title: Increased plasma level of vascular endothelial glycoprotein thrombomodulin as an early indicator of endothelial damage in bone marrow transplantation.
abstract: We investigated the nature of hemostatic alterations occurring after bone marrow transplantation. In 45 patients, we evaluated the coagulation parameters, naturally occurring anticoagulants and thrombomodulin at days +15 and +22 after conditioning therapy. It was observed that endothelial cell damage is a central pathogenetic mechanism in some BMT complications. The increased plasma level of thrombomodulin after conditioning therapy is therefore discussed as a marker of endothelial cell injury. At day +15 a significant increase of fibrinogen from 276.1 mg/dI to 389.1 mg/dI was observed, while the natural anticoagulants all decreased significantly. Eleven patients with clinical complications related to endothelial damage had a significant thrombomodulin increase which, in uncomplicated patients, remained unchanged or resulted in lower than baseline values. Analysis of the data shows a strong correlation between clinical findings, reflecting endothelial cell injury and thrombomodulin increase when the increment is > or = 30%. We found a significant elevation in thrombomodulin in 70% of clinical complications related to endothelial cell damage namely: septicemia, GVHD, VOD. There were four cases (or 9%) of false positive data, and only two (or 4.5%) of false negative results. We therefore propose thrombomodulin assessment as a valid parameter to monitor chemotherapy toxicity-related complications.
authors.affiliation: Division of Clinical Pathology, BMT Center General Hospital, Cremona, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Testa
authors.forename: A
authors.initials: A
authors.lastname: Manna
authors.forename: A
authors.initials: A
authors.lastname: Porcellini
authors.forename: F
authors.initials: F
authors.lastname: Maffi
authors.forename: G
authors.initials: G
authors.lastname: Morstabilini
authors.forename: N
authors.initials: N
authors.lastname: Denti
authors.forename: S
authors.initials: S
authors.lastname: Macchi
authors.forename: G
authors.initials: G
authors.lastname: Rosti
authors.forename: G
authors.initials: G
authors.lastname: Porcellini
authors.forename: D
authors.initials: D
authors.lastname: Cassi
authors.forename: L
authors.initials: L
authors.lastname: Ferrari
mesh_terms: D000293:Adolescent; D000328:Adult; D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D004730:Endothelium, Vascular / Q000473:pathology*; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology; D006504:Hepatic Veno-Occlusive Disease / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D018180:Thrombomodulin / Q000097:blood*; D014409:Tumor Necrosis Factor-alpha / Q000502:physiology
chemical_list: D018180:Thrombomodulin; D014409:Tumor Necrosis Factor-alpha