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Maria Stella Graziani

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Matteo Vidali

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Giuseppe Agosta

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Arianna Lucini Paioni
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email: biochimica.clinica@sibioc.it



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BC: Articoli scritti da M. Marchetti

Trombocitosi e rischio trombotico nelle neoplasie mieloproliferative
Thrombocytosis and risk of thrombosis in myeloproliferative neoplasms
<p>In patients with polycythemia vera (PV) and essential thrombocythemia (ET), two Philadelphia chromosome&ndash;negative myeloproliferative neoplasms (MPN), thrombotic events are frequent and represent the main cause of morbidity and mortality. Patients with MPN can be stratified in thrombotic risk categories according to age and history of thrombosis. Patients older than 60 years or with a history of thrombosis are considered at high-risk. Recently, new developments have brought to a further subcategorization of patients who are not at high risk in the &ldquo;intermediate&rdquo; and &ldquo;low-risk&rdquo; categories, depending on the presence or absence of <em>JAK2V617F</em> mutation and/or cardiovascular risk factors. Thrombocytosis is typical of these diseases, particularly of ET, but its role in the pathogenesis of thrombotic events is still controversial. So far, no study has demonstrated a statistically significant correlation between platelet count and thrombosis in either PV or ET patients. Paradoxically, extreme thrombocytosis (i.e., platelets &gt;1500&times;10<sup>9</sup>/L) is rather associated with hemorrhagic manifestations in patients with ET. Recent biological studies of circulating thrombotic markers performed to characterize the presence of a hypercoagulable state in patients with MPN have shown that platelet qualitative abnormalities, more than platelet count, are associated with hypercoagulability in these patients. Particularly, studies have demonstrated that platelets circulate in an activated status and possess a high prothrombotic potential. These findings suggest that in these diseases the control of platelet activation over the platelet count is an important goal of treatment strategies.</p>
Biochimica Clinica ; 41(2) 128-133
Rassegne - Reviews
 
Il ruolo del laboratorio di coagulazione nel monitoraggio del trattamento eparinico dei pazienti con COVID-19
The role of laboratory monitoring in heparin treatment of COVID-19 patients
<p>Coronavirus disease 2019 (COVID-19) can be associated with serious clinical complications such as acute respiratory distress syndrome (ARDS), sepsis and multiple organ failure (MOF). A key event in the pathophysiology of ARDS is immunothrombosis, a process initiated by the innate immune system that provides a first line of defense for local control of infection. In its physiological form, immunothrombosis is intended to facilitate the recognition, containment and destruction of pathogens, thus protecting the integrity of the host without inducing significant collateral damage. The cytokine storm that occurs during COVID-19 induces often venous and arterial thrombotic events affecting different organs, not limited to the respiratory system. It is therefore necessary to introduce an anticoagulant treatment in patients with COVID-19 to prevent the onset and the extension of thrombotic events. The low molecular weight heparin (LMWH) is the first-choice drug recommended by the main international scientific societies; alternatively, unfractionated heparin (UFH) or fondaparinux can be used. The dosage of these drugs in patients with COVID-19 is still under discussion. The coagulation testing plays an important role in monitoring the efficacy and safety of UFH treatment; in the case of LMWHs, these usually do not require monitoring but, if alterations of renal function occur, it is important to perform the chromogenic determinations of the anti-Xa activity, paying a particular attention to the timing of sampling, the pre-analytical variables, calibration of the test and reference ranges.</p>
Biochimica Clinica ; 17(1) 017-018
COVID-19 - COVID-19