Prospective Investigation of Hemostatic Parameters in Patients Undergoing Hematopoietic Stem Cell Transplantation.

Objective To illustrate the alteration of hemostatic parameters in recipients of hematopoietic stem cell transplantation (HSCT) and then determine its value in transplantation-related complications.

Methods 45 patients receiving HSCT were evaluated prospectively in our institution. Hemostatic parameters were investigated prior to conditioning therapy and then weekly until five weeks after HSCT by enzymimmunoassay.

Results Significant increase was observed in the levels of fibrinogen, tissue plasminogen activator (t-PA) and plasminogen activator inhibitor-1 (PAI-1) after transplant, while Protein C decreased significantly. No significant change existed in prothrombin time (PT), activated partial thromboplastin time (APTT) and antithrombin III (ATIII) levels. Six patients with acute grades II–IV graft-versus-host disease (aGVHD) presented with significantly lower level of Protein C compared with those who had grades 0–I aGVHD, PAI-1 level didn’t change apparently as well as fibrinogen and t-PA in the same time. However, three patients with veno-occlusive disease (VOD) extremely showed elevated PAI-1 levels after the clinical onset of VOD by comparison with mean post-HSCT values in the non-VOD patients; similar result was found in the patient who developed thrombotic microangiopathy (TMA).

Conclusion Our results suggest hemostatic imbalance is one important manifestation during HSCT, reflecting prothrombotic states and endothelial damage, which may be caused by the conditioning regimen and/or transplantation-related complications. The extreme elevation of PAI-1 alteration may be useful to recognize the development of VOD and TMA, while Protein C diminution facilitates the early diagnosis of aGVHD.