Thrombin Generation among Sudanese Patients with Hematological Malignancies

Hematological malignancies can change the levels of plasma molecules involved in coagulation and fibrinolysis such as fibrinopeptide A, fibrinogen, plasminogen activator inhibitor-1 (PAI-1) and D-dimer, markers of endothelial cell integrity (soluble E-selectin, van Willebrand factor and soluble thromboembolism) and of platelet function (beta-thromboglobulin). The aim of this study was to identify the hemostatic abnormalities and vascular damage among the major Sudanese hematological malignancy patients.

This study was undertaken at the Radiation and Isotopes Center Khartoum (RICK), Sudan, during the period of February 2009 to October 2011. 202 patients (in and out patients) who were diagnosed of having hematological malignancies in different age groups on treatment or of treatment were selected as a study group and compared against 50 apparently healthy males and females as a control group. Prothrombin time, activated partial thromboplastic Time (APTT), antithrombin III, protein C, platelet count, von Willebrand factor (vWF), Plasminogen Activator Inhibitor-1 (PAI-1) activity and fibrinogen were gathered from the study group and the control group.

The results showed that the highest prevalence of hematological malignancy was among the study group (CML, 36.6%), while ET, MF and PCV were the lowest (0.5% for any) (P= 0.000). 38.1% of the 202 hematological malignancy patients were female and 61.9% were male. Mean age was 41 years (range 2-86 years). PTT, PT and PC values were not affected by disease, on the other hand there was a decrease in the levels of fibrinogen (P=0.000) and antithrombin III (P= 0.000), elevated vWf (P= 0.000), and PAI-1 was significantly elevated in ALL (P= 0.000) and in AML (P= 0.002) patients.

Markers of coagulation were clearly observed in hematological malignancy patients; also, an indication of fibrinolysis and endothelial activation was confirmed. Some alterations in hemostasis and thrombotic events have frequently been found in hematological malignancy patients. These hemostatic changes may help the thrombotic and bleeding tendency in these patients.