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Thromb Haemost 2018; 118(08): 1390-1396
DOI: 10.1055/s-0038-1661394
Coagulation and Fibrinolysis
Georg Thieme Verlag KG Stuttgart · New York

Haematopoietic Stem Cell Transplantation in Children Shifts the Coagulation System towards a Pro-Coagulant State

Satu Långström
1   Division of Haematology-Oncology and Stem Cell Transplantation, Children's Hospital, Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland
,
Minna Koskenvuo
1   Division of Haematology-Oncology and Stem Cell Transplantation, Children's Hospital, Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland
,
Pasi Huttunen
1   Division of Haematology-Oncology and Stem Cell Transplantation, Children's Hospital, Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland
,
Riitta Lassila
2   Unit for Coagulation Disorders, Department of Haematology, Comprehensive Care Center and Cancer Center, Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland
,
Mervi Taskinen
1   Division of Haematology-Oncology and Stem Cell Transplantation, Children's Hospital, Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland
,
Susanna Ranta
3   Astrid Lindgren Children's Hospital, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden
,
Markku Heikinheimo
1   Division of Haematology-Oncology and Stem Cell Transplantation, Children's Hospital, Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland
,
Anne Mäkipernaa
2   Unit for Coagulation Disorders, Department of Haematology, Comprehensive Care Center and Cancer Center, Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland
› Author Affiliations Funding This study was financially supported by Väre Foundation for Pediatric Cancer Research, by Foundation for Pediatric Research, by Helsinki University Hospital research funds, and by the Academy of Finland.
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Publication History

08 January 2018

11 May 2018

Publication Date:
30 June 2018 (online)

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Abstract

Coagulation system is disturbed by several mechanisms after allogeneic haematopoietic stem cell transplantation (HSCT). We evaluated the effect of HSCT on coagulation system by various conventional and investigational methods in 30 children and adolescents who received HSCT due to haematological malignancies. Pro-thrombin fragment 1 + 2, a specific measure of thrombin generation, and von Willebrand factor, a measure of endothelial activation, increased after conditioning treatment, and remained elevated until 3 months after HSCT (p < 0.05 for all comparisons to pre-conditioning treatment). D-dimer, a measure of fibrin turnover, was elevated from the second week onwards until 4 weeks after HSCT (p < 0.05). Endogenous thrombin potential was increased after conditioning, and at 2 weeks after HSCT (p < 0.05). Furthermore, the activities of acute phase reactants fibrinogen and coagulation factor VIII were increased (p < 0.05 for all comparisons to pre-conditioning treatment) from the first week onwards up to 3 weeks and 3 months after HSCT, respectively. Taken together, paediatric patients receiving HSCT demonstrate distinct and prolonged variations in the coagulation system towards a pro-coagulant state. This shift is of importance when estimating the risk of haemostatic and thrombotic complications in these children.

Keywords

coagulation - paediatric - stem cell transplantation - haematological malignancy - thrombin

Authors' Contributions

S.L., M.K., S.R. and A.M. designed the study. R.L. and M.H. contributed the essential reagents. S.L., M.K. and A.M. analysed the data. S.L. wrote the manuscript. M.K., P.H., R.L., S.R., M.T., M.H. and A.M. critically revised the manuscript. All authors had full access to study data.


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