Multiplate® Analizör: Güvenilir sonuçlar için kullanımı kolay modern bir cihaz…

Multiplate® Analizör: Güvenilir sonuçlar için kullanımı kolay modern bir cihaz…

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  Tam kandan platelet fonksiyonun hassas analizi
  
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  Örnek hazırlama yok
  
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  Paralel ölçümler için 5 test kanalı
  
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  Elektronik ve likit kalite kontrolleri
  

Multiplate ® , piyasada 500’den fazla kurulum ile en yaygın olarak kullanılan platelet fonksiyon analizörleri arasında yer almaktadır. Multiplate ’in interaktif kullanıcı desteği, elektronik pipet ve kullanımı kolay yazılımı ile rutin laboratuarlarda uygulamasının yanı sıra hasta başı kullanımına da olanak sağlar.
Araştırma uygulamaları için, test yöntemleri özelleştirilebilir. (açık sistem)
Multiplate ®,Windows XP tabanlı bir bilgisayarla birleştirilmiş kompakt bir sistemdir (30 x 47 x 10 cm)

Tek kullanımlık test cell

Multiplate® sistemde reaksiyon test cell içinde gerçekleşmektedir. Test cell , iki adet sensör ve teflon (PTFE) kaplamalı magnet karıştırıcıyla birleştirilmiş ve tek kullanımlık olarak dizayn edilmiştir Yani bu sistemde; bir analizde, iki eş zamanlı ölçümün karşılaştırılarak  yapılmasıyla otomatik kalite kontrolü sağlanmış olur (“multiple electrode aggregometry” = MEA).

Sensör teller gümüş kaplıdır. Aktive olan plateletler sensör tellerin üzerine yapıştığında, teller arasındaki elektriksel direnç artar ve bu direnç sistem tarafından düzenli olarak kaydedilir.

Cardinal ve Flower tarafından geliştirilen ve 1980’lerden beri kullanılan impedans agregometre yöntemi tam kandan platelet fonksiyonlarının değerlendirmesinde kullanılır.

Impedans agregometre yöntemi plateletlerin dinlenme aşamasında trombojenik olmaması, fakat aktive olduklarında yüzeylerinde damar çeperleri ve yapay yüzeylerine tutunmalarını sağlayan reseptörler ortaya çıkarmaları prensibine dayanır.

Plateletler, Multiplate test küvetlerindeki sensör tellerine bağlandıklarında teller arasında sürekli olarak kaydedilen direnci artırırlar. Teller arasındaki bu direncin artması için plateletlerin sıkı bir şekilde bağlanması gerekmektedir.

Multiplate cihazının Born agregometresi ve platelet sayımından en önemli farkı, agregasyonun yüzeyler üzerinde olmasıdır. Born agregometresi ve platelet sayımında plateletler yüzeyde değil, sıvı faz içerisinde agregasyona uğrarlar. Bu muhtemelen sadece ağır hastalarda  (örneğin; HIT tip II ve DIC gibi) gerçekleşirken, koagülasyon ve platelet agregasyonu in-vivoda genellikle yüzeylerin üzerinde (vasküler hasarlar  / inflamed vessels / atheromatous plaklar)   gerçekleşmektedir.



Multiplate® Testler:

ADPtest: ADP’nin indüklediği platelet aktivasyonu, klopidogrel, prasugrel ve diğer ADP reseptör antagonistlerine hassastır.

ADPtest HS: ADPtest HS(yüksek hassasiyet). ADP ve Prostaglandin E1’in birlikte uyardığı platelet agregasyonudur. Özellikle heparinize kandaki klopidogrel tespitine hassastır.

ASPItest: Siklooksijenaza bağlı agregasyon (araşidonik asit kullanımıyla), Aspirin®’ne hassas, NSAID’ler ve diğer platelet siklooksijenaz inhibitörlerine hassastır.

TRAPtest: Trombin reseptör (TRAP-6 kullanımıyla) yolu ile platelet uyarılması, IIb/IIIa reseptor antagonistlerine hassastır.

COLtest: Kollajenin indükleği agregasyon.

RISTOtest: vWF ve GpIb’ye bağlı agregasyon (ristocetin’in agonist olarak kullanımıyla).

Kontrol Materyalleri: ASA Kontrol (In vitro analizler için Aspirin®), GpIIbIIIa antagonist (In vitro analizler için), likit kalite kontrol kiti.

Hirudin kan alma tüpleri: Kanda direkt trombin inhibisyonu sağlayan rekombinant hirudin antikoagülanı; fizyolojik kalsiyum konsantrasyonları altında platelet fonksiyon analizine imkan sağlar.

Multiplate® plateletlerin agregasyonunu sürekli olarak kaydeder. Multiplate sensörlerine yapışan trombositler sayesinde artan impedans, agregasyon birimi (AU)’ya çevrilir ve zamana karşı bir grafik oluşturulur. Diğer platelet fonksiyon analizörlerinin aksine  Multiplate®’in ekran görüntüleri ve dökümanları kullanıcıya, platelet fonksiyonunun kalitatif bir değerlendirmesini ve görsel inandırıcılığının kontrolünü sağlar.

Üç değişik parametre hesaplanır: En önemli parametre eğrinin altında kalan alan (AUC) dir. AUC değeri agregasyon eğrisinin toplam yüksekliğinden olduğu kadar eğiminden de etkilenir ve genel trombosit durumunu ölçmek için en uygun parametredir. Araştırma çalışmaları için iki parametre daha hesaplanmaktadır; total agregasyon ve agregasyon eğrisinin hızı.

TRAPtest Trombin reseptörü  tetikler. (IIb/IIIa antagonistlerine hassastır) . Aspirin’in indüklediği siklooksijenaz inhibisyonuna duyarlı değildir, klopidogrel gibi ADP reseptör inhibitörleri çok az hassasiyeti vardır.

ASPItest Aspirin’e hassasiyeti yüksektir ancak klopidogrel gibi ADP reseptör inhibisyonundan etkilenmez.

ADPtest ADP reseptör inhibitörlerine hassastır ancak siklooksigenaz inhibisyonundan etkilenmez.

ADPtest HS Prostaglandin E1 ilavesiyle Klopidogrel’e artmış hassasiyet, özellikle heparinli kan analizinde kullanılır.

RISTOtest Multiplate’e özgü bir testtir ve vWF bozukluklarına karşı hassastır.

"Platelet hyperreactivity in MEA might be a better risk predictor for stent thrombosis than the assessment of the specific clopidogrel effect with the VASP assay."

Jolanta M. Siller-Matula MD et al, Department of Clinical Pharmacology, Medical University of Vienna, Austria

"On-site testing of clopidogrel-related platelet inhibition by impedance aggregometry in neurointerventional radiology is feasible. … Near-patient testing of platelet inhibition before neurointerventional stent placement seems reasonable to adjust the antiplatelet protocol individually if required and has the potential to reduce the thromboembolic complications in interventional neuroradiology.“

Müller-Schunk S, Linn J, Peters N, Spannagl M, Deisenberg M, Brückmann H, Mayer TE. Monitoring of clopidogrel-related platelet inhibition: correlation of nonresponse with clinical outcome in supra-aortic stenting. AJNR Am J Neuroradiol. 2008 Apr;29(4):786-91.

“The Multiplate Analyzer ASPItest is highly sensitive towards aspirin, easy to handle, non-expensive and the tests are reproducible.“

Steinlechner B. et al, Division of Cardiothoracic and Vascular Anesthesia, University Hospital Vienna, Vienna, Austria: Anesthesiology 2007; 107: A1724

".. the Multiplate has a number of user-friendly characteristics: it is semi-automated, needs no preparation of platelet-rich plasma and performs a dual measurement as internal control. In addition, it is also patient-friendly since only 1.2 ml of whole blood is required for the analysis of four agonists.. A good sensitivity for the detection of low aspirin and clopidogrel responders was observed.." Multiplate whole blood impedance aggregometry: A recent experience.

Jaimie Breugelmans, Francine Vertessen, Gerhard Mertens, Alain Gadisseur, Marc Van der Planken. Thrombosis and Haemostasis 2008 100 4: 725-726.

“Patients requiring postoperative blood transfusion showed lower preoperative ADP-mediated aggregometry compared with nontransfused patients…“

Mengistu AM, Wolf MW, Boldt J, Röhm KD, Lang J, Piper SN. Evaluation of a new platelet function analyzer in cardiac surgery: a comparison of modified thromboelastography and whole-blood aggregometry. J Cardiothorac Vasc Anesth. 2008 Feb;22(1):40-6.

“MEA is capable of detecting the effect of clopidogrel treatment and the results of MEA, prior to, and after clopidogrel treatment, correlate well with LTA. No centrifugation steps are needed for MEA and assessment of platelet aggregation can be done in approximately 10 min.“

Sibbing D, Braun S, Jawansky S, Vogt W, Mehilli J, Schömig A, Kastrati A, von Beckerath N. Division of Cardiology, German Heart Center in Munich, Munich, Germany; Eur Heart J. 2008 Jun; 29(12):1504-9

“Multiplate uses anticoagulated whole blood for analysis. Whole blood is the physiological environment where platelet function takes place in vivo, and the use of whole blood for in vitro testing eliminates the need for time-consuming centrifugation steps required for Born aggregation measurements.“

Görlinger K., Jambor C., Ha nke A.A., Dirkmann D., Adamzik M., Hartmann M., Rahe-Meyer N., Perioperative Coagulation Management and Control of Platelet Transfusion by Point-of-Care Platelet Function Analysis; Transfus Med Hemother 2007;34:396–411

“Since hirudin and other direct acting thrombin inhibitors do not reduce the concentration of divalent cations in plasma, these can be considered to provide a more physiological environment than the use of sodium citrate.“

Andrew Johnson, Natalia Dovlatova, Stan Heptinstall. Cardiovascular Medicine, University of Nottingham, Nottingham, UK. Multiple electrode aggregometry and P2Y12 antagonists. Thromb Haemost. 2008 Jun;99(6):1127-9

“Low response to aspirin is associated with an increase of PCI-related myocardial infarction and combined low response to aspirin and clopidogrel increase the risk for 6-month major adverse cardiac events.”

P. Eshtehardi, S. Windecker, O.M. Hess, S. Cook, M. Billinger, M. Togni, R. Vogel, C. Seiler, B. Meier, P. Wenaweser. Department of Cardiology, Swiss Cardiovascular Center Bern, University Hospital, Bern, Switzerland; European Heart Journal 2008 29 (Abstract Supplement), 832.

“In conclusion, MEA is a fast, convenient platelet-function testing method which enables to measure aggregation in whole diluted blood, with very convergent results to those obtained by single platelet counting.“

Tóth O., Calatzis A., Penz S., Losonczy H, Siess W. Institute for Prevention of Cardiovascular Diseases, University of Munich, Munich, Germany. Thromb Haemost. 2006 Dec;96(6):781-8

Full papers, short communications

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  Jolanta M. Siller-Matula MD, Guenter Christ MD, Irene M. Lang MD, Georg Delle-Karth MD, Kurt Huber MD, Bernd Jilma MD. Multiple Electrode Aggregometry better predicts stent thrombosis than the VASP assay. Journal of Thrombosis and Haemostasis, Nov 2009.
  

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  D. Bollinger, M.D.Seeberger, K.A. Tanaka,S. Dell-Kuster, M. Gregor, U. Zenklusen, M. Grapow, D.A. Tsakiris, M. Filipovic. Pre-analytical effects of pneumatic tube transport on impedance platelet aggregometry. Platelets, Nov 2009; 20(7); 458 - 465
  

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  Paniccia R, Antonucci E, Maggini N, Romano E, Gori AM, Marcucci R, Prisco D, Abbate R. Assessment of platelet function on whole blood by multiple electrode aggregometry in high-risk patients with coronary artery disease receiving antiplatelet therapy. Am J Clin Pathol. 2009 Jun;131(6):834-42.
  

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  Velik-Salchner C, Maier S, Innerhofer P, Kolbitsch C, Streif W, Mittermayr M, Praxmarer M, Fries D. An assessment of cardiopulmonary bypass-induced changes in platelet function using whole blood and classical light transmission aggregometry: the results of a pilot study. Anesth Analg. 2009 Jun;108(6):1747-54.
  

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  Siller-Matula J, Christ G, Lang IM, Delle-Karth G, Huber K, Jilma B. Comparison of Platelet Aggregometry and the VASP Assay for the Prediction of Stent Thrombosis. J Kardiol 2009; 19 (5–6) 192
  

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  Jilma-Stohlawetz P, Eichelberger B, Horvath M, Jilma B, Panzer S. In vitro platelet function of platelet concentrates prepared using three different apheresis devices determined by impedance and optical aggregometry. Transfusion. 2009 Apr 17
  

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  Jámbor C, Weber CF, Gerhardt K, Dietrich W, Spannagl M, Heindl B, Zwissler B. Whole Blood Multiple Electrode Aggregometry is a Reliable Point-of-Care Test of Aspirin-Induced Platelet Dysfunction. Anesth Analg. 2009 May 13.
  

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  Sibbing D, Morath T, Stegherr J, Braun S, Vogt W, Hadamitzky M, Schömig A, Kastrati A, von Beckerath N. Impact of proton pump inhibitors on the antiplatelet effects of clopidogrel. Thromb Haemost. 2009 Apr;101(4):714-9.
  

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  Sibbing D, Braun S, Morath T, Mehilli J, Vogt W, Schömig A, Kastrati A, von Beckerath N. Platelet Reactivity After Clopidogrel Treatment Assessed With Point-of-Care Analysis and Early Drug-Eluting Stent Thrombosis. J. Am. Coll. Cardiol. 2009;53;849-856
  

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  Scharbert G, Auer A, Kozek-Langenecker S. Evaluation of the Platelet Mapping Assay on rotational thromboelastometry ROTEM. Platelets 2009 Mar;20(2):125-30.
  

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  Rahe-Meyer N, Winterhalter M, Boden A, Froemke C, Piepenbrock S, Calatzis A, Solomon C. Platelet concentrates transfusion in cardiac surgery and platelet function assessment by multiple electrode aggregometry. Acta Anaesthesiol Scand. 2009 Feb;53(2):168-75.
  

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  Kalb ML, Potura L, Scharbert G, Kozek-Langenecker SA. The effect of ex vivo anticoagulants on whole blood platelet aggregation. Platelets 2009 Feb;20(1):7-11.
  

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  Siller-Matula JM, Spiel AO, Lang I, Kreiner G, Christ G, Jilma B. Effects of pantoprazole and esomeprazole on platelet inhibition by clopidogrel. American heart journal, Jan 2009
  

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  Boldt J, Suttner S, Brosch C, Lehmann A, Mengistu A. Influence on coagulation of a potato-derived hydroxethylstarch (HES 130/0.42) and a maize-derived hydroxethylstarch (HES 130/0.4) in patients undergoing cardiac surgery. British Journal of Anaesthesia, doi:10.1093/bja/aen353. Published online on December 10, 2008.
  

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  Steinlechner B, Dworschak M, Birkenberg B, Duris M, Zeidler P, Fischer H, Milosevic L, Wieselthaler G, Wolner E, Quehenberger P, Jilma B. Platelet dysfunction in outpatients with left ventricular assist devices. Ann Thorac Surg. 2009 Jan;87(1):131-7.
  

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  Jámbor C, Weber CF, Lau A, Spannagl M, Zwissler B. Multiple electrode aggregometry for ex-vivo detection of the anti-platelet effect of non-opioid analgesic drugs. Thrombosis and Haemostasis, Jan 2009
  

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  Skoric B, Milicic D, Lovric D, Gornik I, Skoric KN, Sertic J. Initial patency of the infarct-related artery in patients with acute ST elevation myocardial infarction is related to platelet response to aspirin. Int J Cardiol. 2008 Nov 29.
  

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  Velik-Salchner C, Maier S, Innerhofer P, Streif W, Klingler A, Kolbitsch C, Fries D. Point-of-care whole blood impedance aggregometry versus classical light transmission aggregometry for detecting aspirin and clopidogrel: the results of a pilot study. Anesth Analg. 2008 Dec;107(6):1798-806.
  

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  Rahe-Meyer N, Winterhalter M, Hartmann J, Pattison A, Hecker H, Calatzis A, Solomon C. An evaluation of cyclooxygenase-1 inhibition before coronary artery surgery: aggregometry versus patient self-reporting. Anesth Analg. 2008 Dec;107(6):1791-7.
  

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  Siller-Matula JM, Lang I, Christ G, Jilma B. Calcium-channel blockers reduce the antiplatelet effect of clopidogrel. J Am Coll Cardiol. 2008 Nov 4;52(19):1557-63.
  

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  Ibrahim K, Hass N, Kolschmann S, Strasser RH, Braun-Dullaeus RC. Reversible clopidogrel resistance due to right ventricular myocardial infarction: risk factor of recurrent stent thrombosis? Clin Res Cardiol. 2008 Nov;97(11):797-800.
  

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  Breugelmans J, Vertessen F, Mertens G, Gadisseur A, Van der Planken M. Multiplate whole blood impedance aggregometry: a recent experience. Thromb Haemost. 2008 Oct;100(4):725-6.
  

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  Johnson A, Dovlatova N, Heptinstall S. Multiple electrode aggregometry and P2Y(12) antagonists. Thromb Haemost. 2008 Jun;99(6):1127-9.
  

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  Schulz C, Penz S, Hoffmann C, Langer H, Gillitzer A, Schneider S, Brandl R, Seidl S, Massberg S, Pichler B, Kremmer E, Stellos K, Schönberger T, Siess W, Gawaz M. Platelet GPVI binds to collagenous structures in the core region of human atheromatous plaque and is critical for atheroprogression in vivo. Basic Res Cardiol. 2008 Jul;103(4):356-67.
  

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  Görlinger K, Jambor C, Dirkmann D, Dusse F, Hanke A, Adamzik M, Hartmann M, Philipp S, Weber AA, Rahe-Meyer N. [Platelet Function Analysis with Point-of-Care Methods.] Herz. 2008 Jun;33(4):297-305.
  

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  Sibbing D, Busch G, Braun S, Jawansky S, Schömig A, Kastrati A, Ott I, von Beckerath N. Impact of bivalirudin or unfractionated heparin on platelet aggregation in patients pretreated with 600 mg clopidogrel undergoing elective percutaneous coronary intervention. Eur Heart J. 2008 Jun;29(12):1504-9.
  

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  Kirkeby A, Torup L, Bochsen L, Kjalke M, Abel K, Theilgaard-Monch K, Johansson PI, Bjørn SE, Gerwien J, Leist M. High-dose erythropoietin alters platelet reactivity and bleeding time in rodents in contrast to the neuroprotective variant carbamyl-erythropoietin (CEPO). Thromb Haemost. 2008 Apr;99(4):720-8.
  

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  Seibel K, Berdat P, Boillat C, Wagner B, Zachariou Z, Kessler U. Hemostasis management in pediatric mechanical circulatory support. Ann Thorac Surg. 2008 Apr;85(4):1453-6.
  

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  Müller-Schunk S, Linn J, Peters N, Spannagl M, Deisenberg M, Brückmann H, Mayer TE. Monitoring of clopidogrel-related platelet inhibition: correlation of nonresponse with clinical outcome in supra-aortic stenting. AJNR Am J Neuroradiol. 2008 Apr;29(4):786-91.
  

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  Mengistu AM, Wolf MW, Boldt J, Röhm KD, Lang J, Piper SN. Evaluation of a new platelet function analyzer in cardiac surgery: a comparison of modified thromboelastography and whole-blood aggregometry. J Cardiothorac Vasc Anesth. 2008 Feb;22(1):40-6.
  

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  Sibbing D, Braun S, Jawansky S, Vogt W, Mehilli J, Schömig A, Kastrati A, von Beckerath N. Assessment of ADP-induced platelet aggregation with light transmission aggregometry and multiple electrode platelet aggregometry before and after clopidogrel treatment. Thromb Haemost. 2008 Jan;99(1):121-6.
  

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  Scharbert G, Gebhardt K, Sow Z, Duris M, Deusch E, Kozek-Langenecker S. Point-of-care platelet function tests: detection of platelet inhibition induced by nonopioid analgesic drugs. Blood Coagul Fibrinolysis. 2007 Dec;18(8):775-80.
  

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  Görlinger K., Jambor C., Hanke A.A., Dirkmann D., Adamzik M., Hartmann M., Rahe-Meyer N., Perioperative Coagulation Management and Control of Platelet Transfusion by Point-of-Care Platelet Function Analysis; Transfus Med Hemother 2007;34:396–411.
  

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  Scharbert G, Kalb ML, Duris M, Marschalek C, Kozek-Langenecker SA. Garlic at dietary doses does not impair platelet function. Anesth Analg. 2007 Nov;105(5):1214-8.
  

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  von Pape KW, Dzijan-Horn M, Bohner J, Spannagl M, Weisser H, Calatzis A. [Control of aspirin effect in chronic cardiovascular patients using two whole blood platelet function assays. PFA-100 and Multiplate] Hamostaseologie. 2007 Aug;27(3):155-60.
  

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  Bergmann L, Kienbaum P, Görlinger K, Peters J.; Uneventful removal of an epidural catheter guided by impedance aggregometry in a patient with recent coronary stenting and treated with clopidogrel and acetylsalicylic acid.; Reg Anesth Pain Med. 2007 Jul-Aug;32(4):354-7
  

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  Seyfert UT, Haubelt H, Vogt A, Hellstern P. Variables influencing Multiplate(TM) whole blood impedance platelet aggregometry and turbidimetric platelet aggregation in healthy individuals. Platelets. 2007 May;18(3):199-206.
  

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  Penz SM, Reininger AJ, Toth O, Deckmyn H, Brandl R, Siess W. Glycoprotein Ibalpha inhibition and ADP receptor antagonists, but not aspirin, reduce platelet thrombus formation in flowing blood exposed to atherosclerotic plaques. Thromb Haemost. 2007 Mar;97(3):435-43.
  

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  Mueller T, Dieplinger B, Poelz W, Calatzis A, Haltmayer M. Utility of whole blood impedance aggregometry for the assessment of clopidogrel action using the novel Multiplate analyzer--comparison with two flow cytometric methods. Thromb Res. 2007;121(2):249-58.
  

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  Boldt J, Wolf M, Mengistu A. A new plasma-adapted hydroxyethylstarch preparation: in vitro coagulation studies using thrombelastography and whole blood aggregometry. Anesth Analg. 2007 Feb;104(2):425-30.
  

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  Tóth O, Calatzis A, Penz S, Losonczy H, Siess W. Multiple electrode aggregometry: a new device to measure platelet aggregation in whole blood. Thromb Haemost. 2006 Dec;96(6):781-8.
  

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  Scharbert G, Kalb M, Marschalek C, Kozek-Langenecker SA. The effects of test temperature and storage temperature on platelet aggregation: a whole blood in vitro study. Anesth Analg. 2006 Apr;102(4):1280-4.
  

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  Calatzis A, Wittwer M, Krueger B: A new approach to platelet function analysis in whole blood – The Multiplate Analyzer. Platelets 2004, 15(8), 485-486.