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Thrombotic complications associated with stem cell transplantation.
1Thrombosis and Hemostasis Unit, Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel. ynadir@netvision.net.il
Blood Reviews
|June 16, 2012
Summary
Stem cell transplantation (SCT) can cause thrombotic complications due to endothelial cell injury. This review discusses the pathogenesis and treatment of three microcirculation thromboses: veno-occlusive disease (VOD), thrombotic microangiopathy (TMA), and diffuse alveolar hemorrhage (DAH).
Area of Science:
- Vascular Biology
- Hematology
- Transplantation Medicine
Background:
- Thrombotic complications are frequent in stem cell transplantation (SCT) recipients.
- Endothelial cell injury significantly contributes to hemostatic impairments following SCT.
- Understanding unique vascular bed properties is crucial for site-specific diagnostics and therapeutics.
Purpose of the Study:
- To review the pathogenesis of microcirculation thromboses in SCT.
- To discuss treatment options for SCT-related thrombotic conditions.
- To explore the thrombotic etiology of diffuse alveolar hemorrhage (DAH) in SCT.
Main Methods:
- Literature review focusing on pathogenesis and treatment of SCT-related thromboses.
- Analysis of clinical presentations and autopsy findings.
- Inclusion of insights from experimental models, such as mice experiments for DAH.
Main Results:
- Veno-occlusive disease (VOD) and thrombotic microangiopathy (TMA) are characterized by small vessel thrombosis in the microcirculation.
- Diffuse alveolar hemorrhage (DAH), while presenting hemorrhagically, shows evidence of thrombotic etiology.
- Endothelial cell injury is a central mechanism in SCT-associated thrombotic events.
Conclusions:
- Microcirculation thromboses are significant complications of stem cell transplantation.
- Targeting endothelial cell injury and understanding site-specific vascular properties are key for managing these conditions.
- Further research into the thrombotic nature of DAH is warranted for improved patient outcomes.
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