Chest
Clinical Investigations in Critical CarePlatelet-specific α-Granule Proteins and Thrombospondin in Bronchoalveolar Lavage in the Adult Respiratory Distress Syndrome
Section snippets
Patient Groups
Two groups of patients with ARDS with their respective control subjects were studied. Group 1 consisted of patients with ARDS studied within two days of recognition of the syndrome (n=9), pulmonary fibrosis (n=8), sarcoidosis (n=11), and normal healthy control subjects (n=12), as we have previously reported.4 The samples were collected at the Albert Einstein Medical Center, Northern Division, Philadelphia. Group 2 was studied at the Veterans Administration Hospital, Seattle. In this group, 28
Clinical Information
Clinical information for patients with ARDS in group 1 is illustrated in Table 1. The mean age for patients in this group was 52.8 years. Five of the nine patients had underlying associated sepsis as documented by blood cultures. The remainder had a nonseptic basis for ARDS including viral pneumonia (two patients), and heroin overdosage with aspiration or aspiration pneumonitis alone. Six patients in this group had thrombocytopenia and the mean±SD platelet count was 151.0±99.2 × 103
Discussion
Platelets sequester in the lungs of patients with ARDS1 and progressive thrombocytopenia may occur in as many as 50 percent of patients with nontraumatic ARDS, with the degree of thrombocytopenia paralleling the course of worsening hypoxia.11 Angiographic study of patients with ARDS has revealed pulmonary artery filling defects in as many as 50 percent of patients early in the course of hospitalization.12 Enmeshed platelets, neutrophils and fibrin have been demonstrated to account for
ACKNOWLEDGMENTS
The authors acknowledge the technical assistance of Ms. Kathy James, the assistance of Dr. T. R. Martin in sample collection, ana the secretarial expertise provided by Ms. Sandy Carlson.
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Manuscript received February 2; revision accepted March 15
†Supported by Clinical Investigator award HL01603 NIH, NHLBI; a grant from the American Heart Association, Texas Affiliate; and the Gina Sabatasse Research Grant Award.
‡Supported by the Pulmonary Specialized Centers of Research from NHLBI/NIH, award HL30542.
§On sabbatical leave from the Institute of Hypertension and Angiology, Academy of Medicine, Warsaw, Poland.
||Supported by the American Cancer Society grant PDT-287, NIH grant HL28149. Current address: Department of Medicine, Medical College of Pennsylvania, Philadelphia.
¶Supported by NIH grant HL36579.