Hemophilia: a cautionary status report

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endothelial activation status. 10 In general, Ang-1 stabilizes the endothelium and prevents microvascular leak, and its major sources are pericytes and platelets.Systemic serum or plasma levels of Ang-1 decline precipitously in severe sepsis, as reported previously and in the current study.1,10 Therefore, it seems entirely plausible that thrombocytopenia in sepsis could contribute to adverse clinical outcomes by decreasing the delivery of bioavailable Ang-1 to endothelium at risk.Overall, Claushuis et al have advanced the field by highlighting the importance of platelets in a large cohort of critically ill patients with clinical sepsis.This study was limited by the inability to demonstrate causality inherent to observational clinical studies and by somewhat limited generalizability due to inclusion of only one clinical site in the Netherlands.Further study is needed to identify potential interventions that may be of use in patients with low platelet counts at baseline, using animal models initially.It is unclear whether platelet transfusions or specific interventions to enhance platelet immune function or other innate immune mechanisms would be of value.However, the findings reported by Claushius et al clearly suggest that the roles of platelets in innate immunity, inflammation, and endothelial stabilization may be as clinically important and multifaceted as their role in hemostasis and thrombosis.Conflict-of-interest disclosure: W.C.L. is listed as co-inventor on a patent applied for by the University Health Network (Toronto, ON, Canada) to develop point-of-care tests for endothelial activation biomarkers in infectious diseases.S.M.G. declares no competing financial interests.

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