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(Circulation. 1997;95:11-13.)
© 1997 American Heart Association, Inc.

Articles

Simply Read: Erythrocytes Modulate Platelet Function

Should We Rethink the Way We Give Aspirin?

Bianca Rocca, MD; Garret A. FitzGerald, MD

the Center for Experimental Therapeutics, University of Pennsylvania, Philadelphia, Pa.

Correspondence to Dr G.A. FitzGerald, Center for Experimental Therapeutics, 905 Stellar Chance Laboratories, University of Pennsylvania, 422 Curie Blvd, Philadelphia, PA 19014. E-mail garret@spirit.gcrc.upenn.edu.

Key Words: platelets • aspirin • erythrocytes • thrombosis • Editorials

	Introduction

 
The role of thrombosis in the precipitation of acute clinical syndromes of vascular occlusion, such as myocardial infarction and many strokes, is well established.¹ The sequence of plaque fissure, platelet activation, and superimposed thrombogenesis underlies the use of platelet inhibitors, such as aspirin, in the prevention and treatment of such cardiovascular diseases.^{2 3} Perhaps less well appreciated is the multicellular contribution to thrombogenesis. Among the pioneers of this concept is the group associated with Aaron Marcus.^{2 3} Not only have they drawn our attention to the presence of erythrocytes (RBCs) and polymorphonuclear leukocytes (PMNs) within the thrombus, but they have provided in vitro evidence for bidirectional modulation of platelet function by these cell types. Whereas PMNs appear to diminish the capacity of platelets to respond to agonists,⁴ RBCs appear to facilitate platelet activation.^{5 6} Marcus and colleagues^{7 8} also provided evidence to suggest that interactions among platelets, RBCs, and PMNs may also facilitate the transcellular metabolism of bioactive lipids to novel species. These may, in part, contribute to the functional consequences of such cellular interactions.⁹

Santos and colleagues¹⁰ have now extended their in vitro observations of RBC-platelet interactions into the clinical domain. Before we consider their contribution, which appears in the current issue of Circulation,¹⁰ it is worth providing the context for our present understanding of such phenomena. Almost 90 years ago, Duke¹¹ described measurement of the bleeding time in three patients with anemia and thrombocytopenia. Transfusion raised the platelet count and shortened their prolonged bleeding times to normal. Despite the subsequent decline of . . . [Full Text of this Article]

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