ON THE USE OF RECOMBINANT TISSUE-PLASMINO GEN ACTIVATOR (RT-PA) IS ANOCCLUDED HICKMAN CATHETER FOLLOWING BMT - CLINICAL AND PHYSIOLOGICAL-ASPECTS

A 12 year-old female patient suffering from multifocal Ewing's Sarcoma underwent bone marrow transplantation in March 1992. The donor was th e patients HLA-identical brother. On day 38 following BMT, an occludin g catheter thrombosis of the superior vena cava was diagnosed. Lysis t herapy using rt-PA was initiated. During therapy, serious bleeding occ urred and administration was temporarily discontinued. Normalisation o f previously high fibrinogen levels during an acute phase reaction was seen concomitantly with systemic fibrin and probably also fibrinogen fragments as demonstrated using the Western blot technique. Lysis ther apy resulted in regained catheter patency, while thrombosis of the sup erior vena cava persisted. The reduction in the need for the transfusi on of packed thrombocytes following lysis was seen as being a positive result. The use of rt-PA following BMT should be carefully weighed ag ainst the risks and requires careful patient observation. Due to the s ystemic fibrinolytic and fibrinogenolytic effects combined with mucosi tis and thrombocytopenia as a result of transplantation therapy, a hig h risk of bleeding complications seems likely.