iloprost and Hematologic-Diseases

Osteonecrosis of the hip can lead to advanced arthritis in typically young patients. Hematologic disorders comprise one group of potential causes. These include sickle cell anemia, hemophilia, aplastic anemia, thalassemia, and acute lymphoblastic leukemia. Depending on the stage of disease, treatment options include non-operative management, joint-preserving procedures (percutaneous drilling, core decompression, and vascularized or non-vascularized bone grafting), and joint arthroplasty (resurfacing arthroplasty and THA). Numerous small studies have investigated the efficacy of these options in patients who have specific hematologic disorders. Therefore, this report provides a comprehensive review of the osteonecrosis treatment options and results across the spectrum of patients who have various hematologic disorders.

Topics: Arthroplasty, Replacement, Hip; Bone Density Conservation Agents; Bone Transplantation; Decompression, Surgical; Diphosphonates; Femur Head Necrosis; Hematologic Diseases; Hemiarthroplasty; Humans; Iloprost; Pamidronate; Risk Factors; Vasodilator Agents

Platelet concentrates were pretreated with a stable synthetic prostacyclin analogue (Iloprost) at two different concentrations before the second centrifugation step (pelleting step) of preparation. This resulted in loss of platelet sensitivity to aggregating agents. To mimic the situation after transfusion and to assess the reversibility of platelet inhibition, platelets were washed during and after storage and resuspended in fresh-frozen autologous plasma. The Iloprost-treated and washed platelets exhibited an increased sensitivity to the aggregating agents, compared with the control platelets (p less than 0.01). Post-storage recovery of the synergistic aggregation was more than 80% of prestorage aggregation. Beta-thromboglobulin (beta TG) release and thromboxane B2 (TXB2) formation were significantly inhibited in Iloprost-treated platelets (p less than 0.01). After the second centrifugation step, beta TG release was 0.7% +/- 0.3%, compared with 2.7% +/- 0.9% for the controls. TXB2 was 99 +/- 91 pg/ml, compared with 495 +/- 356 pg/ml for the controls. Platelet morphology and ultrastructure were well preserved during 5-day storage. In addition, Iloprost exerted a cytoprotective effect, as evidenced by the significant reduction in lactate dehydrogenase leakage. Post-storage LDH was 378 +/- 159 and 415 +/- 239 U/l respectively by the two Iloprost concentrations, compared with 1180 +/- 937 U/l for the control platelets. The inhibitory and cytoprotective effects of Iloprost were sustained throughout storage, in contrast to the effect of PGE1 (Prostin) which was limited to the early phase of storage.

Topics: Alprostadil; beta-Thromboglobulin; Blood Platelets; Blood Preservation; Epoprostenol; Hematologic Diseases; Humans; Iloprost; Platelet Aggregation; Platelet Count; Thromboxane B2