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Blood, 15 February 2001, Vol. 97, No. 4, pp. 915-921
HEMATOPOIESIS
New insights into the thrombopoietic status of patients on
dialysis through the evaluation of megakaryocytopoiesis in bone
marrow and of endogenous thrombopoietin levels
Minoru Ando,
Yuhsuke Iwamoto,
Akio Suda,
Ken Tsuchiya, and
Hiroshi Nihei
From the Division of Nephrology, Tokyo Metropolitan
Geriatric Medical Center; the Department of Medicine, Kidney Center,
Tokyo Women's Medical University; and the Suda Clinic, Tokyo,
Japan.
The thrombopoietic status of patients with uremia remains unclear.
This issue was addressed with particular reference to marrow megakaryocytopoiesis and endogenous thrombopoietin (TPO) levels. A
study was conducted in 114 patients on hemodialysis, 43 patients on
continuous ambulatory peritoneal dialysis, and 48 age-matched controls.
Reticulated platelets, a marker of marrow megakaryocytopoiesis, were
measured by flow cytometry. Serum TPO levels, platelet-associated IgG
(PAIgG) levels, and hepatitis C virus (HCV) antibody titers were also
measured by enzyme-linked immunosorbent assay. Circulating and
reticulated platelet counts were significantly lower in the patients on
dialysis than in the controls. Thrombocytopenia (less than
150 × 109/L) was most frequent in the HCV-positive
hemodialysis patients, who had a higher incidences and higher PAIgG
titers. The following results were obtained in the HCV-negative
dialysis patients: (1) platelet counts chronologically decreased with
years on hemodialysis; (2) platelet counts were associated with the
reticulated platelet counts; (3) serum TPO levels were
significantly elevated in the dialysis patients, responding to the
decrease of reticulated platelets; (4) hematocrits had a positive
correlation with serum TPO levels, and serum TPO levels were
significantly higher in the patients on hemodialysis who did not
require recombinant human erythropoietin therapy than in the other
patients. In conclusion, thrombocytopenia is a frequent finding in
patients on dialysis. The failure of megakaryocyte production could
be the principal cause of the platelet reduction, and the peripheral
destruction and sequestration of platelets may be concomitantly
involved. Elevation of serum TPO may in part serve as an aid to
erythropoiesis in dialysis patients.
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