Coagulation disturbances in paediatric patients with hepatic veno-occlusive disease after stem cells transplantation.
BACKGROUND
Hepatic veno-occlusive disease (VOD) is a life threatening complication after stem cells transplantation (SCT). Its prediction, precise diagnosis and treatment remain unclear.


OBJECTIVE
Our goals were to determine the incidence, outcome and changes in haemostatic parameters in patients with VOD. Also, we tried to determine coagulation disturbances and their practical significance in early diagnosis of such patients.


METHODS
We prospectively evaluated all consecutive VOD patients after SCT, aged 3 months to 17 years, from February 2004 to July 2008 treated at the Mother and Child Health Institute of Serbia "Dr Vukan Cupić" (IMD). All patients were diagnosed according to the Seattle criteria. The values of PT, aPTT, fibrinogen, FVIII, AT and vWF were measured on the day prior to the initiation of conditioning regiment and on the days 1, 7 and 14 from the moment of VOD diagnosis. Laboratory testing was performed in the IMD haemostasis laboratory and results were statistically evaluated.


RESULTS
During the study period 74 SCT were performed at IMD. VOD developed 11 patients; 10 of 46 were autologous and 1 of 28 allogeneic SCT patients. In our group of patients the incidence of VOD was 14.8%. VOD was classified as mild in 7, moderate in 1 and severe in 3 patients. At the moment of establishing the diagnosis all patients had a significantly increased activity of vWF, FVIII and fibrinogen, and decreased AT. All of them were dependent on platelet transfusions.


CONCLUSIONS
Platelet transfusion dependence suggests coagulation activation with great significance and indicates a possible development of VOD. Our results also suggest that monitoring coagulation parameters levels in the first five days from the establishment of diagnosis may have a significant predictive value for VOD outcome.
Jevtić
Dragana
D
Mother and Child Health Institute of Serbia "Dr. Vukan Cupić", Belgrade, Serbia. drjevtic@beotel.rs
Vujić
Dragana
D
Zecević
Zeljko
Z
Veljković
Dobrila
D
Gazikalović
Slobodan
S
Elezović
Ivo
I
D000293:Adolescent; D000991:Antithrombins / Q000032:analysis; D001777:Blood Coagulation; D001779:Blood Coagulation Factors / Q000032:analysis; D002648:Child; D002675:Child, Preschool; D005260:Female; D006504:Hepatic Veno-Occlusive Disease / Q000097:blood* / Q000209:etiology; D006801:Humans; D007223:Infant; D008297:Male; D010314:Partial Thromboplastin Time; D010976:Platelet Count; D011517:Prothrombin Time; D033581:Stem Cell Transplantation / Q000009:adverse effects*; D019172:Transplantation Conditioning
D000991:Antithrombins; D001779:Blood Coagulation Factors