von Willebrand factor as a marker of endothelial cell activation following BMT.
Endothelial cell activation may play a role in thrombotic complications of BMT such as hepatic veno-occlusive disease (VOD), right atrial line thrombosis and microangiopathic haemolysis. To assess this, von Willebrand factor antigen (vWF:ag) was measured in 72 patients (25 allografts, 46 autografts and one syngeneic) during the first 6 weeks post-transplant. There was a significant rise in vWF:ag in both allografts and autografts but a greater increase was seen in the allografts. The changes in vWF:ag did not correlate with changes in C reactive protein showing that this was not merely an acute phase response. vWF multimers were normal in a subgroup of uncomplicated transplants showing that there was no large scale endothelial cell disruption. Patients with VOD did not have changes in vWF:ag that were consistently different from uncomplicated controls. Three of four patients who developed line thrombosis had higher levels of vWF:ag compared with control groups; multimeric structure of the vWF was again normal. These results show that there is endothelial cell activation post-BMT and that this is greater in allografts compared with autografts, thus suggesting a possible mechanism for the higher incidence of VOD in this group. There were no useful predictive markers of VOD or thrombosis in individual patients.
Collins
P W
PW
Department of Haematology, Royal London Hospital, UK.
Gutteridge
C N
CN
O'Driscoll
A
A
Blair
S
S
Jones
L
L
Aitchison
R
R
Kelsey
S M
SM
Chopra
R
R
Goldstone
A
A
Newland
A C
AC
D000293:Adolescent; D000328:Adult; D000743:Anemia, Hemolytic / Q000209:etiology; D015415:Biomarkers / Q000097:blood; D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D004730:Endothelium, Vascular / Q000378:metabolism*; D005260:Female; D006504:Hepatic Veno-Occlusive Disease / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D013927:Thrombosis / Q000209:etiology; D013997:Time Factors; D014841:von Willebrand Factor / Q000378:metabolism*
D015415:Biomarkers; D014841:von Willebrand Factor