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

Satu Långström; Minna Koskenvuo; Pasi Huttunen; Riitta Lassila; Mervi Taskinen; Susanna Ranta; Markku Heikinheimo; Anne Mäkipernaa

doi:10.1055/s-0038-1661394

Thrombosis and Haemostasis, Table of Contents

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

Authors

Satu Långström

¹Division of Haematology-Oncology and Stem Cell Transplantation, Children's Hospital, Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland
Minna Koskenvuo

¹Division of Haematology-Oncology and Stem Cell Transplantation, Children's Hospital, Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland
Pasi Huttunen

¹Division of Haematology-Oncology and Stem Cell Transplantation, Children's Hospital, Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland
Riitta Lassila

²Unit for Coagulation Disorders, Department of Haematology, Comprehensive Care Center and Cancer Center, Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland
Mervi Taskinen

¹Division of Haematology-Oncology and Stem Cell Transplantation, Children's Hospital, Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland
Susanna Ranta

³Astrid Lindgren Children's Hospital, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden
Markku Heikinheimo

¹Division of Haematology-Oncology and Stem Cell Transplantation, Children's Hospital, Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland
Anne Mäkipernaa

²Unit for Coagulation Disorders, Department of Haematology, Comprehensive Care Center and Cancer Center, Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland

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

Full Text

References

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