Abstract
Many of the serious, potentially fatal complications of hematopoietic stem cell transplantation
have similarities to the multiple organ dysfunction syndrome (MODS) in critically
ill nontransplant patients. One of these similarities is the alteration in the hemostatic
system in such a way as to lower the levels of the naturally occurring anticoagulant
proteins, especially antithrombin III. As in MODS, the outcome of transplant patients
with these complications correlates with the degree of change in antithrombin III
levels. Preliminary studies suggest that antithrombin III concentrate in pharmacologic
doses along with intensive supportive care efforts can improve the clinical outcome
of patients with these transplant-related complications. Further work to confirm these
findings and, it is hoped, provide insight into the mechanism of action of antithrombin
III in this setting is obviously warranted. Until such studies are completed, however,
the preponderance of evidence suggests that when subjected to a risk-benefit analysis,
patients in the early stages of transplantrelated complications would be better off
receiving antithrombin III supplementation than not.
Keywords:
Hematopoietic stem cell transplantation - multiple organ dysfunction syndrome (MODS)
- antithrombin concentrates - sepsis - systemic inflammatory response syndrome (SIRS).
