Contribution of fibrinolytic tests to the differential diagnosis of veno-occlusive disease complicating pediatric hematopoietic stem cell transplantation†
Corresponding Author
Maria Teresa Sartori MD
Second Chair of Internal Medicine, Department of Cardiologic, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
Second Chair of Internal Medicine, Department of Cardiologic, Thoracic and Vascular Sciences, Via Giustiniani 2, 35128 Padova, Italy.===Search for more papers by this authorSimone Cesaro MD
Division of Pediatric Hematology and Oncology, Department of Pediatrics, University of Padova, Padova, Italy
Search for more papers by this authorMattia Peruzzo MD
Second Chair of Internal Medicine, Department of Cardiologic, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
Search for more papers by this authorChiara Messina MD
Division of Pediatric Hematology and Oncology, Department of Pediatrics, University of Padova, Padova, Italy
Search for more papers by this authorGraziella Saggiorato PhD
Second Chair of Internal Medicine, Department of Cardiologic, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
Search for more papers by this authorElisabetta Calore MD
Division of Pediatric Hematology and Oncology, Department of Pediatrics, University of Padova, Padova, Italy
Search for more papers by this authorMarta Pillon MD
Division of Pediatric Hematology and Oncology, Department of Pediatrics, University of Padova, Padova, Italy
Search for more papers by this authorStefania Varotto MD
Division of Pediatric Hematology and Oncology, Department of Pediatrics, University of Padova, Padova, Italy
Search for more papers by this authorLuca Spiezia MD
Second Chair of Internal Medicine, Department of Cardiologic, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
Search for more papers by this authorGiuseppe Cella MD
Second Chair of Internal Medicine, Department of Cardiologic, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
Search for more papers by this authorCorresponding Author
Maria Teresa Sartori MD
Second Chair of Internal Medicine, Department of Cardiologic, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
Second Chair of Internal Medicine, Department of Cardiologic, Thoracic and Vascular Sciences, Via Giustiniani 2, 35128 Padova, Italy.===Search for more papers by this authorSimone Cesaro MD
Division of Pediatric Hematology and Oncology, Department of Pediatrics, University of Padova, Padova, Italy
Search for more papers by this authorMattia Peruzzo MD
Second Chair of Internal Medicine, Department of Cardiologic, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
Search for more papers by this authorChiara Messina MD
Division of Pediatric Hematology and Oncology, Department of Pediatrics, University of Padova, Padova, Italy
Search for more papers by this authorGraziella Saggiorato PhD
Second Chair of Internal Medicine, Department of Cardiologic, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
Search for more papers by this authorElisabetta Calore MD
Division of Pediatric Hematology and Oncology, Department of Pediatrics, University of Padova, Padova, Italy
Search for more papers by this authorMarta Pillon MD
Division of Pediatric Hematology and Oncology, Department of Pediatrics, University of Padova, Padova, Italy
Search for more papers by this authorStefania Varotto MD
Division of Pediatric Hematology and Oncology, Department of Pediatrics, University of Padova, Padova, Italy
Search for more papers by this authorLuca Spiezia MD
Second Chair of Internal Medicine, Department of Cardiologic, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
Search for more papers by this authorGiuseppe Cella MD
Second Chair of Internal Medicine, Department of Cardiologic, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
Search for more papers by this authorConflict of interest: Nothing to declare.
Abstract
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.
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