Premium
Contribution of fibrinolytic tests to the differential diagnosis of veno‐occlusive disease complicating pediatric hematopoietic stem cell transplantation
Author(s) -
Sartori Maria Teresa,
Cesaro Simone,
Peruzzo Mattia,
Messina Chiara,
Saggiorato Graziella,
Calore Elisabetta,
Pillon Marta,
Varotto Stefania,
Spiezia Luca,
Cella Giuseppe
Publication year - 2012
Publication title -
pediatric blood and cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.116
H-Index - 105
eISSN - 1545-5017
pISSN - 1545-5009
DOI - 10.1002/pbc.23213
Subject(s) - medicine , hematopoietic stem cell transplantation , partial thromboplastin time , gastroenterology , prothrombin time , bilirubin , hepatic veno occlusive disease , antithrombin , liver transplantation , population , fibrinogen , transplantation , surgery , platelet , heparin , environmental health
Background Veno‐occlusive disease (VOD) is a major complication following hematopoietic stem cell transplantation (HSCT). Its diagnosis is based on clinical criteria, which have a limited sensitivity. Increased plasminogen activator inhibitor‐1 (PAI‐1) levels have been suggested as a marker of VOD. We aimed to prospectively evaluate how the fibrinolytic parameters behaved to discriminate VOD from other liver disorders occurring after HSCT in a pediatric population. Procedures A total of 195 HSCT were performed on 161 children and VOD complicated 11 cases (6.8%). Alanine aminotransferase, total bilirubin, PAI‐1 antigen (PAI‐1:Ag) and activity, t‐PA antigen, D‐dimer, prothrombin time, activated partial thromboplastin time, antithrombin, fibrinogen, and platelet counts were measured in 105 HSCT before and then weekly for 1 month after HSCT. Results An early, significant increase in the fibrinolytic parameters was seen in patients who developed VOD, even before VOD was diagnosed clinically, by comparison with patients without complications or those with non‐VOD liver disorders. The combined increase in bilirubin, D‐dimer, and PAI‐1:Ag levels beyond the normal range distinguished VOD cases from other liver complications with a high sensitivity and specificity. Conclusions Our study demonstrates that fibrinolytic tests can help diagnose VOD after HSCT in the pediatric population. Pediatr Blood Cancer 2012; 58: 791–797. © 2011 Wiley Periodicals, Inc.