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Abstract
The occurrence of hemostatic alterations after hematopoietic stem cell transplantation(HSCT)and their possible role in the pathogenesis of thrombotic complications such as the hepatic sinusoidal obstruction syndrome (HSOS)is still a matter of debate.
On the other hand bleeding after HSCT is a daily clinical concern for HSCT units. The aim of this study was to prospectively evaluate the hemostatic alterations in the early period after HSCT(up to day +14)and their relationships (if any) with hemostatic complications. Thirty patients (24 allogenic and 6 autologous HSCT) entered the study. 18 patients suffered from thrombotic and/or hemorrhagic events. Hemostatic parameters were assayed before conditioning regimen and on day 7 and 14 posttransplantation. Patients with overt hemostatic complications exhibited a state of fibrinolysis as proved by the statistically significant positive FDPs on day +7 and the statistically significant higher levels of D-dimer on day +14 (P < 0.05). They also exhibited a state of hypercoagulability as proved by the statistically significant lower levels of protein C on day +14 (P < 0.01). Patients within the non survivor group exhibited a state of endothelial cell activation as proved by the statistically significant higher levels of TPA on day +7 and +14 (P value < 0.05). They also exhibited a state of coagulation and fibrinolysis as proved by the statistically significant higher levels of TAT& Prothrombin fragments 1+2 on day +7 and +14 (P < 0.001 & < 0.01 respectively).
They showed statistically significant lower levels of plasminogen on day 14 (P < 0.05), Positive FDPs was found in a statistically significant higher percentage of patients in the non survivor group on day 0, +7 and on day +14 (P is < 0.01, < 0.05 and < 0.001respectively). Even patients who did not suffer from overt hemostatic complications showed statistically significant hemostatic alterations suggesting that hemostatic alteration could occur on the subclinical level. These results suggest that hemostatic alterations can be detected early after HSCT but their clinical significance remains uncertain due to a lack of correlation between the hemostatic test alterations and the occurrence of hemostatic complications. However some changes in hemostatic parameters can predict poor outcome in the early post HSCT period.