DIAGNOSTIC-VALUE OF HEMOSTATIC PARAMETERS IN BONE-MARROW TRANSPLANT-ASSOCIATED THROMBOTIC MICROANGIOPATHY

We investigated hemostatic parameters in a prospective study of 16 pat ients who received bone marrow transplants (BMT), We found a significa nt rise in the levels of fibrinogen, plasmin-cr, antiplasmin inhibitor complex, tissue-plasminogen activator.plasminogen activator inhibitor complex (t-PA.PAI), von Willebrand factor antigen, and thrombomodulin on day 14 after transplant compared with values before transplant. Pr otein C and thrombin-antithrombin III levels did not change significan tly. No significant changes in prothrombin time ratio, activated parti al thromboplastin time, or protein S Here detected, Patients who had g rades II-IV graft-versus-host disease (GVHD) (n = 6) showed a signific antly higher level of t-PA.PAI on day 14 compared with those with grad es 0-I GVHD (n = 10) (P = 0.0062), Three patients with grades II-IV GV HD developed thrombotic microangiopathy (TMA) on days 19, 19 and 62. I n these patients, we noted significantly lower levels of fibrinogen (P = 0.0383), and significantly higher le, els of t-PA PAI (P = 0.0008) and thrombomodulin (P = 0.0001) on day 14 compared with those patients who did not develop TMA. These results suggest that prothrombotic sta tes and endothelial damage may be caused by the conditioning regimen a nd/or acute GVHD during BRIT; thrombomodulin values on day 14 post BAI T may be useful in surveillance for TMA because of endothelial cell in jury.