Coagulation Disorders In Patients Research Articles

Prothrombotic Coagulation Abnormalities in Patients with Paraprotein-Producing B-Cell Disorders

PurposeAn increased incidence of thromboembolic complications has been observed in multiple myeloma (MM), especially when patients are treated with anthracycline-based chemotherapy. In patients with MM, plasma levels of several prothrombotic coagulation factors are increased, and this can contribute to the prothrombotic state of these patients. Recently, an increased thrombosis risk has also been described for other plasma cell disorders (PCDs), such as monoclonal gammopathy of uncertain significance (MGUS) and systemic amyloidosis. The aim of this study was to analyze prothrombotic coagulation disorders in patients with paraprotein-producing B-cell disorders, such as MGUS, systemic amyloidosis, Waldenström's macroglobulinemia, and MM. Patients and MethodsAn increase in factor VIII and von Willebrand factor was observed in patients with MGUS and systemic amyloidosis that was similar to increases seen in patients with untreated MM. The highest levels were observed in patients with systemic amyloidosis. ResultsWe observed several coagulation abnormalities in patients with different PCDs. ConclusionThese prothrombotic changes in patients with MM, systemic amyloidosis, and Waldenström's macroglobulinemia might be causally related to the observed incidence of venous thromboembolism in these forms of PCDs.

72: Coagulation disorders in patients with chronic fatigue syndrome (CFS) and HHV-6 viremia

72: Coagulation disorders in patients with chronic fatigue syndrome (CFS) and HHV-6 viremia

Unidentified Coagulation Disorders in Post-Tonsillectomy Hemorrhage

We conducted a retrospective study of 6,966 patients who had undergone tonsillectomy or adenotonsillectomy to evaluate the incidence and clinical features of previously unidentified coagulation disorders in patients who experienced postoperative hemorrhage (n = 201). We found that post-tonsillectomy hemorrhage secondary to unidentified coagulation disorders is extremely rare. However, normal coagulation values and an insignificant history do not rule out coagulation disorders. If diffuse, persistent, and bilateral bleeding is not related to arterial hypertension, dissection technique, or local infection, a rapid and detailed analysis of coagulation factors should be considered.

Coagulation disorders in patients with cirrhosis and severe sepsis.

In patients with cirrhosis, severe sepsis may stimulate the extrinsic coagulation pathway resulting in thrombin generation and fibrin formation. To compare 23 patients with severe sepsis to 13 infected patients without severe sepsis and 18 patients without infection. Zymogen forms of clotting factors involved in the extrinsic pathway (i.e., factors VII + X, V, prothrombin), and the presence of soluble fibrin were assessed. Zymogen forms of clotting factors were significantly lower, while Child-Pugh score and the proportion of patients with soluble fibrin were higher in the severe-sepsis group than in the other groups. Decreased zymogen levels were independently correlated with an elevated Child-Pugh score and the presence of severe sepsis. In the severe-sepsis group, after adjustment for the severity of cirrhosis, decreased zymogen levels were associated with significant increases in the relative risk ratios of in-hospital death. Cirrhotic patients with severe sepsis have decreased blood levels of zymogen forms of factors VII+X, V, and prothrombin, which may be due not only to the severity of cirrhosis but also, at least in part, to the consumption of these zymogens by the extrinsic coagulation pathway.

Abnormalities in liver function and coagulation profile following the Fontan procedure

OBJECTIVETo investigate liver function and coagulation disorders in patients with a Fontan circulation at different time intervals after surgery.DESIGNRetrospective analysis of clinical data and cross sectional study relating liver function...

Assessment of Coagulation Disorders in Patients with Acute Leukemia Before and After Cytostatic Treatment

Coagulation disorders are often the reason for fatal bleeding in acute promyelocytic leukemia. Their occurrence as well as pathogenesis and prognostic significance in other subtypes of acute myelogenous leukemia and acute lymphoblastic leukemia is less known. Tests were carried out in 70 patients including 49 with AML and 21 with ALL. In all patients throm-bin-antithrombin complexes (TAT), D-dimer (DD) and plasmin-antiplasmin complexes (PAP), antithrombin 111 activity, fibrinogedfibrin degradation products, AFlT and PT were determined. The tests were performed on diagnosis and after cytostatic treatment.The level of TAT, DD and PAP was elevated in 83% of the patients on diagnosis and in 90% after treatment. The highest values were observed in AML M3 patients. Among leuke-mic patients with normal levels of TAT, DD and PAP at diagnosis, cytostatic treatment had a negligible effect on the level of these markers. During remission the levels of these markers returned to the normal values while in patients without remission they were either elevated or returned to normal values. No correlation between the levels of activation markers and remission rate was reported. DIC was diagnosed in 13 patients including three after chemotherapy. The DIC was acute or subacute in AML and chronic in ALL patients.In the majority of acute leukemia patients there were already changes on diagnosis indicating coagulation activation. Except for AML M3, these usually had a subclinical course. The TAT, DD and PAP tests are not reliable markers of remission in acute leukemias.

Coagulation disorders in patients with liver cirrhosis

Coagulation disorders in patients with liver cirrhosis

Activation of plasma kinin system correlates with severe coagulation disorders in patients with ovarian hyperstimulation syndrome

The aim of this study was to evaluate status of plasma kinin system in patients with ovarian hyperstimulation syndrome (OHSS), in order to investigate whether activation of the plasma kinin system correlates with increased blood coagulability. In the first part of the study, concentrations of plasma prekallikrein (PK) in OHSS cycles (n = 13) were monitored from the day of human chorionic gonadotrophin (HCG) administration to the mid-luteal phase, and were compared with those of control cycles (n = 17). The average value of PK in OHSS cycles began to decrease on day 8, and by day 10 was significantly lower than that of control cycles (86 +/- 6 versus 106 +/- 4%, P <0.01). The time course of changes in PK concentration correlated well with the clinical condition of OHSS patients. In the second part of the study, we obtained data from 26 patients who were hospitalized because of severe OHSS, to investigate the correlation between PK and other haemostatic markers. OHSS patients with severe PK reduction (<80% normal, n = 9) demonstrated significantly higher values of plasma thrombin-antithrombin III and plasmin-alpha2 antiplasmin, and more severe haemoconcentration, compared to those OHSS patients who had no reduction in PK (n = 17). In conclusion, our data suggest that activation of the plasma kinin system occurs specifically and occasionally in OHSS patients, and is associated with increased blood coagulability. Thus, when an OHSS patient demonstrates a low value of plasma PK, more careful management is required to prevent thromboembolic complications.

Coagulation Disorders in Patients with Monoclonal Gammopathies

Monoclonal gammopathies can present as disorders of coagulation whether the gammopathy is due to a malignant B-cell lymphoproliferative disorder or a monoclonal gammopathy of undetermined significance. Detection of the monoclonal gammopathy involves quantification of immunoglobulins including kappa and lambda along with high-resolution electrophoresis of serum. Immunofixation is occasionally needed on serum and always needed on urine for the final diagnosis.

Evaluation of Coagulation Disorders in Patients with Diseases of Waldeyer’s Ring

The presence of pre-existing hemostatic disorders in a surgical patient may pose difficulties in the care of patients during and after surgery. To reduce the risk of excessive hemorrhage, this article has stressed the value of a thorough medical history, physical examination, and appropriate laboratory assays before surgery. When these measures reveal no evidence of a coagulation disorder, the surgeon can have confidence that the patient's hemostatic system has the appropriate resources to prevent excessive bleeding during surgery. However, if the coagulation screening procedure suggests that an abnormality exists, specific diagnostic assays must be performed before any necessary surgery to determine the exact nature of the coagulopathy. When this information is present, specific forms of blood component therapy can be given to minimize the risk of excessive hemorrhage during the operative period.

Coagulation Disorders in Patients with Tumors of the Uterus

Sixty-eight previously untreated female subjects were studied: 26 patients with cervical carcinoma, 22 with endometrial carcinoma, and 20 with benign uterine diseases. These patients, together with 25 healthy female control subjects, underwent several coagulation tests, including beta-thromboglobulin (beta-TG) and platelet factor 4 (PF4) plasma levels. Of all the parameters considered, the variations in beta-TG and PF4 were the most interesting. They were increased in patients with cervical and endometrial carcinoma. The sensitivity of the two tests reached 79% (15/19) for patients with invasive cervical carcinoma and 74% (16/22) for all patients with endometrial carcinoma. Our data demonstrate that among the investigated parameters beta-TG and PF4 are the earliest disorders of the hemostatic system and are more frequently increased in the gynecologic malignancies.

Haemodynamic data, blood gas measurements and coagulation disorders in acute respiratory failure of patients with chronic lung disease (author's transl)

24 subjects with chronic obstructive pulmonary disease were investigated in the course of acute respiratory failure defined by hypoxaemia, hypercapnia and respiratory acidosis. Haemodynamic data of right heart catheterization and coagulation tests were particularly studied. 12 of these subjects had right heart failure defined by a rise of right ventricular end-diastolic pressure above 10 Torr. Coagulation tests brought evidence of consumption coagulopathy in 8 patients, 7 of whom had right heart failure. Data suggest a significant correlation between right heart failure and coagulation disorders in patients with acute exacerbation of chronic obstructive pulmonary disease. These disturbances, accompanied by reduction of pulmonary vascular area, could be in part related to the presence of microthrombi in pulmonary arterial vessels.