• Journal of Interdisciplinary Genomics
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• v.3 no.2
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• pp.41-46
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• 2021

Inherited platelet function disorders (IPFDs) are a disease group of heterogeneous bleeding disorders associated with congenital defects of platelet functions. Normal platelets essential role for primary hemostasis by adhesion, activation, secretion of granules, aggregation, and procoagulant activity of platelets. The accurate diagnosis of IPFDs is challenging due to unavailability of important testing methods, including light transmission aggregometry and flow cytometry, in several medical centers in Korea. Among several IPFDs, Glanzmann thrombasthenia (GT) is a most representative IPFD and is relatively frequently found compare to the other types of rarer IPFDs. GT is an autosomal recessive disorder caused by mutations of ITGA2B or ITGB3. There are quantitative or qualitative defects of the GPIIb/IIIa complex in platelet, which is the binding receptor for fibrinogen, von Willbrand factor, and fibronectin in GT patients. Therefore, patients with GT have normal platelet count and normal platelet morphology, but they have severely decreased platelet aggregation. Thus, GT patients have a very severe hemorrhagic phenotypes that begins at a very early age and persists throughout life. In this article, the general contents about platelet functions and respective IPFDs, the overall contents of GT, and the current status of genetic diagnosis of GT in Korea will be reviewed.

• Journal of Korean Neurosurgical Society
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• v.62 no.1
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• pp.3-9
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• 2019

As more intracranial aneurysms and other cerebrovascular pathologies are treated with neurointervention procedure, thromboembolic events that frequently lead to serious neurological deficit or fatal outcomes are increasing. In order to prevent the thromboembolic events, antiplatelet therapy is used in most procedures including coil embolization, stenting, and flow diversion. However, because of variable individual pharmacodynamics responses to antiplatelet drugs, especially clopidogrel, it is difficult for clinicians to select the adequate antiplatelet regimen and its optimal dose. This article reviews the neurointervention literature related to antiplatelet therapy and suggests a strategy for tailoring antiplatelet therapy in individual patients undergoing neurointervention based on the results of platelet function testing.

• Korean Journal of Clinical Laboratory Science
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• v.41 no.1
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• pp.1-5
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• 2009

The Platelet Function Analyzer (PFA)$^{(R)}$-100 measures the ability of platelets activated in a high-shear environment to occlude an aperture in a membrane treated with collagen and epinephrine (CEPI) or collagen and ADP (CADP). The time taken for the flow across the membrane to stop (closure time, CT) is recorded. The aim of this study was to assess the potential of the PFA$^{(R)}$-100 as a primary clinical screening tool using the wide spectrum of clinical samples assessed for platelet function as well as to perform the optimal algorithm for the use of PFA$^{(R)}$-100. We established the reference interval in 460 hospital inpatients defined as having normal platelet function based on classical laboratory tests. The reference interval by using the range $5^{th}$ and $95^{th}$ percentile was 84~251 seconds for males CEPI-CT and 85~249 seconds for females CEPI-CT. A total of 1,200 inpatients were enrolled to identify impaired hemostasis before surgical interventions. The abnormal group showing prolonged CEPI-CT was 303 cases (18.9%). Only 3 cases had both abnormal CEPI-CT and CADP-CT. Several factors including sample errors, drugs, hematologic abnoralities were contributed to unexpected prolonged CEPI-CT for screening test. The von Willebrand factor (vWF:Ag) assay was performed only in one patient to verify the algorithm for the use of PFA$^{(R)}$-100. The PFA$^{(R)}$-100 was sensitive and rapid method for primary screening test of platelet dysfunction, so we can substitute it for the bleeding time in routine clinical practice.

• Clinical and Experimental Pediatrics
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• v.64 no.1
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• pp.31-36
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• 2021

Background: The diagnosis of esophageal varices (EV) is based on the findings of esophagogastroduodenoscopy (EGD), biopsy, and serum markers. Thus, noninvasive cost-effective tests through which high-risk EV children can be diagnosed are needed. Purpose: This cross-sectional study aimed to identify the noninvasive markers for EV in children with liver cirrhosis. Methods: A total of 98 children with liver cirrhosis were evaluated in this study. The spleen size, platelet count, serum albumin, liver function test results, and risk scores were evaluated prior to endoscopy. The endoscopic investigations aimed to identify the presence of EV and red signs, and determine varices sizes. Results: Endoscopy revealed varices in 43 subjects (43.9%). The spleen size, platelet count, international normalized ratio, aspartate aminotransferase to platelet ratio index (APRI), platelet count to spleen size ratio, and risk score differed significantly between patients with and without EV on univariate analysis; however, the logistic regression analysis showed no differences, indicating that none of these parameters were independently associated with the presence of EV. Conclusion: Platelet count, risk score, platelet count to spleen size, and APRI can be useful tools for the identification of high-risk patients with EV and might reduce the need for invasive methods like EGD.

• The Journal of Internal Korean Medicine
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• v.28 no.3
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• pp.464-472
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• 2007

Objectives : Nowadays the combined use of oriental herbal medicines and western biomedical medicines has been prevalent but controversial. Warfarin has been much reported to interact with some herbal medicines so that it influences prothrombin time(PT) & international normalized ratio(INR). This study was aimed to examine how much warfarin interacts with herbal medicines during treatment of stroke patients Methods : This was a retrospective case control study of 53 patients whowere treated with concomitant treatment of herbal medicines & warfarin. They were within normal limit in liver function, renal function, hematocrit, hemoglobin, and platelet count at first admission lab. We classified them into 2 classes: study group (taking herbal medicines including Panax ginseng, Angelica sinensis, Zingiber officinale, Salvia miltiorrhiza that were reported to interact with warfarin to impact PT (INR) and control group (taking other herbal medicines). We followed up PT (INR) at 5-10 days interval with AST, ALT, BUN, creatinine, hematocrit, hemoglobin, and platelet count. Results : AST, BUN, creatinine, hemoglobin, hematocrit, and platelet count were not changed significantly between first and final tests during the admission period. Only ALT decreased significantly in the control group. Neither baseline nor peak PT (INR) was significantly different between the groups. However, only warfarin dose was significantly correlated with PT and INR (r=0.810, r=0.798, p<0.01). Conclusions : It was concluded that PT(INR) was not influenced with herbal medicines and warfarin but by far dependent on warfarin dose in stroke patients restricted with normal liver function, renal function, and hematocrit, hemoglobin, and platelet count. Further prospective study is needed on larger samples to conclude that the combined therapy of herbal medicines and warfarin is safe.

• Neonatal Medicine
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• v.18 no.1
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• pp.6-13
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• 2011

All newborn infants with clinically significant bleeding should be evaluated for a hemostatic deficit. Medical history should include the following data: familial bleeding disorders, maternal illness and medication, age of bleeding onset, and prophylactic administration of vitamin K. The first essential step for evaluating bleeding neonates is determining whether the baby is sick or well. The physician should also evaluate the extent of the bleeding, features of bleeding lesions, and other abnormal findings from the physical examination. Skeletal anomalies may provide diagnostic clues. Depending on the clinical features and results of screening tests, other tests including coagulation factors may be useful for determining the diagnosis. All laboratory results must be considered in the context of age-related reference values. The platelet function analyzer provides a promising alternative to bleeding time. Fibrin degradation products and D-dimers are used for screening and specially testing fibrinolytic activity, respectively. The Apt test may help to rule out factors derived from maternal blood. Radiologic imaging studies are important because asymptomatic intracranial hemorrhages are common in neonates.

• Korean Journal of Veterinary Service
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• v.45 no.1
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• pp.55-61
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• 2022

In veterinary medicine, a variety of disease are known to cause coagulation abnormalities. Identification of these coagulation abnormalities have been relied on traditional coagulation assays(platelet concentration, aPTT, PT, D-dimer, fibrinogen) which take only a small part of the coagulation pathways rather than global hemostatic capacity. Among of the hypercoagulable diseases, cardiovascular disease, such as mitral valvular disease, was not regarded as the cause of the hypercoagulability. The value of a thromboelastography (TEG) as an early predictor of coagulopathy, especially hypercoagulability, has been founded. It was associated with decreased R and K values, and increased MA and α angle. The objective of this study was to compare thromboelastography results and those of traditional coagulation tests between twenty adult dogs with mitral insufficiency (MVI group) and eleven adult healthy dogs (Healthy group). As a results, MA values in the patients with mitral insufficiency (68.8±7.8 mm) were significantly higher than the normal patients (60.4±4.8 mm) (P value<0.05). Although a little report has been reported in veterinary medicine, platelet activation seems to be related with hypercoagulability in MVI patients in human medicine. The result of this report can support this pathophysiology in veterinary medicine. In addition to traditional coagulation assay, global assessment of coagulopathy using TEG, especially ability to detect hypercoagulability, may be useful for customized treatment in MVI patients. To achieve this, further study is needed to define pathophysiology and effect of medication.

• Journal of Chest Surgery
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• v.40 no.4 s.273
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• pp.273-279
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• 2007

Background: We evaluate the efficacy of ultra-hydrophilic coated bypass circuits in comparison with uncoated bypass circuits in a porcine cardiopulmonary bypass model. Material and Method: Normothermic cardiopulmonary bypass was peformed in 10 anesthetized pigs via the left atrium and ascending aorta with a centrifugal biopump. Ultra-hydrophilic coated bypass circuits wore used in 5 pigs (the study group) and uncoated bypass circuits were used for the control group. Platelet counts and platelet aggregation tests were peformed. The thrombin-antithrombin(TAT) complex level and total protein level were evaluated. Result: There were no significant changes En the platelet counts and aggregation ability of both groups. The TAT complex levels were not different between the two groups. The total protein level was significantly lower in the control group after cessation of cardiopulmonary bypass. Conclusion: The clinical effects of ultra-hydrophilic coating circuits were not remarkable, in terms of reducing inflammatory reaction and protection of platelet function. However, the effect of protection for blood protein adsorption might be acceptable.

• Journal of Veterinary Clinics
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• v.34 no.2
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• pp.65-69
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• 2017

Thromboembolic complications are increasing in veterinary medicine. Thromboelastography (TEG) is a more comprehensive method for assessing the clotting process than standard plasma-based coagulation tests. This study compared the ability of TEG and standard coagulation tests to analyze the overall hemostatic state of dogs. The study involved 40 dogs with underlying diseases that predispose to hypercoagulability, including neoplasia, hyperadrenocorticism, immune-mediated diseases, gastrointestinal diseases, and protein-losing nephropathies and enteropathies, and 20 healthy dogs. Their overall hemostatic functional state was evaluated by TEG and routine coagulation assays, including activated partial thromboplastin time, prothrombin time, platelet count, and D-dimer concentration. TEG analysis showed significant differences in clot formation time, ${\alpha}$ angle, and maximum amplitude (MA) between diseased and control dogs (P < 0.001 each). Increased MA was the most frequent abnormality on TEG and was indicative of hypercoagulability. TEG was useful in detecting hemostatic dysfunction in dogs with diseases associated with hypercoagulability. Dogs with TEG tracings indicative of hypercoagulability are likely to be in procoagulant states. Future prospective studies are needed to evaluate whether TEG tracings indicative of hypercoagulability are predictive of thrombosis in dogs.

• Clinical and Experimental Pediatrics
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• v.48 no.5
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• pp.461-468
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• 2005

The major function of immune system is to protect infections. The immune systems are composed of innate and adaptive immunity. In adaptive immunity, the cellular and humoral components interact each other. Neonates and infants are infected frequently, because immune systems are naive and easy to expose to infectious agents. The complete history and physical examination is essential to evaluate the child with recurrent infections. The environmental risk factors of recurrent infections are day care center, cigarette smoke, and air pollution. The underlying diseases such as immunodeficiency, autoimmune diseases, allergy, and disorders of anatomy or physiology increase the susceptibility to infections. In immunodeficiency, infections are characterized by severe, chronic, recurrent, and unusual microbial agents infection. The defects of antibody production are susceptible to sinopulmonary bacterial infections. T cells defects are vulerable to numerous organisms such as virus, fungi, bacteria and etc. The screening tests for immune functions are the quantitative and qualitative measurements of each immune components. A complete blood count with white blood cell, differential, and platelet provide quantitative informations of immune components. Total complement and immunoglobulin levels represent the humoral component. Antibody levels of previously injected vaccines also provide informations of the antigen specific antibody immune responses. T cell and subsets count is quantitative measurement of cell mediated immunity. Delayed hypersensitivity skin test is a crude measurement of T cell function. The long term outcome of children with recurrent infections is completely dependent on the underlying diseases, the initial time of diagnosis and therapy, continued management, and genetic counscelling.