Changes in and prognostic value of platelet parameters in wounded with polytrauma

BACKGROUND: Polytrauma as a manifestation of combat surgical trauma is one of the pressing problems of modern military medicine. Given the new data on the role of the platelet component of hematopoiesis in the development of hemorrhagic syndrome, in predicting outcomes and complications in various diseases, there is an urgent need to analyze the quantitative and functional parameters of circulating platelets in traumatic disease. AIM: To assess the dynamics of platelet parameters in wounded with polytrauma, as well as its diagnostic and prognostic significance. METHODS: The total number of platelets, plateletcrit, mean platelet volume, platelet distribution width, and the percentage of large platelets were recorded using the Medonic 630 Thor hematology analyzer (Boule Medical AB, Sweden). The severity of injuries was assessed using the “military field surgery—admission status” and “military field surgery—injury (gunshot wound)” scales, as well as the Baker trauma severity score. The risk of developing secondary venous thromboembolic complications was assessed using the Caprini score. RESULTS: Polytrauma was found to be associated with consistent dynamic changes in platelet parameters, which can be considered prognostic factors for a fatal outcome. In wounded with a favorable prognosis, the total number of platelets increased by more than fourfold by day 20 after the injury. At the same time, with a 2-fold increase in plateletcrit, the mean platelet volume and the platelet distribution width decreased 1.3-fold and 1.2-fold, respectively, which reflects the reactivity of thrombopoiesis and the functional activity of circulating platelets. In the group of wounded with a fatal outcome, the severity and nature of the dynamics of platelet parameters were reversed. Predictors of a fatal outcome in wounded with polytrauma included a decrease in the total number of platelets and plateletcrit to less than 225.1 × 10³/μL and 0.2%, respectively, as well as an increase in mean platelet volume to more than 8.3 fL, platelet distribution width to more than 17.1%, and the percentage of large platelets to more than 38.1%. CONCLUSION: A favorable prognosis in patients with polytrauma is determined by an initially normal level of circulating platelets, followed by a significant increase in their number and functional activity up to day 20 after the injury. An unfavorable prognosis in patients with polytrauma is associated with the worsening of the initially present thrombocytopenia and a decrease in the functional activity of circulating platelets throughout all stages of traumatic disease.