title: Diagnostic value of hemostatic parameters in bone marrow transplant-associated thrombotic microangiopathy.
abstract: 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.
authors.affiliation: First Department of Internal Medicine, Yokohama City University School of Medicine, Yokohama, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Kanamori
authors.forename: A
authors.initials: A
authors.lastname: Maruta
authors.forename: S
authors.initials: S
authors.lastname: Sasaki
authors.forename: E
authors.initials: E
authors.lastname: Yamazaki
authors.forename: S
authors.initials: S
authors.lastname: Ueda
authors.forename: K
authors.initials: K
authors.lastname: Katoh
authors.forename: T
authors.initials: T
authors.lastname: Tamura
authors.forename: M
authors.initials: M
authors.lastname: Otsuka-Aoba
authors.forename: J
authors.initials: J
authors.lastname: Taguchi
authors.forename: H
authors.initials: H
authors.lastname: Harano
authors.forename: K
authors.initials: K
authors.lastname: Ogawa
authors.forename: H
authors.initials: H
authors.lastname: Mohri
authors.forename: T
authors.initials: T
authors.lastname: Okubo
authors.forename: M
authors.initials: M
authors.lastname: Matsuzaki
authors.forename: S
authors.initials: S
authors.lastname: Watanabe
authors.forename: H
authors.initials: H
authors.lastname: Koharazawa
authors.forename: H
authors.initials: H
authors.lastname: Fujita
authors.forename: F
authors.initials: F
authors.lastname: Kodama
mesh_terms: 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