Early haemostatic modifications following cryopreserved graft infusion

The nature of the graft used for the rescue of patients undergoing autologous bone marrow transplantation is that of a complex mixture of pharmacological agents and cellular debris known to have a number of effects on the haemostatic system. The present study was undertaken to evaluate the occurrence and the degree of haemostatic alterations during and immediately following graft infusion in 24 patients suffering from haematological malignancies. On day 0, before graft infusion, the majority of patients appeared with laboratory signs of enhanced thrombin generation, platelet activation, and endothelial damage, most likely due to the conditioning regimen. However, the graft infusion per se was accompanied in the short term by a further increment of some parameters indicating a thrombotic risk (as thrombin-antithrombin complex, beta-thrombo globulin, platelet factor four, and von Willebrand factor antigen, together with a concomitant prolongation of partial thromboplastin time and a reduction of prothrombin time. In contrast there was no further modification of antithrombin III or protein C levels nor an increase in fibrinopeptide A levels. We hypothesize that complex interactions between agents contained in the graft mixture and host haemostatic system are involved in the pathogenesis of the haemostatic alterations which followed cryopreserved graft infusion; however, in our series, these were not accompanied by clinical signs of thrombotic or haemorrhagic events.