title: Coagulation changes in individuals with sickle cell trait.
abstract: Sickle cell disorders, such as Hb SS and Hb SC, are associated with a hypercoagulable state that may contribute to the vaso-occlusive episodes observed in the disorders. To what extent increased coagulation activity occurs in individuals with sickle cell trait has had limited study. Because such information may help clarify clinical and pathologic findings that may occur in these individuals and may be useful in clarifying the hypercoagulable state in sickle cell disease, we have examined individuals with Hb AS to determine the extent that increased coagulation activity does occur. We measured d-dimers, thrombin-antithrombin (TAT) complexes, prothrombin fragment 1.2 (F1.2), absolute blood monocyte levels, proteins C and S, and isotypes of antiphospholipid antibodies in individuals with Hb AS and in matched controls (Hb AA). Results showed that d-dimers, TAT, and F1.2 were increased significantly above normal levels. Absolute blood monocyte levels were increased. The d-dimers, TAT, F1.2, and monocyte counts showed significant increasing trends through groups of increasing severity (Hb AA, Hb AS, Hb SC, and Hb SS). Our study shows that individuals with Hb AS have increased coagulation activity, with d-dimers, TAT, and F1.2 being consistent indicators. The measures of coagulation activity in Hb AS are lower than in patients with Hb SC and Hb SS disease. These results extend our previous observation that the degree of coagulation activation parallels the degree of disease severity among sickle cell genotypes. The findings suggest that monocytosis, with the possible expression of monocyte-derived tissue factor, and the associated hypercoagulable state are driven by disease severity.
authors.affiliation: Department of Medicine, Mount Sinai Hospital Medical Center, Chicago, Illinois 60608, USA. wesm@sinai.org
authors.forename: M P
authors.initials: MP
authors.lastname: Westerman
authors.forename: D
authors.initials: D
authors.lastname: Green
authors.forename: A
authors.initials: A
authors.lastname: Gilman-Sachs
authors.forename: K
authors.initials: K
authors.lastname: Beaman
authors.forename: S
authors.initials: S
authors.lastname: Freels
authors.forename: L
authors.initials: L
authors.lastname: Boggio
authors.forename: S
authors.initials: S
authors.lastname: Allen
authors.forename: R
authors.initials: R
authors.lastname: Schlegel
authors.forename: P
authors.initials: P
authors.lastname: Williamson
mesh_terms: D000328:Adult; D000368:Aged; D017152:Antibodies, Antiphospholipid / Q000097:blood; D000990:Antithrombin III; D001778:Blood Coagulation Disorders / Q000209:etiology*; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D006450:Hemoglobin SC Disease / Q000097:blood; D006451:Hemoglobin, Sickle / Q000032:analysis; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D009000:Monocytes; D009994:Osmolar Concentration; D010446:Peptide Fragments / Q000097:blood; D010447:Peptide Hydrolases / Q000097:blood; D011516:Prothrombin; D012805:Sickle Cell Trait / Q000097:blood / Q000150:complications*; D014556:Urine
chemical_list: D017152:Antibodies, Antiphospholipid; D005338:Fibrin Fibrinogen Degradation Products; D006451:Hemoglobin, Sickle; D010446:Peptide Fragments; C046193:antithrombin III-protease complex; C036309:fibrin fragment D; C045879:prothrombin fragment 1.2; D000990:Antithrombin III; D011516:Prothrombin; D010447:Peptide Hydrolases