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Thromb Haemost 2005; 93(04): 682-689
DOI: 10.1160/TH04-09-0621
Blood Coagulation, Fibrinolysis and Cellular Haemostasis
Schattauer GmbH

Role of fibrinolytic and clotting parameters in the diagnosis of liver veno-occlusive disease after hematopoietic stem cell transplantation in a pediatric population

Maria Teresa Sartori
1   2nd Chair of Internal Medicine, Department of Medical and Surgical Sciences; University of Padua Medical School, Padua, Italy
,
Luca Spiezia
1   2nd Chair of Internal Medicine, Department of Medical and Surgical Sciences; University of Padua Medical School, Padua, Italy
,
Simone Cesaro
2   Clinic of Paediatric Hematology and Oncology; University of Padua Medical School, Padua, Italy
,
Chiara Messina
2   Clinic of Paediatric Hematology and Oncology; University of Padua Medical School, Padua, Italy
,
Myriam Paris
2   Clinic of Paediatric Hematology and Oncology; University of Padua Medical School, Padua, Italy
,
Marta Pillon
2   Clinic of Paediatric Hematology and Oncology; University of Padua Medical School, Padua, Italy
,
Graziella Saggiorato
1   2nd Chair of Internal Medicine, Department of Medical and Surgical Sciences; University of Padua Medical School, Padua, Italy
,
Antonio Pagnan
1   2nd Chair of Internal Medicine, Department of Medical and Surgical Sciences; University of Padua Medical School, Padua, Italy
,
Antonio Girolami
1   2nd Chair of Internal Medicine, Department of Medical and Surgical Sciences; University of Padua Medical School, Padua, Italy
,
Luigi Zanesco
2   Clinic of Paediatric Hematology and Oncology; University of Padua Medical School, Padua, Italy
,
Giuseppe Cella
1   2nd Chair of Internal Medicine, Department of Medical and Surgical Sciences; University of Padua Medical School, Padua, Italy
› Author Affiliations
Further Information

Publication History

Received 22 September 2004

Accepted after revision 06 March 2004

Publication Date:
09 March 2018 (online)

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Summary

Hepatic veno-occlusive disease (VOD) is a severe complication after hematopoietic stem cell transplantation (HSCT). Recent studies, mainly in adults receiving HSCT, have identified an increase in the plasminogen activator inhibitor-1 (PAI-1) as a possible marker of VOD. To confirm this finding, the fibrinolytic, coagulation and liver function parameters were assayed before and weekly for 1 month after 61 HSCT performed in 53 consecutive children. Non-VOD patients had a slight increase in t-PA antigen, fibrinogen and P-selectin levels, as well as a mildly longer aPTT and a drop in antithrombin after HSCT. The 6 children with VOD (9.84%) had an early and significant increase in PAI-1 antigen and activity (p< 0.0001), t-PA antigen (p< 0.0001) and D-dimer (p< 0.01) levels, and a decrease in plasminogen, α2-antiplasmin and PT emerged 2(±1) days before the clinical diagnosis of VOD by comparison with mean post-HSCT values in the non-VOD patients. Significant differences were also detected for these parameters and antithrombin levels between non-VOD and VOD patients soon after the clinical onset of VOD, whereas the rise in bilirubin levels became significant only later on. In conclusion, variations in fibrinolytic test findings after HSCT, and PAI-1 in particular, may facilitate the early diagnosis of VOD in pediatric patients after HSCT.

Keywords

Hematopoietic stem cell transplantation - paediatric - veno-occlusive disease - plasminogen activator inhibitor - busulphan
 

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