Catani L, Gugliotta L, Mattioli Belmonte M, Vianelli N, Gherlinzoni F, Miggiano M C, Belardinelli A R, Rosti G, Calori E, Bandini G
Institute of Hematology L. & A. Seràgnoli, University of Bologna, Italy.
Bone Marrow Transplant. 1993 Sep;12(3):253-9.
Severe thrombotic alterations, such as veno-occlusive disease of the liver, may occur in the early phase following high-dose chemoradiotherapy and BMT. In this study, performed in patients with hematological malignancies subjected to allogeneic (10 cases) and autologous (20 cases) BMT, we have monitored laboratory hemostatic parameters to better understand the pathogenetic mechanism of thrombosis and particularly of veno-occlusive disease. Prothrombin time, activated partial thromboplastin time, plasma fibrinogen, markers of hypercoagulability (thrombin-antithrombin complex and prothrombin fragment F1+2); natural anticoagulants (protein C, protein S and antithrombin) together with fibrinolytic parameters (plasminogen, alpha 2-antiplasmin, tissue-plasminogen activator, plasminogen activator inhibitor and D-dimer) were assessed before transplant, on day 0 and weekly for 1 month thereafter. A hypercoagulability state, not related to an impairment of the anticoagulant and fibrinolytic systems, was documented before and after autologous and allogeneic transplant. Two patients developed veno-occlusive disease: they did not show any difference from the other patients before transplant while they presented a decrease of the natural anticoagulants along with altered fibrinolytic parameters only at the clinical onset of veno-occlusive disease. In conclusion, in this study a state of marked hypercoagulability was documented in BMT patients and the hemostatic laboratory parameters evaluated were not able to predict the occurrence of the thrombotic complications.
严重的血栓形成改变，如肝静脉闭塞性疾病，可能发生在大剂量放化疗和骨髓移植后的早期阶段。在这项针对接受异基因（10例）和自体（20例）骨髓移植的血液系统恶性肿瘤患者进行的研究中，我们监测了实验室止血参数，以更好地了解血栓形成特别是肝静脉闭塞性疾病的发病机制。在移植前、第0天以及此后1个月每周评估凝血酶原时间、活化部分凝血活酶时间、血浆纤维蛋白原、高凝状态标志物（凝血酶 - 抗凝血酶复合物和凝血酶原片段F1 + 2）；天然抗凝剂（蛋白C、蛋白S和抗凝血酶）以及纤溶参数（纤溶酶原、α2 - 抗纤溶酶、组织纤溶酶原激活物、纤溶酶原激活物抑制剂和D - 二聚体）。自体和异基因移植前后均记录到一种与抗凝和纤溶系统损害无关的高凝状态。两名患者发生了肝静脉闭塞性疾病：在移植前他们与其他患者没有任何差异，而仅在肝静脉闭塞性疾病临床发作时，他们出现了天然抗凝剂减少以及纤溶参数改变。总之，在这项研究中，骨髓移植患者记录到明显的高凝状态，并且所评估的实验室止血参数无法预测血栓并发症的发生。
