CHANGES IN HEMOSTATIC PARAMETERS IN HEPATIC VENOOCCLUSIVE DISEASE FOLLOWING BONE-MARROW TRANSPLANTATION

Hepatic veno-occlusive disease (VOD) is a major complication after bon e marrow transplantation (BMT). Its prediction, diagnosis and treatmen t remain unclear. Examination was made of changes in hemostatic parame ters in patients with or without VOD after BMT. Twenty-seven children were studied following BMT. Eight of them developed VOD. Tissue plasmi nogen activator (t-PA), plasminogen activator inhibitor 1 (PAI-1), thr ombomodulin (TM), von Willebrand factor (vWF), factor VII, fibrinogen (FBG), FDP, D-dimer (D-D), plasminogen (PLG), thrombin-antithrombin II I (TAT), alpha 2-plasmin inhibitor/plasmin complex (PIC), antithrombin III (AT-III), protein C, N-terminal propeptide for type III procollag en (P-III-P), were measured weekly from pre-BMT to day 28 after BMT. I n VOD patients, t-PA and PAI-1 significantly increased (P < 0.05) and FBG significantly fell during the post-transplant period (P < 0.05). S ignificantly low AT-III and PLG were also noted before VOD (P < 0.05). There were no changes in other hemostatic parameters. t-PA, PAI-1 and FBG would thus appear useful markers for the diagnosis of VOD, and AT -III and PLG, predictive markers for VOD. The coagulation-fibrinolysis system following endothelial cell damage mag contribute to the onset of VOD.