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In circulation, platelets may come into contact with both exogenous (cardiac glycoside treatment) and endogenously produced inhibitors of Na+/K+-ATPase. We examined whether blocking of platelet Na+/K+-ATPase by ouabain results in generation of procoagulant activity. It was shown that an in vitro treatment of platelets with ouabain (20-200 µM for 20 to 60 min) is associated with an intracellular accumulation of sodium ([Na+]i), generation of a weak calcium signal, and expression of procoagulant activity. The ouabain-induced procoagulant response was dose- and time-related, less pronounced than that evoked by collagen and similar to that produced by gramicidin, not affected by EDTA or aspirin, and strongly reduced in the absence of extracellular Na+ or by hyperosmolality. Flow cytometry studies revealed that ouabain treatment results in a unimodal left shift in the forward and side scatter of the entire platelet population indicating morphological changes of the plasma membrane. The shift was dose related, weaker than that evoked by collagen and similar to that produced by gramicidin. Ouabain-treated platelets express phosphatidylserine (PS). The ouabain-evoked PS expression was dose- and time-dependent, weaker than that produced by collagen and similar to that evoked by gramicidin. Electronic cell sizing measurements showed a dose-dependent increase in mean platelet volume upon treatment with ouabain. Hypoosmotically-evoked platelet swelling resulted in the appearance of procoagulant activity. Thromboelastography measurements indicate that, in whole blood, nanomolar (50-1000 nM, 15 min) concentrations of ouabain significantly accelerate the rate of clot formation initiated by contact and high extracellular concentration of calcium. We conclude that inefficiently operating platelet Na+/K+-ATPase results in a rise in [Na+]i. An increase in [Na+]i and the swelling associated with it may produce PS exposure and a rise in membrane curvature leading to the generation of a procoagulant activity.
In the course of hyperbaric expositions divers undergo extremely stressful conditions. Insufficient compensatory mechanisms and/or inadequate procedure of decompression most frequently lead to the development of decompression sickness (DCS). The formation of gas bubbles in tissue is thought to be a key factor in the onset of DCS. However there are several reported cases of DCS in which gas bubbles could not be detected. Thus a predictive biochemical marker of increased risk of DCS is still much sought after. There is also no general agreement on the nature of reported changes in the number of circulating blood cells induced by diving and decompression. The aim of this study was to evaluate the effect of two different breathing mixtures used in simulated hyperbaric expositions on circulating blood cells and its predictive role in DCS risk assessment. 60 healthy divers underwent hyperbaric exposures at 0.7 MPa with 35 min plateau. 21 divers used air and the other group of 39 divers used trimix (pO2-0.04 MPa, pN2-0.08 MPa, pHe-0.71 MPa) as a breathing mixture. Total decompression time in both groups was 3 hours and 7 min. The following parameters were measured: erythrocyte, leukocyte, neutrophile, and platelet count, haematocrit, MPV, MCHC, MCV, CD61, CD62P expression on platelets, and microplatelets. Hyperbaric exposures and decompressions had a pronounced effect on platelets in the group using air as a breathing mixture contrary to the group using heliox as a breathing mixture where in fact the number of platelets decreased. There were also observed increased amounts of microplatelets in the group using air. CD62P expression in the air group increased after decompression whereas expression of CD61 was not affected in both groups of divers. We observed an increased number of leukocytes and neutrophiles in both groups of divers. Diving and decompression had no significant effect on the number of erythrocytes and their morphology in both groups. Conclusion: Measurements of platelet count, microplatelets as well as the expression of CD62P on platelets seem to be of importance in the assessment of the risk of DCS. The predictive role of the observed changes in leukocyte and neutrophile count after decompression should be further investigated.
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