Diagnostic value of hemostatic parameters in bone marrow transplant-associated thrombotic microangiopathy

被引:38
作者
Kanamori, H
Maruta, A
Sasaki, S
Yamazaki, E
Ueda, S
Katoh, K
Tamura, T
Otsuka-Aoba, M
Taguchi, J
Harano, H
Ogawa, K
Mohri, H
Okubo, T
Matsuzaki, M
Watanabe, S
Koharazawa, H
Fujita, H
Kodama, F
机构
[1] Yokohama City Univ, Sch Med, Dept Internal Med 1, Kanazawa Ku, Yokohama, Kanagawa 236, Japan
[2] Kanagawa Canc Ctr, Dept Hematol Chemotherapy, Yokohama, Kanagawa, Japan
[3] Yokohama City Univ Hosp, Div Blood Transfus, Yokohama, Kanagawa, Japan
[4] Yokohama City Univ Hosp, Div Lab Med, Yokohama, Kanagawa, Japan
关键词
bone marrow transplantation; thrombotic microangiopathy; hemostatic parameters; thrombomodulin; endothelial injury;
D O I
10.1038/sj.bmt.1701151
中图分类号
Q6 [生物物理学];
学科分类号
071011 ;
摘要
We investigated hemostatic parameters in a prospective study of 16 patients who received bone marrow transplants (BMT), We found a significant rise in the levels of fibrinogen, plasmin-cr, antiplasmin inhibitor complex, tissue-plasminogen activator.plasminogen activator inhibitor complex (t-PA.PAI), von Willebrand factor antigen, and thrombomodulin on day 14 after transplant compared with values before transplant. Protein C and thrombin-antithrombin III levels did not change significantly. No significant changes in prothrombin time ratio, activated partial thromboplastin time, or protein S Here detected, Patients who had grades II-IV graft-versus-host disease (GVHD) (n = 6) showed a significantly higher level of t-PA.PAI on day 14 compared with those with grades 0-I GVHD (n = 10) (P = 0.0062), Three patients with grades II-IV GVHD developed thrombotic microangiopathy (TMA) on days 19, 19 and 62. In these patients, we noted significantly lower levels of fibrinogen (P = 0.0383), and significantly higher le, els of t-PA PAI (P = 0.0008) and thrombomodulin (P = 0.0001) on day 14 compared with those patients who did not develop TMA. These results suggest that prothrombotic states and endothelial damage may be caused by the conditioning regimen and/or acute GVHD during BRIT; thrombomodulin values on day 14 post BAIT may be useful in surveillance for TMA because of endothelial cell injury.
引用
收藏
页码:705 / 709
页数:5
相关论文
共 26 条
[1]   TREATMENT OF MALIGNANT-LYMPHOMA IN 100 PATIENTS WITH CHEMOTHERAPY, TOTAL-BODY IRRADIATION, AND MARROW TRANSPLANTATION [J].
APPELBAUM, FR ;
SULLIVAN, KM ;
BUCKNER, CD ;
CLIFT, RA ;
DEEG, HJ ;
FEFER, A ;
HILL, R ;
MORTIMER, J ;
NEIMAN, PE ;
SANDERS, JE ;
SINGER, J ;
STEWART, P ;
STORB, R ;
THOMAS, ED .
JOURNAL OF CLINICAL ONCOLOGY, 1987, 5 (09) :1340-1347
[2]  
FAIONI EM, 1993, BLOOD, V81, P3458
[3]  
FORMAN SJ, 1994, BLOOD, V83, P2392
[4]  
GHARPURE VS, 1995, BONE MARROW TRANSPL, V16, P715
[5]  
GORDON BG, 1993, BONE MARROW TRANSPL, V11, P61
[6]  
HARPER PL, 1990, BONE MARROW TRANSPL, V5, P39
[7]  
HOLLER E, 1989, BLOOD, V73, P2018
[8]  
ISHII H, 1991, THROMB HAEMOSTASIS, V65, P618
[9]   VENOOCCLUSIVE DISEASE OF THE LIVER FOLLOWING BONE-MARROW TRANSPLANTATION [J].
JONES, RJ ;
LEE, KSK ;
BESCHORNER, WE ;
VOGEL, VG ;
GROCHOW, LB ;
BRAINE, HG ;
VOGELSANG, GB ;
SENSENBRENNER, LL ;
SANTOS, GW ;
SARAL, R .
TRANSPLANTATION, 1987, 44 (06) :778-783
[10]   MICROANGIOPATHY FOLLOWING ALLOGENEIC MARROW TRANSPLANTATION - ASSOCIATION WITH CYCLOSPORINE AND METHYLPREDNISOLONE FOR GRAFT-VERSUS-HOST DISEASE PROPHYLAXIS [J].
KALHS, P ;
BRUGGER, S ;
SCHWARZINGER, I ;
GREINIX, HT ;
KEIL, F ;
KYRLE, PA ;
KNOBL, P ;
SCHNEIDER, B ;
HOCKER, P ;
LINKESCH, W ;
LECHNER, K .
TRANSPLANTATION, 1995, 60 (09) :949-957