Gupta Shveta, Carmona Roxana, Malvar Jemily, Young Guy
Division of Transfusion Medicine and Coagulation, Baylor College of Medicine, Houston, TX, United States.
Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, Los Angeles, CA, United States.
Thromb Res. 2017 Mar;151:44-50. doi: 10.1016/j.thromres.2016.09.017. Epub 2016 Sep 21.
Recent epidemiological evidence suggests sickle cell disease (SCD) and sickle cell trait (SCT) is a risk factor for venous thromboembolism. The increased in-vivo markers of thrombin generation support the notion that such patients are in a chronic hypercoagulable state. In an attempt to better understand the underlying mechanism, global hemostatic assays including thrombin generation assay (TGA) and thromboelastography (TEG) have been utilized by several groups, but thus far, have shown inconsistent results either due to small sample size or technical differences.
Global hemostatic characterization of children with SCD or SCT by using TGA and modified TEG methods.
In this pilot study, we obtained TGA, TEG and other hemostatic data on specimens from 13 patients with SCD, 14 with SCT and 12 race-matched healthy controls (NC).
R time and K time with modified TEG methods were significantly shorter in SCD when compared to SCT and NC. Alpha and MA did not show any significant differences between the groups. There was no difference seen between SCT and NC. TGA profiles did not show any difference between the three groups. As expected the in-vivo markers of thrombin generation and activation of fibrinolysis including D dimer and thrombin-antithrombin complexes were significantly higher in SCD subjects as compared to SCT and NC.
The modified TEG methods are able to detect the activated coagulation system for the SCD population but a larger and more homogenous SCT cohort needs to be studied for more conclusive results.
近期流行病学证据表明，镰状细胞病（SCD）和镰状细胞性状（SCT）是静脉血栓栓塞的危险因素。凝血酶生成的体内标志物增加支持了这些患者处于慢性高凝状态的观点。为了更好地理解潜在机制，多个研究小组采用了包括凝血酶生成测定（TGA）和血栓弹力图（TEG）在内的全面止血检测方法，但迄今为止，由于样本量小或技术差异，结果并不一致。
通过使用TGA和改良TEG方法对患有SCD或SCT的儿童进行全面止血特征分析。
在这项初步研究中，我们获取了13例SCD患者、14例SCT患者和12例种族匹配的健康对照（NC）的标本的TGA、TEG和其他止血数据。
与SCT和NC相比，采用改良TEG方法时，SCD患者的R时间和K时间显著缩短。各组之间的α角和最大振幅（MA）没有显示出任何显著差异。SCT和NC之间没有差异。TGA曲线在三组之间没有显示出任何差异。正如预期的那样，与SCT和NC相比，SCD患者中凝血酶生成和纤维蛋白溶解激活的体内标志物，包括D - 二聚体和凝血酶 - 抗凝血酶复合物显著更高。
改良TEG方法能够检测SCD人群中激活的凝血系统，但需要研究更大且更同质的SCT队列以获得更具结论性的结果。
