PMID- 9293452
OWN - NLM
STAT- MEDLINE
DCOM- 19971022
LR  - 20061115
IS  - 0300-8630 (Print)
IS  - 0300-8630 (Linking)
VI  - 209
IP  - 4
DP  - 1997 Jul-Aug
TI  - Humoral coagulation and early complications after allogeneic bone marrow 
      transplantation.
PG  - 209-15
AB  - Alterations of the coagulation system that may lead to coagulation activation and 
      thrombosis are common sequelae after allogeneic bone marrow transplantation 
      (BMT). We performed prophylactic anticoagulation by low dose heparin (50 
      units/kg/day) and substitution of antithrombin (AT) concentrate to sustain plasma 
      levels above 90% of pooled normal human plasma. Conventional tests for plasmatic 
      hemostasis and substitution of AT concentrate were recorded for 50 patients until 
      day +50 after BMT. Incidence of sepsis, graft-versus-host-disease [GVHD], 
      capillary leakage syndrome [CLS] and veno-occlusive disease of the liver [VOD] 
      were investigated and compared with the results of patients without any of these 
      complications. Patients with proven sepsis (n = 6) showed decreased activity of 
      AT, and a prolonged activated partial thromboplastin time (aPTT), while 
      fibrinogen levels were slightly increased. This constellation was interpreted as 
      mild to moderate activation of the humoral coagulation cascade. Patients with VOD 
      (n = 10) showed an increased consumption of AT concentrate at day +7 followed by 
      a decrease of prothrombin time, of clotting factors II and VII, and a 
      prolongation of aPTT at days +11 to +18 after BMT. This suggests, that activation 
      of coagulation precedes decreased synthesis of coagulation factors. Patients with 
      CLS (n = 15) or GVHD > or = II degree (n = 14) showed no major alterations of 
      coagulation parameters. In conclusion, after BMT, two types of coagulopathy were 
      observed: (i) an activation of the coagulation cascade (i.e. sepsis and VOD) 
      which was followed by (ii) a diminished synthesis of coagulation factors (VOD). 
      In order to perform timely therapeutic interventions in the coagulation system in 
      patients with sepsis and/or VOD it appears to be important to assess the clinical 
      value of parameters for early detection of coagulation activation as thrombin-AT 
      complexes, D-dimers and F1 + 2 fragments.
FAU - Nurnberger, W
AU  - Nurnberger W
AD  - Department for Pediatric Hematology and Oncology, Heinrich Heine University 
      Medical Center, Dusseldorf, Germany.
FAU - Kruck, H
AU  - Kruck H
FAU - Mauz-Korholz, C
AU  - Mauz-Korholz C
FAU - Burdach, S
AU  - Burdach S
FAU - Gobel, U
AU  - Gobel U
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - Germany
TA  - Klin Padiatr
JT  - Klinische Padiatrie
JID - 0326144
RN  - 0 (Anticoagulants)
RN  - 0 (Blood Coagulation Factors)
RN  - 9000-94-6 (Antithrombin III)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Adolescent
MH  - Anticoagulants/administration & dosage/adverse effects
MH  - Antithrombin III/administration & dosage/adverse effects
MH  - Blood Coagulation Factors/metabolism
MH  - Blood Coagulation Tests
MH  - Bone Marrow Transplantation/*physiology
MH  - Child
MH  - Child, Preschool
MH  - Female
MH  - Heparin/administration & dosage/adverse effects
MH  - Humans
MH  - Infant
MH  - Male
MH  - Thrombosis/*blood/prevention & control
EDAT- 1997/07/01 00:00
MHDA- 1997/09/18 00:01
CRDT- 1997/07/01 00:00
PHST- 1997/07/01 00:00 [pubmed]
PHST- 1997/09/18 00:01 [medline]
PHST- 1997/07/01 00:00 [entrez]
AID - 10.1055/s-2008-1043952 [doi]
PST - ppublish
SO  - Klin Padiatr. 1997 Jul-Aug;209(4):209-15. doi: 10.1055/s-2008-1043952.