Li Li, Roest Mark, Sang Yaqiu, Remijn Jasper A, Fijnheer Rob, Smit Karel, Huskens Dana, Wan Jun, de Laat Bas, Konings Joke
Department of Platelet Pathophysiology, Synapse Research Institute, Maastricht, Netherlands.
Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, Netherlands.
Front Cardiovasc Med. 2022 Jun 27;9:919495. doi: 10.3389/fcvm.2022.919495. eCollection 2022.
Multiple myeloma (MM) is associated with a high prevalence of bleeding and an increased risk of thrombo-embolism. MM patients have reduced platelet- and red blood cell (RBC) numbers in blood, which may indicate that the paradoxical hemostasis profile is a consequence of a disturbed platelet and RBC homeostasis.
To get better insight in the disbalanced hemostasis of MM patients.
We conducted a case-control study on the whole blood (WB) coagulation profiles of 21 MM patients and 21 controls. We measured thrombin generation (TG) in WB and platelet poor plasma (PPP) of MM patients and controls.
In WB-TG, we observed that the median time to the thrombin Peak was 52% longer in MM patients than in controls, while the median endogenous thrombin potential until the Peak (ETPp) was 39% higher in MM-patients than in controls. In line with these findings, the levels of platelets, RBCs, white blood cells and agonist induced platelet activation were decreased in MM patients compared to controls. The plasma TG experiments showed no differences between MM-patients and controls.
Patients with MM have a disturbed blood cell metabolism and a disbalanced WB-TG profile. This disbalance may explain the paradoxically high prevalence of bleeding symptoms in MM patients vs. an increased thrombosis risk. There was no disturbance observed in plasma TG, indicating that blood cells are the major determinants for the disbalanced hemostasis in MM patients.
多发性骨髓瘤（MM）与出血的高发生率及血栓栓塞风险增加相关。MM患者血液中的血小板和红细胞（RBC）数量减少，这可能表明矛盾的止血特征是血小板和RBC内环境稳态紊乱的结果。
更深入了解MM患者失衡的止血情况。
我们对21例MM患者和21例对照者的全血（WB）凝血谱进行了病例对照研究。我们测量了MM患者和对照者WB及乏血小板血浆（PPP）中的凝血酶生成（TG）。
在WB-TG中，我们观察到MM患者达到凝血酶峰值的中位时间比对照者长52%，而MM患者直至峰值的内源性凝血酶潜能（ETPp）比对照者高39%。与这些发现一致，与对照者相比，MM患者的血小板、RBC、白细胞水平及激动剂诱导的血小板活化均降低。血浆TG实验显示MM患者与对照者之间无差异。
MM患者存在血细胞代谢紊乱及WB-TG谱失衡。这种失衡可能解释了MM患者出血症状发生率高与血栓形成风险增加这一矛盾现象。未观察到血浆TG紊乱，表明血细胞是MM患者止血失衡的主要决定因素。
