SUBCLINICAL ALTERATIONS IN COAGULATION AND FIBRINOLYSIS IN PATIENTS UNDERGOING AUTOLOGOUS PERIPHERAL-BLOOD STEM-CELL TRANSPLANTATION

We monitored 30 laboratory hemostatic parameters in an attempt to bett er comprehend alterations in coagulation and fibrinolysis in 10 patien ts with hematological malignancies subjected to autologous peripheral blood stem cell transplantation (APBSCT). These parameters were assess ed before and just after high-dose conditioning chemotherapy, on days 1, 7, 14 and 28. Although, clinical manifestations associated viith fi brino-coagulation disorders never occurred, including veno-occlusive d isease, a statistically significant increase was seen in 7 of 30 param eters, compared to values seen before conditioning chemotherapy. These were sub-divided into early and late phase parameters. The early phas e parameters, which increased during the first day after the condition ing chemotherapy was given, then returned to baseline values, included protein C, plasma tissue factor and tissue-plasminogen activator. The late phase parameters, which increased over baseline values during da ys 7 to 28, included free-protein S, fibrinogen, plasmin-alpha(2)-plas min inhibitor complex and soluble-thrombomodulin. The increase of earl y phase parameters, as produced by the liver and by endothelial cells, may reflect tissue damage by conditioning chemotherapy. Late phase pa rameters increased in parallel with C-reactive protein, which suggests a correlation with the degree of inflammation, such as the presence o f infective disease during neutropenia. These subclinical alterations in coagulation and fibrinolysis which take on a biphasic pattern durin g the course of APBSCT should be kept in mind by the attending physici ans during therapy.