Diagnostic value of hemostatic parameters in bone marrow transplant-associated thrombotic microangiopathy.
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-alpha2 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 were 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 levels 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 BMT; thrombomodulin values on day 14 post BMT may be useful in surveillance for TMA because of endothelial cell injury.
Kanamori
H
H
First Department of Internal Medicine, Yokohama City University School of Medicine, Yokohama, Japan.
Maruta
A
A
Sasaki
S
S
Yamazaki
E
E
Ueda
S
S
Katoh
K
K
Tamura
T
T
Otsuka-Aoba
M
M
Taguchi
J
J
Harano
H
H
Ogawa
K
K
Mohri
H
H
Okubo
T
T
Matsuzaki
M
M
Watanabe
S
S
Koharazawa
H
H
Fujita
H
H
Kodama
F
F
D000293:Adolescent; D000328:Adult; D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D005260:Female; D006487:Hemostasis; D006801:Humans; D008297:Male; D008833:Microcirculation / Q000473:pathology*; D008875:Middle Aged; D011237:Predictive Value of Tests; D013927:Thrombosis / Q000097:blood / Q000175:diagnosis* / Q000209:etiology