Thrombocythaemia is defined as a circulating platelet count above 450x10$^9$/L in humans. The major cause of thrombocythaemia is reactive $(secondary)$ thrombocythaemia which occurs secondary to many conditions such as infection, cancer and inflammation. However, acquired clonal mutations in mainly Janus Kinas 2 $(JAK2)$, CALR and MPL cause essential thrombocythaemia $(ET)$. ET is a rare disease that leads to an increased risk of cardiovascular thrombotic events. Current treatment of ET uses combination of low dose aspirin to decrease platelet function and cytoreductive agents to decrease thrombopoiesis. The most commonly used cytoreductive agents are hydroxyurea, anagrelide and interferon-$alpha$ and all have unwanted side effects. Cytokine receptor-like factor 3 $(CRLF3)$ is a 2.4kb gene that is ubiquitously expressed throughout the haematopoietic system. Very little is known about the function of CRLF3, with only one peer reviewed journal article in the literature which shows that CRLF3 may negatively regulate the cell cycle at the G0/G1 phase. However, nothing is known about the role of CRLF3 in platelet biology. Using a Crlf3 knockout mouse $(Crlf3-/-)$ developed by the Wellcome Trust Sanger Institute we show CRLF3’s role in platelet biogenesis and how it could be used as a novel therapeutic target to treat ET. Crlf3-/- mice have an isolated and sustained 25-40$\%$ decrease in platelet count compared to wildtype $(WT)$ controls. Platelet function is unaffected as demonstrated in a range in a range of in vitro assays. The thrombocytopenia is a consequence of abnormalities in hematopoietic cells, as shown by bone marrow transplantations. Megakaryopoiesis is upregulated in Crlf3-/- mice and proplatelet morphology is unaffected, suggesting the thrombocytopenia is due to increased platelet clearance. Indeed, splenectomised Crlf3-/- mice show normalised platelet counts within 7 days, showing rapid splenic removal of platelets is responsible for the thrombocytopenia. Abnormal large platelet structures that resemble proplatelets shafts $(preplatelets)$ are abnormally present in the circulation of elderly Crlf3/- mice. Immunohistochemistry showed increased and aberrant tubulin expression in Crlf3-/- platelets compared to WT controls, especially in the preplatelet forms. Cold induced depolymerisation of microtubules was decreased in Crlf3-/- platelets, suggestive of increased tubulin stability, however, the ratio of detyrosinated to tyrosinated tubulin was not altered. We then crossbred Crlf3-/- mice with JAK2 V617F ET mice, to determine the effect of Crlf3 ablation of thrombocythaemia. Crossbred mice showed restoration of platelet counts to WT values without grossly affecting platelet function or other blood lineages, providing the rational for CRLF3 as a novel therapeutic target for treatment of ET. Finally, we aimed to resolve the crustal structure of CRLF3 and discover its interactome. To this end, we were able to resolve the crystal structure of a C-terminal portion of the full length protein containing the predicted fibronectin type III domain. To shed light on the interactome of CRLF3, endogenous CRLF3 was tagged with a tandem affinity purification $(TAP)$ tag using CRISPR/Cas9 technology in induced pluripotent stem cells $(iPSCs)$. We have been able to produce megakaryocytes from these TAP-tagged iPSCs by forward programming. However, as yet we have not been able to generate enough MKs to have adequate material to perform immunoprecipitation assays. Therefore, the interactome of CRLF3 in MKs remains unknown. In conclusion, we identified a mechanism by which Crlf3 controls platelet biogenesis. Slowed maturation of Crlf3-/- preplatelets in the peripheral circulation potentially due to increased structural stability leads to rapid removal of these immature forms by the spleen and therefore a decrease in platelet count. The isolated effect on platelet numbers and normalisation of platelet count in ET mice deficient of Crlf3 provides the rational for further study on CRLF3 drug targeting as a novel therapeutic strategy for ET.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Nucleotide- and nucleoside-degrading enzymes are present in the surface of platelets, blood cells involved in clotting disturbances of Trypanosoma evansi-infected animals. Thus, this study was aimed at evaluating the activity of the enzymes NTPDase, 5 - nucleotidase and adenosine deaminase in platelets of rats experimentally infected by T. evansi. Animals were divided into four groups, according to the degree of parasitemia. Samples were collected at days 3 (group A: at the beginning of parasitemia), 5 (group B: high parasitemia) and 15 (group C: chronic infection). Group D (control group) was composed of non-infected animals. Blood samples with citrate as the anticoagulant were collected and used for platelet separation and enzymatic assays. NTPDase, 5 - nucleotidase and adenosine deaminase (ADA) activities were decreased (p<0.05) in platelets from rats of groups A and B, when compared to the control group. In group C, only NTPDase and 5 -nucleoside activities were decreased (p<0.001), observed by ADP and AMP hydrolysis. The correlation between platelet count and nucleotide and nucleoside hydrolysis was positive and statistically significant (p<0.05) in groups A and B. Platelet aggregation of all infected groups was decreased in comparison to the control group (p<0.05). Based upon the results, it is concluded that the alterations observed in the activity of the enzymes NTPDase, 5 -nucleotidase and adenosine deaminase in platelets of T. evansi-infected animals might be related to thrombocytopenia. / Nucleotide- and nucleoside-degrading enzymes are present in the surface of platelets, blood cells involved in clotting disturbances of Trypanosoma evansi-infected animals. Thus, this study was aimed at evaluating the activity of the enzymes NTPDase, 5 - nucleotidase and adenosine deaminase in platelets of rats experimentally infected by T. evansi. Animals were divided into four groups, according to the degree of parasitemia. Samples were collected at days 3 (group A: at the beginning of parasitemia), 5 (group B: high parasitemia) and 15 (group C: chronic infection). Group D (control group) was composed of non-infected animals. Blood samples with citrate as the anticoagulant were collected and used for platelet separation and enzymatic assays. NTPDase, 5 - nucleotidase and adenosine deaminase (ADA) activities were decreased (p<0.05) in platelets from rats of groups A and B, when compared to the control group. In group C, only NTPDase and 5 -nucleoside activities were decreased (p<0.001), observed by ADP and AMP hydrolysis. The correlation between platelet count and nucleotide and nucleoside hydrolysis was positive and statistically significant (p<0.05) in groups A and B. Platelet aggregation of all infected groups was decreased in comparison to the control group (p<0.05). Based upon the results, it is concluded that the alterations observed in the activity of the enzymes NTPDase, 5 -nucleotidase and adenosine deaminase in platelets of T. evansi-infected animals might be related to thrombocytopenia.

Submitted by Claudia Rocha (claudia.rocha@udesc.br) on 2018-03-21T13:33:38Z No. of bitstreams: 1 PGCA17MA227.pdf: 1295144 bytes, checksum: d5bbe4c0123a299ec156229a16f2d98a (MD5) / Made available in DSpace on 2018-03-21T13:33:38Z (GMT). No. of bitstreams: 1 PGCA17MA227.pdf: 1295144 bytes, checksum: d5bbe4c0123a299ec156229a16f2d98a (MD5) Previous issue date: 2017-07-14 / Feline leukemia virus (FeLV) and feline immunodeficiency virus (FIV) belong to the Retroviridae family, being the most important viral infectious agents in cats. FeLV infection is commonly manifested through immunosuppression, anemia, and lymphoma. FIV is responsible for primarily depleting immune system action of the host. The prevalence of these viral infections varies in different locations around the world. In Brazil, there is a lack of data about highest prevalence of infected animals. Therefore, a cross-sectional study was conducted to determine the prevalence and related factors in FeLV and FIV infections in cat from Santa Catarina Plateau. In the meantime, a second study was conducted with the objective of describing and comparing the clinical and hematological changes that affect FeLV positive domestic cats. The prevalence was 22.26% (61/274) for FeLV infection, 5.84% (16/274) for FIV and 1.46% (4/274) for both viruses. Cats that presented aggressive behavior (OR = 1.18) and males (OR = 2.41) were more likely to be FeLV positive. Aggressive cats (OR = 8.00), males (OR = 5.87) and older (OR = 1.01) had a greater chance of testing positive for FIV. The most observed clinical sign in FeLV positive sick cats was pallor of mucous membranes (65, 51%; 19/29), followed by neurological changes (20, 69%; 6/29), lymphoma (17, 24%; 5/29), secondary infections (10, 34%; 3/29) and leukemia (6.9%; 2/29). At the complete blood count, the means found in Group 3 (FeLV positive and affected by viral disease) were lower than for Groups 1 (FeLV negative and healthy) and 2 (FeLV positive and asymptomatic) for erythrocyte counts, hemoglobin concentration, hematocrit and eosinophils, while for nucleated erythrocytes was higher. The mean number for corpuscular volume was higher in the Group 3 than Group 1. At the same time, platelet count was lower. The most frequent hematological changes in Group 3 were anemia (65, 51%; 9/29) and thrombocytopenia (62.7%; 18/29). Hematological changes found in FeLV positive and symptomatic felines are more severe than those found in healthy FeLV felines. The prevalence for FeLV infection was high, showing that the local feline population is at risk and it is needed to implement measures to control the disease spreading / O vírus da leucemia felina (FeLV) e o vírus da imunodeficiência felina (FIV) pertencem a família Retroviridae e são os agentes infecciosos virais mais importantes em gatos. A infecção pelo FeLV é manifestada comumente através de imunossupressão, anemia e linfoma. O FIV é responsável por causar principalmente depleção da ação do sistema imune do hospedeiro. A prevalência para a infecção por esses vírus varia entre diferentes regiões no planeta. No Brasil há poucos dados, aonde é possível observar alta prevalência de animais infectados. Portanto, um estudo transversal foi realizado para determinar a prevalência e os fatores associados a infecção por FeLV e FIV em gatos do Planalto de Santa Catarina. Em paralelo um segundo estudo foi conduzido, com o objetivo de descrever e comparar as alterações clínicas e hematológicas que acometem os gatos domésticos FeLV positivos. A prevalência encontrada foi 22,26% (61/274) para a infecção por FeLV, 5,84% (16/274) para FIV e 1,46% (4/274) para ambos os vírus. Gatos que apresentaram comportamento agressivo (OR=1.18) e machos (OR=2.41) apresentaram maior chance de ser positivos para FeLV. Gatos agressivos (OR= 8.00), machos (OR= 5.87) e mais velhos (OR=1,01) apresentaram maior chance de testar positivo pra FIV. A apresentação clínica mais observada nos gatos FeLV positivos e doentes foi palidez de mucosa (65,51%; 19/29); alterações neurológicas (20,69%; 6/29); linfoma (17,24%; 5/29); coinfecções (10,34%; 3/29) e leucemia (6,9%; 2/29). No hemograma, as médias encontradas para o Grupo 3 (FeLV positivos e com doença causada pelo vírus) foram menores que para os Grupos 1 (FeLV negativos e saudáveis) e 2 (FeLV positivos e assintomáticos) para contagem de eritrócitos, concentração de hemoglobina, hematócrito e eosinófilos, enquanto para eritrócitos nucleados foi maior. A média encontrada para volume globular médio foi maior para o Grupo 3 que para o Grupo 1 e para a contagem de plaquetas foi menor. As alterações hematológicas mais encontradas no Grupo 3 foram a anemia [65,51%; 19/29] e a trombocitopenia [62,7%; 18/29]. As alterações hematológicas encontradas em felinos FeLV positivos e sintomáticos são mais severas que as encontradas em felinos FeLV positivos saudáveis. A prevalência para a infecção por FeLV é alta, colocando a população de felinos da região em risco e demonstrando a necessidade de implementação de medidas de controle da disseminação da doença

Objetivo: Avaliar a freqüência das células T reguladoras (Tregs) em crianças com diagnóstico novo de Púrpura Trombocitopênica Imune (PTI) e a sua associação com a contagem de plaquetas na ocasião, comparando os achados com os de controles saudáveis. Pacientes e Métodos: Foi realizado um estudo caso-controle, no qual foram incluídos 19 pacientes com diagnóstico novo de PTI e 19 controles. Para cada um dos casos, foram coletadas quatro amostras de sangue em períodos distintos, sendo eles ao diagnóstico – antes da instituição de qualquer terapêutica – e após um, três e seis meses do mesmo. Para os controles, utilizou-se amostra de sangue de 19 pacientes saudáveis, coletadas eletivamente. Em todas as amostras de sangue foi realizada contagem de plaquetas através de hemograma e avaliação dos linfócitos Tregs (CD4+ CD25+ Foxp3) por citometria de fluxo. Resultados: A idade média ao diagnóstico de PTI foi de 6,53 ± 4,14 anos. Dos 17 pacientes tratados, 13 receberam apenas corticosteróide oral e quatro pacientes receberam corticosteróide e imunoglobulina endovenosa associada em algum momento do tratamento. Em relação à evolução da doença, 14 crianças apresentaram remissão completa, duas remissão e três PTI crônica. Houve diferença estatisticamente significativa no número de plaquetas entre os grupos caso e controle nas amostras 1 e 4. Não houve diferença significativa na contagem de Tregs entre os casos e os controles em nenhum momento de coleta. Não foi encontrada correlação estatisticamente significativa entre Tregs e o número de plaquetas entre os casos e os controles, nem nos pacientes do grupo caso ou do grupo controle analisados separadamente. Não houve diferença na contagem de células Tregs entre os grupos de pacientes crônicos e não crônicos. Conclusão: Os achados deste estudo não nos permitiu evidenciar correlação estatisticamente significativa entre Tregs e o número de plaquetas nos grupos caso e controle. As células T CD4+ CD25+ Foxp3 (Tregs) parecem não desempenhar um papel crucial na regulação da auto-imunidade em pacientes pediátricos com diagnóstico de PTI, provavelmente, devido à existência de outros mecanismos responsáveis pela auto-imunidade em crianças, ainda não identificados. / Objective: To assess the frequency of regulatory T cells (Tregs) in children with a new diagnosis of Immune Thrombocytopenic Purpura (ITP), and its association with the counts of platelets on the occasion, and compare with healthy controls. Patients and Methods: A case-control study was conducted, in which 19 patients with new diagnosis of ITP and 19 controls were included. For each case, four blood samples were collected at different point times, that is, at the diagnosis – before the establishment of any treatment – and after one, three and six months. For the controls, electively collected blood samples from 19 healthy patients were used. For all blood samples, platelets were counted through a CBC and assessment of Treg lymphocytes (CD4+ CD25+ Foxp3) by flow cytometry. Results: The mean age at the ITP diagnosis was 6.53 ± 4.14 years. Of 17 treated patients, 13 received oral corticosteroid only, and four patients received corticosteroid and associated intravenous human immunoglobulin at some point in the treatment. Regarding the disease course, 14 children showed full remission, two partial remission, and three chronic ITP. There was a statistically significant difference in the number of platelets between the case and control groups in the samples 1 and 4. There was no significant difference in the counts of Tregs between cases and controls at any collection time. No statistically significant correlation was found between Tregs and number of platelets between cases and controls, neither in patients in the case group nor in the control group who were analyzed separately. There was no difference in the counts of Treg cells between the groups of chronic and non-chronic patients. Conclusion: The findings of this study did not show any statistically significant correlation between Tregs and number of platelets in the case and control groups. The T cells CD4+ CD25+ Foxp3 (Tregs) seems did not play a key role in the regulation of self-immunity in pediatric patients diagnosed with ITP. Other mechanisms, which aren’t still identified, are likely to account for self-immunity in children.

Ehrlichia canis e Anaplasma platys são parasitas de células sanguíneas transmitidos por carrapatos de larga distribuição mundial. O objetivo deste trabalho foi detectar a presença de E. canis e A. platys em cães naturalmente infectados no município de Porto Alegre, RS, Brasil, através de técnicas sorológicas e moleculares; realizar análise molecular dos agentes através do sequenciamento de um fragmento do gene 16S rRNA e compará-lo com sequências disponíveis no Genbank. Adicionalmente, avaliamos os parâmetros hematológicos e possíveis fatores de risco associados à infecção. Amostras de sangue foram coletadas de 146 cães residentes no Bairro Arquipélago, região suburbana de Porto Alegre e 53 cães mantidos no Centro de Controle de Zoonoses (CCZ). Dentre os animais analisados, 27 (13,56%) apresentaram resultado positivo na nPCR e 20 (10,2%) apresentaram sorologia positiva para A. platys. Através da ferramenta BLASTn, as sequências obtidas neste estudo foram comparadas e mostraram similaridade de 99,75% a 100% em relação a outras sequências de A. platys disponíveis no Genbank. Neste estudo não foi observada a presença de E. canis. DNA do agente não foi amplificado em nenhuma das amostras analisadas através de técnicas moleculares, e tampouco foram detectados cães sororreagentes, indicando a baixa prevalência do agente no município. Ao comparar a prevalência de infecção/exposição entre as populações estudadas, não observamos diferença significativa entre elas. Não foram observadas diferenças significativas nos parâmetros hematológicos e fatores de risco analisados nos animais infectados ou expostos, exceto a contagem de basófilos, que foi associada positivamente com infecção por A. platys. / Erlichia canis and Anaplasma platys are tick borne disease which has a worldwide geographic distribution. The aim of this study was to detect the presence of E. canis and A. platys in naturally infected dogs in Porto Alegre/RS – Brazil by serological and molecular techniques, performing molecular analysis of the agents by sequencing of a fragment of the 16S rRNA and comparing it with sequences available in Genbank. Additionally, we evaluated the hematological parameters and potential risk factors associated with infection. Blood samples were collected from 146 dogs living in the Arquipelago neighborhood, a suburban area of Porto Alegre and 53 dogs from Control Centrer of Zoonosis (CCZ). Among the examined animals, 27 (13.56%) were positive by nPCR and 20 (10.2%) were seropositive for A. platys. Through the BLASTn, the sequences obtained in this study were compared and showed similarity of 99.75% to 100% as compared to other sequences of A. platys available in Genbank. None of the dogs showed antibodies or E. canis DNA, indicating the low occurrence of the agent in Porto Alegre. There were no significant differences between positive groups and hematological parameters, or among the risk factors evaluated, except basophils count was associated with A. platys infection.

Objetivo: Avaliar a freqüência das células T reguladoras (Tregs) em crianças com diagnóstico novo de Púrpura Trombocitopênica Imune (PTI) e a sua associação com a contagem de plaquetas na ocasião, comparando os achados com os de controles saudáveis. Pacientes e Métodos: Foi realizado um estudo caso-controle, no qual foram incluídos 19 pacientes com diagnóstico novo de PTI e 19 controles. Para cada um dos casos, foram coletadas quatro amostras de sangue em períodos distintos, sendo eles ao diagnóstico – antes da instituição de qualquer terapêutica – e após um, três e seis meses do mesmo. Para os controles, utilizou-se amostra de sangue de 19 pacientes saudáveis, coletadas eletivamente. Em todas as amostras de sangue foi realizada contagem de plaquetas através de hemograma e avaliação dos linfócitos Tregs (CD4+ CD25+ Foxp3) por citometria de fluxo. Resultados: A idade média ao diagnóstico de PTI foi de 6,53 ± 4,14 anos. Dos 17 pacientes tratados, 13 receberam apenas corticosteróide oral e quatro pacientes receberam corticosteróide e imunoglobulina endovenosa associada em algum momento do tratamento. Em relação à evolução da doença, 14 crianças apresentaram remissão completa, duas remissão e três PTI crônica. Houve diferença estatisticamente significativa no número de plaquetas entre os grupos caso e controle nas amostras 1 e 4. Não houve diferença significativa na contagem de Tregs entre os casos e os controles em nenhum momento de coleta. Não foi encontrada correlação estatisticamente significativa entre Tregs e o número de plaquetas entre os casos e os controles, nem nos pacientes do grupo caso ou do grupo controle analisados separadamente. Não houve diferença na contagem de células Tregs entre os grupos de pacientes crônicos e não crônicos. Conclusão: Os achados deste estudo não nos permitiu evidenciar correlação estatisticamente significativa entre Tregs e o número de plaquetas nos grupos caso e controle. As células T CD4+ CD25+ Foxp3 (Tregs) parecem não desempenhar um papel crucial na regulação da auto-imunidade em pacientes pediátricos com diagnóstico de PTI, provavelmente, devido à existência de outros mecanismos responsáveis pela auto-imunidade em crianças, ainda não identificados. / Objective: To assess the frequency of regulatory T cells (Tregs) in children with a new diagnosis of Immune Thrombocytopenic Purpura (ITP), and its association with the counts of platelets on the occasion, and compare with healthy controls. Patients and Methods: A case-control study was conducted, in which 19 patients with new diagnosis of ITP and 19 controls were included. For each case, four blood samples were collected at different point times, that is, at the diagnosis – before the establishment of any treatment – and after one, three and six months. For the controls, electively collected blood samples from 19 healthy patients were used. For all blood samples, platelets were counted through a CBC and assessment of Treg lymphocytes (CD4+ CD25+ Foxp3) by flow cytometry. Results: The mean age at the ITP diagnosis was 6.53 ± 4.14 years. Of 17 treated patients, 13 received oral corticosteroid only, and four patients received corticosteroid and associated intravenous human immunoglobulin at some point in the treatment. Regarding the disease course, 14 children showed full remission, two partial remission, and three chronic ITP. There was a statistically significant difference in the number of platelets between the case and control groups in the samples 1 and 4. There was no significant difference in the counts of Tregs between cases and controls at any collection time. No statistically significant correlation was found between Tregs and number of platelets between cases and controls, neither in patients in the case group nor in the control group who were analyzed separately. There was no difference in the counts of Treg cells between the groups of chronic and non-chronic patients. Conclusion: The findings of this study did not show any statistically significant correlation between Tregs and number of platelets in the case and control groups. The T cells CD4+ CD25+ Foxp3 (Tregs) seems did not play a key role in the regulation of self-immunity in pediatric patients diagnosed with ITP. Other mechanisms, which aren’t still identified, are likely to account for self-immunity in children.

Introdução: O sangramento por queda de escara é uma complicação potencialmente letal da ligadura elástica (LE) de varizes de esôfago. Os fatores relacionados a esse evento são pouco explorados na literatura, porém a coagulopatia, principalmente a plaquetopenia, do paciente com cirrose poderia estar implicada. O número e a função plaquetária têm particular relevância na manutenção da hemostasia, uma vez que a geração de trombina depende fortemente desses parâmetros. Entretanto, dados demonstram a preservação da função plaquetária como consequência de mecanismos compensatórios representados, principalmente, pelo aumento dos níveis do fator de von Willebrand (FVW) e diminuição de ADAMTS13. Deste modo, os pontos de corte para contagem plaquetária utilizados na prática clínica não refletiriam o risco de sangramento após procedimentos. Objetivos: O objetivo desse estudo foi descrever a função plaquetária em pacientes com cirrose e a sua influência no sangramento após LE de varizes de esôfago. Pacientes e Métodos: 1) Casuística. Foram incluídos pacientes com diagnóstico de cirrose, de diferentes etiologias, encaminhados para realização de LE como profilaxia primária ou secundária de sangramento por varizes de esôfago. Os critérios de inclusão foram: a) idade acima de 18 anos; b) pacientes com cirrose e varizes de esôfago com indicação de ligadura elástica eletiva e c) concordância em participar do estudo. Os critérios de exclusão foram: a) doenças pulmonares e cardíacas graves; b) carcinoma hepatocelular; c) insuficiência renal com uremia ou dialítica; d) uso de qualquer droga que interfere na coagulação. 2) Métodos. Imediatamente antes da realização da endoscopia digestiva com LE, foi coletada amostra de sangue de cada paciente para a realização dos seguintes testes: contagem de plaquetas, testes relacionados à função plaquetária (adesão e agregação medida pela superfície coberta (SC) com valor de referência: > 7,5% e tamanho do agregado (AS) com valor de referência: > 25um² pela tecnologia Impact- R®), antigeno de FVW (referência: 40-157%), atividade de FVW (referência: 38- 176%), proteinase ADAMTS13 (referência: 40-130%), P-selectina por citometria (34,9±2,32%) e P-selectina solúvel (92-212ng/mL). Os pacientes foram estratificados de acordo com número de plaquetas. O grau de comprometimento da função hepática foi avaliado pelos estadiamentos de Child-Pugh e MELD. O desfecho primário do estudo foi a ocorrência do sangramento atribuído à queda da escara da LE. Resultados: Foram incluídos 111 pacientes, divididos em três grupos: A) plaquetas < 50x10³/mm³ (n = 38; 34,2%); B) plaquetas entre 50x10³/mm³ e 100x10³/mm³ (n = 47; 42,4%) e C) plaquetas > 100x10³/mm³ (n = 26; 23,4%). Os três grupos não diferiram significativamente em relação aos seguintes parâmetros: gênero, etiologia e grau de disfunção hepática. Na comparação entre os grupos, os parâmetros hemoglobina e bilirrubina foram significantemente maior no grupo B (p=0,04 e p=0,009, respectivamente). Nos testes relacionados à função plaquetária, encontramos no Impact-R®, SC de 7 ± 4% e AS de 52 ± 24?m2. Na avaliação do FVW o valor encontrado foi de 369 ± 157% para o antígeno e 336 ± 149% para atividade. ADAMTS13 apresentou resultado 73 ± 24%. Na comparação entre os grupos: o parâmetro Impact-R® SC foi no grupo A: 4,9 ± 3%, no grupo B: 7,7 ± 4,6% e 9,1 ± 3,6 no grupo C (p < 0,005). O AS foi de 49,9 ± 22,4% no grupo A, no grupo B foi 55,1 ± 26,6% e 51,3 ± 20 no grupo C (p=0,599). Os outros parâmetros específicos relacionados à função plaquetária não foram significantes: o antígeno do FVW com p=0,926, a atividade do FVW com p=0,870 e ADAMTS13 com p=0,080. O resultado da P-selectina por citometria de fluxo foi de 37,8 ± 23% e P-selectina solúvel foi 182,3 ± 86 ng/mL. A maioria dos pacientes (58,5%) realizaram LE como profilaxia primária. A presença de sinais vermelhos ocorreu em 74% e a gastropatia hipertensiva foi vista em 95% dos pacientes. Houve sangramento após LE em seis (5,4%) pacientes, sendo duas ocorrências no grupo A, uma no grupo B e três no grupo C (p=0,316). O valor médio do MELD foi 13 ± 3,6, sendo 12,6 ± 3,3 no grupo sem sangramento e 16 ± 5,9 no grupo sem sangramento (p=0,025). Quando comparados os pacientes sem e com sangramento não encontramos diferença estatisticamente significante em nenhum parâmetro de função plaquetária. Conclusões: Os resultados dos testes de adesão e agregação plaquetária: SC e AS; FVW e ADAMTS13 demonstraram compensação funcional a despeito da plaquetopenia e não se correlacionaram com o risco de sangramento após LE de varizes de esôfago. O MELD foi significantemente maior nos pacientes que sangraram / Introduction: Bleeding caused by ulceration after band ligation of esophageal varices is a potentially fatal complication. Contributing factors to this event are little explored in the literature, although coagulopathy, principally thrombocytopenia, in patients with cirrhosis could be implicated. The number and function of platelets has particular relevance to the maintenance of hemostasis, since thrombin generation depends heavily on these parameters. However, data show that the preservation of platelet function is a consequence of compensatory mechanisms represented principally by an increase in von Willebrand factor (VWF) levels and a reduction in ADAMTS13. Because of this, the cutoff points for platelet count used in routine clinical practice do not reflect the risk of bleeding following invasive procedures. Objective: The aim of this study was to describe platelet function in patients with cirrhosis and its influence on the bleeding following band ligation of esophageal varices. Methodology: 1) Inclusion. Patients with cirrhosis of different etiologies, referred for band ligation as primary or secondary prophylaxis of bleeding from esophageal varices were included. Inclusion criteria were: a) age > 18 years; b) patients with cirrhosis and esophageal varices elegible for elective band ligation; c) agreement to participate in the study. The exclusion criteria were: severe pulmonary or cardiovascular disease; b) hepatocellular carcinoma; c) renal dysfunction with uremia or requiring dialysis; d) use of any medication that could interfere with coagulation. 2) Methods. Immediately prior to digestive endoscopy with band ligation, a blood sample was taken from each patient to carry out the following coagulation tests: platelet count, platelet function test (adhesion and aggregation measured as surface coverage (SC) with normal range: > 7.5% and aggregate size (AS) with normal range: > 25um² by Impact-R® technology), antigen of VWF (normal range: 40- 157%), activity of VWF (normal range: 38-176%), protease ADAMTS13 (normal range: 40-130%), P-Selectin by cytometry (34.9±2.32%) and soluble P-Selectin (92- 212ng/mL). The degree of hepatic function was staged according to Child-Pugh and MELD. The principal clinical event assessed by the study was the occurrence of post-banding bleeding. Results: 111 patients were included in the study, divided into three groups: A) platelet count < 50x10³/mm³ (n=38; 34.2%); B) platelet count between 50x10³/mm³ and 100x10³/mm³ (n=47; 42.4%); and C) platelet count > 100x10³/mm³ (n=26; 23.4%). The three groups did not differ significantly in relation to the following parameters: gender, cirrhosis etiology and degree of hepatic dysfunction. The comparison among groups showed that the parameters hemoglobin and bilirubin were significantly higher in group B (p=0.04 and p=0.009, respectively). With regards to platelet function, in Impact-R® the mean SC was 7 ± 4%; in group A was 4.9 ± 3%, in group B was 7.7 ± 4.6% and 9,1 ± 3,6 in group C (p < 0.005). The AS was 52 ± 24?m2; in group A was 49.9 ± 22.4%, in group B was 55.1 ± 26.6% and 51.3 ± 20 in group C (p=0.599). The mean VWF value was 369 ± 157% for antigen and 336 ± 149% for activity. ADAMTS13 activity values were 73 ± 24%. The comparison among groups showed that the other specific parameters for platelet function were not significant: VWF antigen with p=0.926, VWF activity with p=0.870 and ADAMTS13 with p=0.080. The result of P-Selectin by flow cytometry was 37.8 ± 23% and soluble P-Selectin was 182.3 ± 86ng/mL. The majority of patients (58.5%) underwent band ligation as primary prophylaxis. Red signs appeared in 74%, and hypertensive gastropathy was seen in 95% of patients. There was bleeding following band ligation in 6 (5.4%) of patients, with 2 occurring in group A, 1 in group B, and 3 in group C (p=0.316). The mean MELD score was 13 ± 3.6, with 12.6 ± 3.3 in the group without bleeding, and 16 ± 5.9 in the group with bleeding (p=0.025). When patients with bleeding were compared with those without, there was no statistically significant difference in any parameter for platelet function. Conclusions: The results of the platelet function test SC and AS; VWF and ADAMTS13 tests showed functional compensation for thrombocytopenia, and did not correlate with the risk of bleeding following band ligation of esophageal varices. The MELD score was significantly higher in patients who suffered bleeding

Conclusion:Medical treatment may have a role in platelet count after transfusion. Since the TACSI platelets passed the quality requirements, and the vast majority of patients platelet count increased after TACSI platelet transfusion, the TACSI platelets will replace the old method to produce platelets at the Uppsala University hospital.     Methods: A new approach that pools 8 buffy coats (TACSI platelets) that were separated into 2 units instead of 4-6 buffy coats pooled to 1 unit was investigated in this study. After the platelets were extracted from the buffy coats their quality was controlled and subsequently the platelet product was evaluated in 96 patients.   Results: The results showed that 80 % of the platelet units passed the European quality requirements. Further, the platelet count was increased in most patients that received TACSI platelets. Conclusion: Medical treatment may have a role in platelet count after transfusion. Since the TACSI platelets passed the quality requirements, and the vast majority of patients platelet count increased after TACSI platelet transfusion, the TACSI platelets will replace the old method to produce platelets at the Uppsala University hospital.

La protéine Bcl-xL fait partie de la famille des protéines anti-apoptotiques Bcl-2. Il a été montré que cette protéine avait un rôle majeur dans la formation des plaquettes chez la souris (mégacaryopoïèse). Une dérégulation de cette protéine pourrait aboutir à une altération de la mégacaryopoïèse et donner des pathologies humaines comme des thrombopénies chroniques. Une des causes de thrombopénies chroniques est le purpura thrombopénique immunologique (ou PTI), qui associe deux mécanismes physiopathologiques : une destruction auto-immune des plaquettes et une insuffisance de leur production par la moelle osseuse. Le PTI est un diagnostic d’exclusion par élimination de toutes les causes connues de thrombopénie. Au sein de notre cohorte de patients suivis en médecine interne pour cette maladie, nous avons identifié certains patients qui présentaient un profil non-immunologique, c’est-à-dire l’absence d’auto-immunité et une non réponse à tous les traitements immunomodulateurs, ou pas d’indication à un traitement compte tenu d’un taux de plaquettes suffisant. Nous montrons dans ce travail de thèse que Bcl-xL est nécessaire pour la survie du mégacaryocyte humain pendant toute la mégacaryopoïèse, à la différence de la souris. Par ailleurs, certains patients ont une altération intrinsèque de la formation des proplaquettes, et certains d’entre eux ont également une diminution de l’ARN messager et de la protéine Bcl-xL dans leurs plaquettes. Ces observations nouvelles suggèrent l’implication de Bcl-xL dans la physiopathologie de leur maladie et ouvrent la voie à l’identification d’une potentielle nouvelle cause de thrombopénie chronique. / The Bcl-xL protein is a member of Bcl-2 anti-apoptotic proteins. It has been shown in mouse that this protein had a major role in platelet production (megakaryopoiesis). Bcl-xL deregulation could lead to megakaryopoiesis impairement and explain some human diseases such as chronic thrombocytopenias. One cause of chronic thrombocytopenia is immune thrombocytopenia (ITP) that associates 2 pathophysiological mechanisms: an immune-mediated platelet destruction and an insufficient production from the bone marrow cells. ITP is a diagnosis of exclusion when all known causes of thrombocytopenia have been ruled out by diagnosis work-up. In ITP cohort of patients followed in our internal medicine department, we have identified some patients with a haematological profile of their disease, ie absence of overt features of auto-immunity, and absence of response to immunomudulatory treatments, or no indication to such treatment because of sufficient platelet count. We demonstrate in this study that Bcl-xL is necessary for megakaryocyte survival during all megakaryopoiesis, contrary to what was found in mouse. Moreover, some patients have an intrinsically impaired proplatelet formation, and some of them also have a decrease of Bcl-xL mRNA and protein in their platelets. These novel observations suggest that a deregulation of Bcl-xL is a possible cause of their disease and lead the way to the identification of a potentially new cause of chronic thrombocytopenia in human

Psuedothrombocytopenia, the presence of platelet clumping on the peripheral blood film, is usually considered to rule out the diagnosis of immune thrombocytopenia (ITP) or other causes of increased platelet destruction and to be a laboratory artifact of no clinical significance. We report a case of concurrent psuedothrombocytopenia and ITP. While the examination of the peripheral blood film remains a critical element of the diagnostic approach to thrombocytopenia, this case emphasizes the importance of confirming the relevance of morphologic findings by additional testing.