Haematologica 2004;89: supplement no. 8 - Supplements ...

80Oral CommunicationsCO-115STUDY OF THE ASSOCIATION OF PFA-100® CLOSURE TIMEAND THE SKIN BLEEDING TIME WITH THE SEVERITY OFBLEEDING SYMPTOMS IN PATIENTS SCREENED FORBLEEDING DIATHESISPodda GM,* Bucciarelli P,* Lussana F,° Lecchi A,*Cattaneo M°*Centro Emofilia e Trombosi Angelo Bianchi BonomiIRCCS Ospedale Maggiore, Departimento diMedicina Interna, Università di Milano; °Unità diEmatologia e Trombosi, Ospedale San Paolo, DMCO,Università di Milano, ItalyWe compared the association of PFA-100® closuretime (CT) and the Bleeding Time (BT) with the severityof bleeding history in 128 consecutive patientsreferred to our Center from June 2002 through June2003 to be screened for bleeding disorders, due tothe presence of bleeding symptoms or the casualfinding of abnormal screening tests of hemostasis. Allpatients underwent a careful medical interview andwere assigned a “bleeding score”, based on the number,type, frequency and severity (need for bloodtransfusion and/or surgical or medical intervention)of bleeding symptoms. In addition, all patientsunderwent a first-line screening, which included PT,APTT, BT and PFA-100® CT (with both the collagen-ADP and the collagen-epinephrine cartridges). Thesearch for Von Willebrand disease (VWD), plateletfunction disorders (PFD), clotting factor defects andabnormalities of fibrinolysis was performed accordingto the results of the first line screening tests andthe severity and type of bleeding history. Seven (6%)patients had type-1 VWD, 7 (6%) PFD, 29 (23%)defects of coagulation, 18 (14%) defects of the contactsystem or lupus anticoagulant, while in 67(52%) all tests gave normal results. The sensitivity ofPFA-100® for VWD was 86% (both cartridges), forPFD 71% (collagen-epinephrine) and 14% (collagen-ADP). The sensitivity of BT for VWD was 29%, forPFD 57%. After dividing the patient population infour quartiles of distribution, according to the severityof the bleeding score (null, low, intermediate andsevere), only the CT values of collagen-epinephrineshowed a progressive and significant prolongationfrom the first to the fourth quartile (p=0.04). Noassociation of BT and collagen-ADP CT with theseverity of bleeding history was found. In conclusion,PFA-100 showed a better sensitivity than BTfor VWD and PFD. CT with the collagen-epinephrinecartridge was significantly associated with the severityof the bleeding history.CO-1161-DEAMINO-8-D-ARGININE VASOPRESSIN AND PFA-100 TMIN PERCUTANEOUS ULTRASOUND GUIDED RENAL BIOPSY:A RANDOMIZED PLACEBO CONTROLLED TRIALBonifati C,* Ranieri P,° Sardone V,° Petruzzellis S,°Micelli M,° Strippoli GFM,* Campobasso N,*Schena FP,* Manno C**Istituto di Nefrologia, Università degli Studi, Bari;°Laboratorio di Coagulazione, Azienda Policlinico,Bari, ItalyBackground. Risks associated with percutaneousrenal biopsy decreased in the past two decadesbecause of technical advances. However, bleedingcomplications still occur in about 1/3 of proceduresresulting in increased costs and hospital stay. Weevaluated the pre-biopsy treatment with DDAVP onthe post-biopsy bleeding complications and the reliabilityof the in vitro closure time (CT) determinedwith the PFA-100(e)TM system (Dade-Behring, Marburg,Germany) for the evaluation of primary hemostasis.Methods. A randomized controlled trial withblinding of participants, investigators and outcomeassessors was performed in patients with normal renalfunction, IVY bleeding time and coagulation; patientswere centrally randomized to DDAVP 0.3 µg/kg s.c. 1hour prior to biopsy versus matched placebo. Beforeand after biopsy were evaluated: CT with PFA-100TM[Collagen-epinephrine (CEPI-CT) and Collagen-ADP(CAPD-CT)], FVIII:c, vWF:Ag and vWF:RCo. Post biopsybleeding complications were evaluated after 24-hours with renal ultrasound. Analysis was by intentionto treat. Results. Forty patients with no demographicdifferences were allocated to DDAVP/placebo(20/20). DDAVP vs placebo significantly reduced thenumber (6/20 versus 12/20; p=0.04) and the size ofhematomas (83±173.7 mm 2 vs 254.7±257.7 mm 2 ;p=0.02). DDAVP, but not placebo, significantly reducedCEPI-CT [137.6±33.7 to 102.3±34.4 seconds(p=0.008)] and CADP-CT [80.9±12.0 to 64.4±21.8seconds (p=0.003)] and increased FVIII:C [94.1±34.5to 196.0±111.0 IU/dl (p=0.002)], vWF:Ag [114.2±28.6to 170.3±59.0 IU/dl (p=0.004)] and vWF:Rco[111.7±26.8 to 180.3±68.1% (p=0.002)]. Correlationbetween CT and FVIII:c/vWF:Ag/vW:RCo (p