TUMOR-CELL U-PA AS A CAUSE OF FIBRINOLYTIC BLEEDING IN METASTATIC DISEASE

Tumour cells may express urokinase type plasminogen activator (u-PA). This may influence the invasive properties of the cells but has implic ated in production of a systemic bleeding state. Two patients are desc ribed in whom severe bleeding occurred in association with disseminate d malignancies, Thrombin generation was little disturbed and platelet numbers were insufficient to account for the bleeding. Florid plasmin generation was evident in the circulation and the fibrinolytic inhibit or tranexamic acid controlled the bleeding well, Free active u-PA was demonstrated in the circulation and u-PA antigen on the malignant cell s which invaded the marrow of one of the patients. Tumour cell u-PA ma y occasionally be responsible for a bleeding state.