Pediatric Hematology/Oncology and ImmunopathologyPediatric Hematology/Oncology and ImmunopathologyВопросы гематологии/онкологии и иммунопатологии в педиатрии1726-17082414-9314Fund Doctors, Innovations, Science for Children26910.24287/1726-1708-2019-18-3-120-129LITERATURE REVIEWОБЗОР ЛИТЕРАТУРЫReversible platelet aggregation in the presence of calcium ions: mechanisms and potential valueОбратимая агрегация тромбоцитов в присутствии ионов кальция: механизмы и потенциальная значимостьhttps://orcid.org/0000-0002-0448-3981FilkovaA. A.ФильковаА. А.
Russian Federation

Moscow

Москва

https://orcid.org/0000-0002-8128-7757PanteleevM. A.ПантелеевМ. А.
Russian Federation

Mikhail А. Panteleev, PhD, DSc, Head of the Laboratory of cellular hemostasis and trombosis of Dmitriy Rogachev National Medical Research Center of Pediatric Hematology, Oncology, Immunology Ministry of Healthcare of Russian Federation

117997, Moscow, Samory Mashela st., 1

Пантелеев Михаил Александрович, доктор физико-математических наук, профессор, заведующий лабораторией клеточного гемостаза и тромбоза НМИЦ детской гематологии, онкологии и иммунологии им. Дмитрия Рогачева Минздрава России

117997, Москва, ГСП-7, ул. Саморы Машела, 1

mapanteleev@yandex.ruhttps://orcid.org/0000-0003-4720-7319SveshnikovaA. N.СвешниковаА. Н.
Russian Federation

Moscow

Москва

Lomonosov Moscow State UniversityФГБОУ ВО «Московский государственный университет им. М.В. Ломоносова»Center for Theoretical Problems of Physicochemical Pharmacology Russian Academy of SciencesФГБУН «Центр теоретических проблем физико-химической фармакологии» РАНDmitriy Rogachev National Medical Research Center of Pediatric Hematology, Oncology, Immunology Ministry of Healthcare of Russian FederationФГБУ «Национальный медицинский исследовательский центр детской гематологии, онкологии и иммунологии им. Дмитрия Рогачева» Минздрава РоссииMoscow Institute of Physics and TechnologyФГАОУ ВО «Московский физико-технический институт (государственный университет)»Sechenovskiy UniversityФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России130920191831201291309201913092019Copyright ©; 2019, «D. Rogachev NMRCPHOI»Copyright ©; 2019, ФГБУ «НМИЦ ДГОИ им. Дмитрия Рогачева» Минздрава России2019«D. Rogachev NMRCPHOI»ФГБУ «НМИЦ ДГОИ им. Дмитрия Рогачева» Минздрава Россииhttps://creativecommons.org/licenses/by/4.0https://hemoncim.com/jour/article/view/269

Disorders in the functions of platelets – blood cells responsible for the blood clots formation and prevention – are observed as independent diseases, as a complication of cancer and hematological diseases or as a result of a therapy. Nowadays, a test of platelet aggregation by aggregometry is the only diagnostic method for assessing the platelets functions. There are several varieties of aggregometry, which differ both in the method of recording the formation of platelet aggregates and in the method of preparing platelets for the experiment. In most laboratories, it is customary to conduct aggregometry in platelet-rich plasma in the presence of citrate ions. In this case, the concentration of calcium ions in plasma decreases, it prevents the thrombin formation and the plasma coagulation. On the other hand, it has long been known that platelet aggregation in response to ADP in the presence of calcium ions (in blood plasma collected in heparin or hirudin tubes, also blocking plasma clotting) is reversible: after 1-5 minutes after the addition of the activator, the disaggregation begins until the light transmission of the solution (platelet concentration) returns to its original level. This phenomenon is called "reversible” platelet aggregation. Reversible aggregation (“disaggregation”) is sometimes observed in aggregometry of citrate plasma, especially in pediatric patients. However, it is usually not considered normal and is considered a sign of platelet dysfunction. This review considers the known mechanisms of disaggregation in the presence or absence of calcium ions in the medium. The role of secondary activation of platelets as a potential cause of irreversible aggregation is discussed, as well as possible versions for explaining the results of aggregometry, when reversible platelet aggregation is observed.

Нарушения функционирования тромбоцитов – клеток крови, ответственных за образование тромбов и остановку кровотечения, – наблюдаются как самостоятельные заболевания, как осложнение онкологических и гематологических заболеваний или как следствие терапии. Тестирование агрегации тромбоцитов методом агрегометрии – практически единственный диагностический инструмент оценки функциональности тромбоцитов. Существует несколько разновидностей агрегометрии, которые различаются по методу регистрации образования тромбоцитарных агрегатов, а также способу подготовки тромбоцитов для эксперимента. В большинстве лабораторий принято проводить агрегометрию в богатой тромбоцитами плазме в присутствии ионов цитрата. В этом случае снижается концентрация ионов кальция в плазме, что предотвращает образование тромбина и свертывание плазмы крови. С другой стороны, известно, что агрегация тромбоцитов в ответ на АДФ в присутствии ионов кальция (в плазме крови, взятой на гепарин или гирудин, также блокирующие свертывание плазмы) обратима: через 1–5 мин после добавления активатора начинается распад агрегатов вплоть до полного возвращения светопропускания раствора (концентрации тромбоцитов) на исходный уровень. Этот феномен называют «обратимой» агрегацией тромбоцитов (дезагрегацией); в некоторых случаях она наблюдается и в агрегометрии в цитратной плазме, особенно у педиатрических пациентов, однако обычно дезагрегация не считается нормой и рассматривается как признак дисфункции тромбоцитов. В настоящем обзоре рассмотрены известные механизмы дезагрегации тромбоцитарных агрегатов в присутствии и отсутствии кальция в среде. Обсуждается роль вторичной активации тромбоцитов как потенциальной причины необратимой агрегации, а также возможные варианты интерпретации результатов агрегометрии, в которой наблюдается обратимая агрегация тромбоцитов.

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