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Thank you for attending THSNA 2026. The virtual meeting is now closed.
Presentation Details
| Increased levels of D-Dimer and Plasminogen Activator Inhibitor-1 in Immune Thrombocytopenia: Implications for thrombotic complications Kannan Meganathan1, Jeevanatham.Kaviarasi1, Chitrali L Roy1, Ravi Ranjan2, Manoranjan Mahapatra2, Renu Saxena2, Jawed Fareed3. 1Blood and Vascular Biology Research Lab, Department of Biotechnology, Central University of Tamil Nadu, Thiruvarur 610101.INDIA, Thiruvarur, India.2Department of Hematology, All India Institute of Medical Sciences, New Delhi 110029.INDIA, New Delhi, India.3Department of Molecular Pharmacology and Neuroscience, Loyola University Chicago IL 60153, USA, Chicago, IL, USA |
Abstract
Background: Immune Thrombocytopenia (ITP) is an autoimmune hematologic disorder characterized by isolated thrombocytopenia resulting from increased platelet destruction or impaired platelet production. While traditionally regarded as a bleeding disorder, individuals with ITP have increased risk for thrombotic events, raising critical concerns about the hemostatic imbalance in ITP. Objectives: To predict the risk of thrombosis in ITP, we aimed to evaluate two key hemostatic parameters, namely D-dimer and Plasminogen Activator Inhibitor-1 (PAI-1) and associated them with the clinical parameters. Methods: The study enrolled a total of 36 participants which included 18 primary ITP and 18 healthy controls. The study was approved by the institutional human ethics committee (EC No. 514). Blood samples were collected from the participants enrolled at the All India Institute of Medical Sciences (AIIMS), New Delhi. A comprehensive clinical assessment was performed for all the participants. The clinical assessment included patient demographics (age, sex), history of bleeding episodes, previous thrombotic events, medication history, and complete blood cell counts (CBC). Measurement of CBC and preparation of platelet-poor plasma were performed from the whole blood sample, following standard protocols. Hemostatic parameters such as D-Dimer and PAI-1 were quantified using commercially available ELISA kits using IMUCLONE ELISA kit and IMUBIND ELISA kit, respectively. Statistical analysis was performed using the student’s t-test (for normally distributed data) or the Mann-Whitney U test (for non-normally distributed data). Correlation analysis was performed to evaluate the relationship between the hemostatic parameters (D-dimer and PAI-1) and clinical parameters, including complete blood cell counts and other hematological parameters. Results: The results demonstrated elevated plasma concentrations of both D-dimer and PAI-1 in ITP compared to healthy controls. About 64% of ITP patients exhibited D-dimer values above 400 ng/mL, a threshold suggestive of active fibrinolysis or subclinical thrombosis (Figure 1). The PAI-1 average values for ITP and control were 41.4 ng/mL and 37.4 ng/mL respectively. Quantitative data analysis revealed strong correlations between these biomarkers and several hematological parameters (Figure 2). PAI-1 showed a strong positive correlation with mean platelet volume (MPV) (r = 0.84822) and a moderate correlation with platelet count (r = 0.48613), suggesting a link between platelet activation and fibrinolytic inhibition. Notably, PAI-1 was strongly inversely correlated with white blood cell count (r = –0.84598), possibly indicating a regulatory or compensatory response to immune activation. Conversely, D-dimer levels displayed a moderate to strong negative correlation with platelet count (r = –0.63033), MPV (r = –0.65052), and hemoglobin (r = –0.52273), suggesting that elevated D-dimer levels may reflect increased clot formation and breakdown in the presence of reduced platelet indices. A mild positive correlation with WBC (r = 0.37319) further underscores the role of inflammation in driving thrombin generation. Conclusions: The above findings collectively support the hypothesis that ITP patients exhibit a paradoxical prothrombotic state despite thrombocytopenia. Though the currently enrolled patients have not exhibited the classical symptoms of thrombosis, the pro-fibrinolytic signal from D-dimer and the anti-fibrinolytic signal from PAI-1 indicate increased thrombotic risk in these individuals.
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No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.