Pihusch Rudolf, Salat Christoph, Schmidt Edwin, Göhring Peter, Pihusch Markus, Hiller Erhard, Holler Ernst, Kolb Hans-Jochem
Medizinische Klinik III-Grobetahadern, Klinikum der Ludwig Maximilians-Universität München, München, Germany.
Transplantation. 2002 Nov 15;74(9):1303-9. doi: 10.1097/00007890-200211150-00018.
Hemostatic complications are not uncommon after bone marrow transplantation (BMT). However, little is known about the frequency, localization, determinants, and outcome of hemostatic events in autologous and allogeneic BMT.
Four hundred forty-seven patients (364 allogeneic, 83 autologous transplants) were evaluated retrospectively for the presence of hemostatic complications (bleeding, thrombosis, hepatic veno-occlusive disease [VOD], microangiopathic hemolytic anemia) from the start of conditioning therapy until June 2000.
A total of 83.2% of the patients presented with at least one hemostatic complication during the investigational period. Most bleeding episodes occurred within the first 4 weeks after transplantation and were relatively mild. However, 27.1% of the patients hemorrhaged severely, generally doubling the overall mortality of the BMT recipients. Fatal gastrointestinal or intracerebral hemorrhages contributed to 1.1% of the events. Bleeding was strongly associated with prolonged thrombocytopenia and graft-versus-host disease (GVHD). Hemorrhagic cystitis may additionally have been triggered by the preceding conditioning regimens containing cyclophosphamide. Thromboembolic events occurred most frequently in allogeneic transplant recipients, for whom the incidence was 14.6%. Chronic GVHD and treatment with steroids were the major determining factors. The incidence of hepatic VOD in 4.7% of the allogeneic transplant recipients was associated with a high fatality rate. Busulfan conditioning increased the VOD risk 2.6-fold. Moderate or severe microangiopathic hemolytic anemia was associated with GVHD and occurred in 14.6% of the allogeneic transplant recipients, leading to an increased overall mortality.
Hemostatic disturbances, commonly found in the course of transplantation, are associated with a high transplantation risk and closely related to thrombocytopenia and immunologic complications.
骨髓移植（BMT）后止血并发症并不罕见。然而，关于自体和异基因BMT中止血事件的发生率、部位、决定因素及结局，人们了解甚少。
回顾性评估了447例患者（364例异基因移植，83例自体移植），从预处理开始至2000年6月，观察其是否存在止血并发症（出血、血栓形成、肝静脉闭塞病[VOD]、微血管病性溶血性贫血）。
在研究期间，共有83.2%的患者出现至少一种止血并发症。大多数出血事件发生在移植后的前4周内，且相对较轻。然而，27.1%的患者发生严重出血，这通常使BMT受者的总体死亡率增加一倍。致命的胃肠道或脑出血占所有事件的1.1%。出血与血小板减少持续时间延长及移植物抗宿主病（GVHD）密切相关。含环磷酰胺的预处理方案可能还会引发出血性膀胱炎。血栓栓塞事件在异基因移植受者中最常见，发生率为14.6%。慢性GVHD和使用类固醇治疗是主要决定因素。4.7%的异基因移植受者发生肝VOD，其死亡率较高。白消安预处理使VOD风险增加2.6倍。中度或重度微血管病性溶血性贫血与GVHD相关，在14.6%的异基因移植受者中发生，导致总体死亡率增加。
移植过程中常见的止血障碍与高移植风险相关，且与血小板减少和免疫并发症密切相关。
