PLT volume (MPV) and count. The total patients were 36 (f=15, m=21). The mean patients' age was 46 (±16) years. The mean length of the time patients had received hemodialysis was 32 (±36) months. The mean PLT count was 165 (±70) [x10³mu/L]. The mean MPV was 9 (±1) fl. The mean plasma HCO3- was 20 (±2.6) mEq/L. In this study a significant inverse correlation of PLT count with MPV and a significant positive association of PLT count with plasma HCO3 and also a significant inverse correlation of MPV with plasma HCO3- were found. Positive association of mild relative acidemia with PLT count and its negative correlation with MPV may further support the reverse epidemiology of serum bicarbonate in end-stage renal disease patients on hemodialysis which needs more attention as a protective role in mild relative acidosis of regular hemodialysis patients.

          Translated abstract

          O estágio terminal de suficiência renal freqüentemente está associado a sangramentos anormais e que representam complicações importantes na evolução desta moléstia. A tendência hemorrágica é atribuída a alterações primárias de hemostasia, decorrentes principalmente da disfunção plaquetária. O objetivo deste estudo foi o de elucidar quando como pacientes urêmicos, em hemodiálise o nível de HCO3 afeta a contagem plaquetária e o seu volume médio. O número de pacientes estudados foi 36 (fem.15, masc. = 21). A idade foi de 46 ± 16 anos. A contagem média das plaquetas foi de 165(± 70) x 10³mi/l, o volume médio foi de 9 (± 1) fl. O HCO3 plasmático médio foi de 20 (± 2,6) mEq/l. No estudo foi observada uma correlação inversa entre a contagem plaquetária e o volume médio associado com associação positiva significante das plaquetas com o HCO3 do plasma e também correlação significativa inversa do volume médio plaquetário e HCO3 plasma. A associação positiva e sua correlação negativa com o volume médio plaquetário podem sugerir reversão da epidemiologia do estágio terminal de insuficiência renal de pacientes em hemodiálise que necessitam de maior proteção quando da acidose leve em vigência de hemodiálise.

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          The biological significance of platelet volume: its relationship to bleeding time, platelet thromboxane B2 production and megakaryocyte nuclear DNA concentration.

          Bleeding time, platelet thromboxane B2 production and megakaryocyte nuclear DNA concentration were measured in rabbits recovering from thrombocytopenia caused by a single injection of anti-platelet serum. Similar measurements were made on rabbits in a steady state of normal platelet production. The effects of a sustained state of thrombocytopenia on megakaryocyte DNA concentration were investigated by repeated daily injections of anti-platelet serum. It is shown that bleeding time depends on both platelet count and mean platelet volume. Furthermore changes in mean platelet volume appear to play a more important role in haemostasis than changes in platelet count. The mean megakaryocyte nuclear DNA concentration is significantly increased after 24 hours of thrombocytopenia and continues to increase as thrombocytopenia is sustained. Thromboxane B2 production/unit volume of platelet is increased in platelets produced after 24 hours of thrombocytopenia compared with platelets produced in normal steady state function. As a consequence platelets produced in response to thrombocytopenia not only have a larger mean platelet volume but are also more reactive. Mean platelet volume, as well as platelet count, should be considered as an index of haemostasis and its dysfunction, thrombosis.
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            Risks of chronic metabolic acidosis in patients with chronic kidney disease.

            Risks of chronic metabolic acidosis in patients with chronic kidney disease. Metabolic acidosis is associated with chronic renal failure (CRF). Often, maintenance dialysis therapies are not able to reverse this condition. The major systemic consequences of chronic metabolic acidosis are increased protein catabolism, decreased protein synthesis, and a negative protein balance that improves after bicarbonate supplementation. Metabolic acidosis also induces insulin resistance and a decrease in the elevated serum leptin levels associated with CRF. These three factors may promote protein catabolism in maintenance dialysis patients. Available data suggest that metabolic acidosis is both catabolic and anti-anabolic. Several clinical studies have shown that correction of metabolic acidosis in maintenance dialysis patients is associated with modest improvements in nutritional status. Preliminary evidence indicates that metabolic acidosis may play a role in beta2-microglobulin accumulation, as well as the hypertriglyceridemia seen in renal failure. Interventional studies for metabolic acidosis have yielded inconsistent results in CRF and maintenance hemodialysis patients. In chronic peritoneal dialysis patients, the mitigation of acidemia appears more consistently to improve nutritional status and reduce hospitalizations. Large-scale, prospective, randomized interventional studies are needed to ascertain the potential benefits of correcting acidemia in maintenance hemodialysis patients. To avoid adverse events, an aggressive management approach is necessary to correct metabolic acidosis. Clinicians should attempt to adhere to the National Kidney Foundation Kidney Disease Outcome Quality Initiative (K/DOQI) guidelines for maintenance dialysis patients. The guidelines recommend maintenance of serum bicarbonate levels at 22 mEq/L or greater.
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              Plateletcrit, mean platelet volume, platelet distribution width: its expected values and correlation with parallel red blood cell parameters.

              The quantitation of platelets in peripheral blood is a well-recognized tool. Recently, new indices related to erythrocytes and platelet counts have been provided by hematologic analyzers. Concerning the platelet parameter, the three important parameters are plateletcrit (PCT), mean platelet volume (MPV), platelet distribution width (PDW). The purpose of the study is to investigate these three parameters to define their expected values and the correlation with the parallel red blood cell parameters, hematocrit (HCT), mean corpuscular volumer (MCV), and red blood cell distribution width (RDW). Blood samples form 215 volunteers were analyzed for platelet parameters using Technicon H*3. The average (mean +/- SD) values obtained with expected ranges were PCT 0.24 +/- 0.05% (range, 0.23-0.24%), MPV 12.79 +/- 5.91 fL (range, 12.39-13.19 fL), and PDW 46.79 +/- 2.70% (range, 46.61-46.97%). Concerning the correlation between PCT, MPV, and RDW and their parallel red blood cell parameters, there was no significant correlation between PCT and HCT, and between MPV and MCV. However, there was a significant correlation between PDW and RDW. It seems that the anisocytosis of red blood cells and platelets might co-occur. However, these data are basic observations; further in-depth evaluation of the platelet parameters is recommended.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Journal
                rbhh
                Revista Brasileira de Hematologia e Hemoterapia
                Rev. Bras. Hematol. Hemoter.
                Associação Brasileira de Hematologia e Hemoterapia e Terapia Celular (São Paulo )
                1806-0870
                June 2006
                : 28
                : 2
                : 127-130
                Affiliations
                [1 ] Shahrekord University of Medical Sciences Iran
                [2 ] Hospital Bu Ali Iran
                Article
                S1516-84842006000200012
                10.1590/S1516-84842006000200012
                536f4bf5-3751-4cba-9df3-15221c444e91

                http://creativecommons.org/licenses/by/4.0/

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                SciELO Brazil

                Self URI (journal page): http://www.scielo.br/scielo.php?script=sci_serial&pid=1516-8484&lng=en
                Categories
                HEMATOLOGY
                MEDICINE, RESEARCH & EXPERIMENTAL

                Medicine,Hematology
                Platelet count,hemodialysis,end-stage renal failure,mean platelet volume (MPV),plasma HCO3-,Plaquetas,hemodiálise,insuficiência renal,volume médio plaquetário,HCO3- plasmático

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