Clinical Investigation Of Hemostatic Parameters In The Course Of Hematopoietic Stem Cell Transplantation

Objective: (1) To illustrate the alteration of hemostatie parameters inrecipients of hematopoietic stem cell transplantation (HSCT); (2) Todetermine their value in early transplant-related complications; (3) Toestablish early diagnosis index for transplant-associated thrombotic disease.Methods: (1) 95 patients receiving HSCT were evaluated in our institution.Blood. samples were collected prior to conditioning therapy and then weeklyuntil the fifth week after HSCT. (2)The following parameters were measuredby enzymimmunoassay and hemagglutinin equipment: plasminogen activatorinhibitor-1 (PAI-1), tissue-plasminogen activator (t-PA), protein C (PC),yon Willebrand factor (vWF), Thrombomodulin (TM),activated partialthromboplastin time (APTT), prothrombin time (PT), fibrinogen (Fg),antithrombin (AT), D-Dimer (D-Di). (3)Accroding to the occurrence oftransplant-associated complications, we divided them into four groups: 41patients without any complication were. defined as uncomplicated group, 29as aGVHD group, 6 as thrombus group, 19 as infection group. Retrospectiveanalyses were performed for the hemostatic parameters and the complications.Results: (1)Increased levels of PAI-1, APTT, PT, Fg, D-Di, TM and vWF were observed after transplantation, while PC, t-PA and AT decreased.(2)Significant increase was found in the level of PAI-1 and t-PA in thethrombus group compared with aGVHD group (P=0.002, P=0.003);Significant diminution was found in the level of PC in the aGVHD groupcompared with infection group(P=0.006);the increased level of APTT and thedecreased level of Fg were found in the aGVHD group (P=0.005, P=0.006);the increased level of PT and D-Di were found in the infection group(P=0.032, P=0.011). No significance existed in vWF, TM and AT.Conclusion: Our results suggest hemostatic, imbalance is one importantmanifestation during HSCT, reflecting prothrombotic states and endothelialdamage, which may be caused by the conditioning regimen and/ortransplantation-related complications. The increased level of PAI-1 and t-PAwere considered as discriminated value between HVOD and aGVHD. Thedecreased level of PC was considered as a index maker in the diagnosis ofaGVHD, and the discriminated diagnosis value between aGVHD andinfection.