Venous Thromboembolism after Allogeneic Pediatric Hematopoietic Stem Cell Transplantation: A Single-Center Study.
Venous Thromboembolism after Allogeneic Pediatric Hematopoietic Stem Cell Transplantation: A Single-Center Study.
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DOI：
10.4274/tjh.2013.0066
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发表时间：
2015-09
期刊：
影响因子：
--
通讯作者：
Uçkan D
中科院分区：
文献类型：
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作者：
Azık F;Gökçebay DG;Tavil B;Işık P;Tunç B;Uçkan D
造血干细胞移植（HSCT）患儿静脉血栓栓塞（VTE）的发病率较高。本研究的目的是评估同种异体造血干细胞移植（HSCT）患儿静脉血栓栓塞（VTE）的发生率以及移植前血栓形成危险因素对血栓形成的影响。我们回顾性评估了2010年4月至2012年11月期间接受同种异体HSCT的92例患者，这些患者在HSCT后完成了100天。HSCT前，采集所有患者的凝血功能、获得性和遗传性血栓形成前风险因素，包括FV G1691 A（凝血因子V Leiden）、凝血酶原G20210 A、亚甲基四氢叶酸还原酶（MTHFR）C677 T和MTHFR A1298 C突变;以及血清同型半胱氨酸和脂蛋白（a）、血浆抗凝血酶III、蛋白C和蛋白S水平。在血栓形成倾向筛查中，8例患者（9%）为凝血因子V Leiden杂合子，5例患者（6%）为MTHFR 677 TT纯合子，12例患者（14%）为MTHFR 1298 CC纯合子，2例患者（2%）为凝血酶原G20210 A突变杂合子。我们在5例患者（5.4%）中观察到VTE;在这5例患者中的3例中发现了血栓形成前风险因素，而5例患者中的4例有中心静脉导管。已确定VTE与遗传性血栓前危险因素之间无显著关系。HSCT后的VTE似乎是一种低频率事件，可能是由于低剂量、低分子量肝素预防所致，在没有前瞻性研究的情况下，不能完全排除遗传性血栓前危险因素的作用。
Venous thromboembolism (VTE) in children who undergo hematopoietic stem cell transplantation (HSCT) has high morbidity. The aim of this study is to assess the incidence of VTE in allogeneic pediatric HSCT recipients and the contribution of pretransplant prothrombotic risk factors to thrombosis. We retrospectively evaluated 92 patients between April 2010 and November 2012 undergoing allogeneic HSCT who had completed 100 days post-HSCT. Before HSCT, coagulation profiles; acquired and inherited prothrombotic risk factors including FV G1691A (factor V Leiden), prothrombin G20210A, methylenetetrahydrofolate reductase (MTHFR) C677T, and MTHFR A1298C mutations; and serum homocysteine and lipoprotein (a), plasma antithrombin III, protein C, and protein S levels were obtained from all patients. In the screening of thrombophilia, 8 patients (9%) were heterozygous for factor V Leiden, 5 (6%) were homozygous for MTHFR 677TT, 12 (14%) were homozygous for MTHFR 1298CC, and 2 (2%) were heterozygous for prothrombin G20210A mutation. We observed VTE in 5 patients (5.4%); a prothrombotic risk factor was found in 3 out of these 5 patients, while 4 out of 5 patients had central venous catheters. It was determined there was no significant relationship between VTE and inherited prothrombotic risk factors. VTE after HSCT seems to be a low-frequency event that may be due to low-dose, low-molecular-weight heparin prophylaxis, and the role of inherited prothrombotic risk factors cannot be entirely excluded without a prospective study.