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A Point-of-Care Device for Diagnosis of Platelet Injury in Trauma Patients


OBJECTIVE: Develop a portable, point-of-care device that directly measures the platelet contribution to clot characteristics. DESCRIPTION: Hemorrhage, associated with trauma is one of the leading causes of preventable death on the modern battlefield. Posttraumatic hemostasis is often impaired by the rapid onset of coagulopathy which has been observed in up to 36% of trauma patients. Trauma-associated coagulopathy is indiscriminant and widely recognized to increase mortality and morbidity. A decrease in clot strength as measured by thrombelastography (TEG) has been identified as the earliest and most sensitive predictor of blood transfusion requirement and mortality in trauma patients. Clot strength, as defined by maximal amplitude by TEG and maximal clot firmness by rotational thromboelastometry is determined by the integrity of the fibrin network and the contractile force applied to this network by platelets. Unfortunately, TEG devices are neither rapid nor portable limiting their ability to reverse the rapidly evolving downward spiral that coagulopathic trauma patients face. This time lag to begin treatment of patients with severe trauma can mean the difference between life and death. Studies indicate that platelets become inhibited early during trauma as identified by a decrease in both light aggregation and reduced clot strength by TEG platelet mapping. These interactions are governed by the interaction between the platelet glycoprotein (GP) IIb/IIIa receptor and its specific binding to fibrin during clot formation and consolidation. However, the specific contribution of platelet GPIIb/IIIa-fibrin interactions to hemostasis during trauma is an important unanswered question. PHASE I: Determine the feasibility of establishing technical and scientific merit of platelet diagnostic technology. The feasibility studies are to determine the development of platelet microforce measurements as a new tool for the monitoring of antiplatelet therapy, and as an approach to define bleeding risk in trauma. These studies will also begin to define individual platelet receptor contributions to hemostasis during the critical early phase of traumatic injury and fluid resuscitation. PHASE II: Based on the Phase I feasibility study, develop, demonstrate and validate a laboratory prototype that enables direct and independent measurement of platelet micro forces thus providing more rapid and clinically-actionable information. This device should demonstrate capability for direct and independent measurement of platelet micro forces thus providing more rapid and clinically actionable information. PHASE III DUAL USE APPLICATIONS: The goal of the Phase III effort is transition to field operational use. Capability will be further matured to support/augment military operational medicine as well as transition to general, non-military emergency medicine. REFERENCES: 1. Hess et all (2008),"Department of Pathology, University of Maryland Medical Center, Baltimore, Maryland 21201, USA."2. Arinsburg et all (2012),"Determination of human platelet antigen typing by molecular methods: Importance in diagnosis and early treatment."3. Fries D. Martini (2010),"Role of fibrinogen in trauma-induced coagulopathy"Department of General and Surgical Critical Care Medicine, Innsbruck Medical University, Anichstrasse 35, Innsbruck, Austria. 4. Michael M. Sawyer,"Trauma and Thrombelastography", Denver Health and Hospital, 777 Bannock St, Denver, CO 80204, USA
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