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Plasma levels of D‐dimer and circulating endothelial adhesion molecules in veno‐occlusive disease of the liver following allogeneic bone marrow transplantation
Author(s) -
Südhoff Thomas,
Heins Michael,
Söhngen Dietmar,
Lenz Viola,
Wehmeier Artur,
Meckenstock Gerald,
Schneider Wolfgang,
Reinauer Hans,
Heyll Axel,
Aul Carlo
Publication year - 1998
Publication title -
european journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 84
eISSN - 1600-0609
pISSN - 0902-4441
DOI - 10.1111/j.1600-0609.1998.tb01006.x
Subject(s) - d dimer , medicine , hepatic veno occlusive disease , complication , fibrin , gastroenterology , endothelial activation , disseminated intravascular coagulation , liver transplantation , transplantation , surgery , immunology , endothelium , hematopoietic stem cell transplantation
Veno‐occlusive disease (VOD) of the liver is a frequent and life‐threatening complication of BMT. Recently, successful treatment by t‐PA has been reported but has been compromised by fatal bleeding events. Therefore, t‐PA application should be restricted to patients with severe VOD. However, moderate and severe forms of VOD are difficult to distinguish in early stages. We analyzed plasma levels of cross‐linked fibrin degradation products (D‐dimer) and soluble endothelial adhesion molecules such as sE‐selectin, sVCAM‐1 and sICAM‐1 in 10 consecutive patients undergoing allogeneic BMT to evaluate their use in identifying severe forms of VOD. During the observation period, 4 episodes of VOD occurred, 2 of which were fatal due to early onset of multiorgan failure. Concentrations of D‐dimer generally increased after transplantation. However, there was an additional significant increase in D‐dimer levels during severe VOD. Thus, D‐dimer levels above 1000 μg/1 were only found in 2 cases with severe VOD and fatal outcome. When compared with bilirubin concentrations substantial increases of D‐dimers appeared earlier during the course of severe VOD. In contrast, VOD episodes were not accompanied by significant increases in sE‐selectin, sVCAM‐1 and sICAM‐1 levels. It is concluded that measurement of D‐dimer concentrations may aid accuracy to the early diagnosis of severe VOD.