Hemorrhagic Microthrombovasculitis: Primary Hemostasis and Immunological Parameters

• Main Authors: AR Raimzhanov, OA Dzhakypbaev
• Format: Article
• Language: Russian
• Published: Practical Medicine Publishing House 2016-01-01
• Series: Kliničeskaâ onkogematologiâ
• Subjects: hemorrhagic microthrombovasculitis; ristomycin-induced platelet aggregation; interleukins (IL-1b; IL-2; IL-6); tumor necrosis factor-a; homocysteine; heparin; dexamethasone; azathioprine; therapeutic plasmapheresis
• Online Access: http://bloodjournal.ru/en/hemorrhagic-microthrombovasculitis-primary-hemostasis-and-immunological-parameters/
• ISSN: 1997-6933; 2500-2139

Background & Aims. Hemorrhagic microthrombovasculitis (HMTV) is the most common disease among hypersensitive immunocomplex systemic vasculites. The high prevalence of the disease and increasing growth of the number of HMTV patients, the severity of the clinical course, and frequent joint, GIT, and kidney involvement (30–50 %) demonstrate the important social and economic significance of this problem and the need in further specification and evaluation of unspecified pathogenetic factors with development of new treatment approaches. The aim of this work is to evaluate the ristomycin-induced platelet aggregation, cytokines and homocysteine levels in HMTV patients. Methods. 48 HMTV patients treated in the Kyrgyz Scientific Center for Hematology over the period from September, 2013, till March, 2015, were enrolled in the study (25 men and 23 women). The age median was 23 years. In all patients, the disease was diagnosed based on clinical data and lab test findings. The following lab tests were performed: ristomycin-induced platelet aggregation, cytokines and homocysteine levels in HMTV patients. The basic treatment options included the use of anticoagulants, antiaggregants, fibrinolysis activators, and prostacyclin; in case of II–III activity degree of the autoimmune/immunocomplex process, medium doses corticosteroids with anticoagulants, antiaggregants, and therapeutic plasmapheresis are used. Results. The study demonstrated that patients with a high degree of activity of the autoimmune inflammation presented increased ristomycin-induced platelet aggregation, increased concentrations of interleukin-6 (IL-6) and tumor necrosis factor-a (TNF-a) and hyperhomocysteinemia. After the treatment, in patients with generalized HMTV, the concentrations of IL-6 and TNF-a reduced by 10 % and 18.3 %, respectively, but the IL-6 level remained above the normal limits. Conclusion. The data presented here demonstrate the importance of testing platelet aggregation upon the effect of specific inducers, as well as concentrations of proinflammatory cytokines and homocysteine in HMTV patients.