Platelets, Coagulation and Fibrinolysis in Patients with Diabetic Retinopathy

Summary

Twenty control subjects, 12 insulin treated and 10 non-insulin treated diabetics were studied. All diabetics had retinopathy documented by fluorescein angiography and fluorophotometry. Factor VUIRiAg and plasma fibrinogen concentrations were elevated in both diabetic groups, but more so in the insulin treated patients. Within this latter group the plasma fibrinogen was also correlated with the degree of retinopathy.

Platelets separated on linear isosmolar Percoll gradients showed an increase in intraplatelet βTG content and concentration and a slight increase in volume of the lightest platelets in the insulin treated diabetics. Plasma platelet factor 4 and antithrombin III concentrations were normal and plasma βTG levels were elevated only in those patients with renal insufficiency. Platelet aggregometry was performed in 18 diabetic subjects and found to be normal.

It is concluded that abnormalities of coagulation and platelets in diabetes are determined by metabolic factors rather than the severity of microvascular disease per se.

Keywords

Diabetic retinopathy - Platelets - Coagulation fibrinolysis

• References

• 1 Colwell JA, Halushka PV. Annotation. Platelet function in diabetes mellitus. Br J Haematol 1980; 44: 521-526
• 2 Jones RL, Peterson CM. Haematologic alterations in diabetes mellitus. Am J Med 1981; 70: 339-352
• 3 Bern MM. Platelet functions in diabetes mellitus. Diabetes 1978; 27: 342-352
• 4 Colwell JA, Halushka PV, Sarji KE, Sagel J. Platelet function and diabetes mellitus. Med Clin North Am 1978; 62: 753-766
• 5 Dobbie JG, Kwaan HC, Colwell J, Suwanwela N. Role of platelets in pathogenesis of diabetic retinopathy. Arch Ophthalmol 1974; 91: 107-109
• 6 Heath H, Brigden WD, Canever JV, Pollock J, Hunter PR, Kelsey J, Bloom A. Platelet adhesiveness and aggregation in relation to diabetic retinopathy. Diabetologia 1971; 7: 308-315
• 7 Colwell JA, Halushka PV, Sarji K, Levine J, Sagel J, Nair RMG. Altered platelet function in diabetes mellitus. Diabetes 1976; 25 suppl 2 826-831
• 8 Mustard JF, Packham MA. Platelets and diabetes mellitus. Editorial. N Engl J Med 1977; 297: 1345-1357
• 9 Porta M, Hilgard P, Kohner EM. Platelet shape change abnormalities in diabetic retinopathy. Diabetologia 1980; 18: 217-221
• 10 Aimer LO, Pandolfi M. Fibrinolysis and diabetic retinopathy. Diabetes 1976; 25 (Suppl 2) 807-810
• 11 Nakagawa S, Nakayama H, Sasaki T, Yoshino K, Yu YY, Shinozaki K, Aoki S, Mashimo K. A simple method for the determination of serum free insulin levels in insulin-treated patients. Diabetes 1973; 22: 590-600
• 12 Heding LG, Kasperska-Czyzykowa T. C-peptide and proinsulin after oral glucose. Acta Med Scand (Suppl). 1980; 639: 33-36
• 13 Laurell CB. Quantitative estimations of proteins by electrophoresis in agarose gel containing antibodies. Anal Biochem 1966; 15: 45-52
• 14 Mancini G, Carbonara AO, Heremans JF. Immunochemical quantitation of antigens by single radial immunodiffusion. Immuno-chemistry 1965; 2: 235-254
• 15 Martin JF, Shaw TJ, Heggie J, Penington DG. The measurement of the density of human platelets and its relationship to volume. Br J Haematol 1983. (in press).
• 16 Chesterman CN, McGready IR, Doyle DJ, Morgan FJ. Plasma levels of platelet factor 4 measured by radioimmunoassay. Br J Haematol 1978; 40: 489-500
• 17 Brooks AM V. Experience with fluorophotometry. Aust J Ophthalmol 1982; 10: 41-51
• 18 Khosla PK, Mahabaleswara M, Tiwari HK, Saraya AK. Platelet aggregation and retinal microangiopathy in diabetes and hypertension. Acta Haematol (Basel) 1979; 61: 161-167
• 19 Kwaan HC, Colwell JA, Cruz S, Suwanwela N, Dobbie JG. Increased platelet aggregation in diabetes mellitus. J Lab Clin Med 1972; 80: 236-246
• 20 O’Malley BC, Timperley WR, Ward JD, Porter NR, Preston FE. Platelet abnormalities in diabetic peripheral neuropathy. Lancet 1975; 2: 1274-1276
• 21 Sagel J, Colwell LA, Crook L, Laimins M. Increased platelet aggregation in early diabetes mellitus. Ann Intern Med 1975; 82: 733-738
• 22 Davis JW, Phillips PE, Yue KTN, Lewis HD, Hartman CR. Platelet aggregation. Adult-onset diabetes mellitus and coronary artery disease. JAMA 1978; 239: 732-734
• 23 Haanen C, Holdrinet A. Blood platelet aggregation under various conditions and in some diseases. Exp Biol Med 1968; 3: 164-174
• 24 Petersen HD, Gormsen J. Platelet aggregation in diabetes mellitus. Acta Med Scand 1978; 203: 125-130
• 25 Coller BS, Frank RN, Milton RC, Gralnick HR. Plasma cofactors of platelet function: correlation with diabetic retinopathy and hemoglobins A_1a-c . Ann Intern Med 1978; 88: 311-316
• 26 Colwell JA, Sagel J, Crook L, Chambers A, Laimins M. Correlation of platelet aggregation, plasma factor activity, and megathrombocytes in diabetic subjects with and without vascular disease. Metabolism 1977; 26: 279-285
• 27 Garg SK, Lackner H, Karpatkin S. The increased percentage of megathrombocytes in various clinical disorders. Ann Intern Med 1972; 77: 361-369
• 28 Doyle DJ, Chesterman CN, Cade JF, McGready JR, Rennie GC, Morgan FJ. Plasma concentrations of platelet-specific proteins correlated with platelet survival. Blood 1980; 55: 82-84
• 29 Kaplan KL, Owen J. Plasma levels of β-thromboglobulin and platelet factor 4 as indices of platelet activation in vivo. Blood 1981; 57: 199-202
• 30 Guzzo J, Niewiarowski S, Musial J, Bastl C, Grossman RA, Rao AK, Berman I, Paul D. Secreted platelet proteins with antiheparin and mitogenic activities in chronic renal failure. J Lab Clin Med 1980; 96: 102-113
• 31 Green D, Santhanam S, Krumlowsky FA, del GrecoF. Elevated β-thromboglobulin in patients with chronic renal failure: effect of hemodialysis. J Lab Clin Med 1980; 95: 679-685
• 32 Ludlam CA, Cash JD. Studies on the liberation of β-thromboglobulin from human platelets in vitro. Br J Haematol 1976; 33: 239-247
• 33 Preston FE, Ward JD, Marcola BH, Porter NR, Timperley WR, O’Malley BC. Elevated β-thromboglobulin levels and circulating platelet aggregates in diabetic microangiopathy. Lancet 1978; 1: 238-239
• 34 Borsey DQ, Dawes J, Fraser DM, Prowse CV, Elton RA, Clarke BF. Plasma beta-thromboglobulin in diabetes mellitus. Diabetologia 1980; 18: 353-357
• 35 Campbell IW, Dawes J, Fraser DM, Pepper DS, Clarke BF, Duncan LJP, Cash JD. Plasma β-thromboglobulin in diabetes mellitus. Diabetes 1977; 26: 1175-1177
• 36 Leading Article. Platelets, beta-thromboglobulin, and diabetes mellitus. Lancet 1978; 1: 250-251
• 37 Oost VanB A. Detection of platelet activation in thrombosis; development of new in vitro methods. Thesis, University of Utrecht 1981: 89-101
• 38 Gensini GF, Abbate R, Favilla S, Neri SemeriGG. Changes of platelet function and blood clotting in diabetes mellitus. Thromb Haemostas 1979; 42: 983-993
• 39 Lufkin EG, Fass DN, O’Fallon WM, Bowie EJW. Increased von Willebrand factor in diabetes mellitus. Metabolism 1979; 28: 63-66
• 40 Porta M, Townsend C, Clover GM, Nanson M, Alderson AR, McCraw A, Kohner EM. Evidence for functional endothelial cell damage in early diabetic retinopathy. Diabetologia 1981; 20: 597-601
• 41 Little HL, Sacks AH. Role of abnormal blood rheology in the pathogenesis of diabetic retinopathy. Trans Am Acad Ophthalmol Otolaryngol 1977; 82: 522-533
• 42 Cederholm-Williams SA, Doman TL, Turner RC. The metabolism of fibrinogen and plasminogen related to diabetic retinopathy in man. Eur J Clin Invest 1981; 11: 133-138