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Area of Science:

  • Hematology
  • Oncology
  • Biochemistry

Background:

  • Coagulopathies are frequent complications in hematological malignancies, leading to severe bleeding or thrombosis.
  • Extracellular vesicles (EVs) carry procoagulant and fibrinolytic factors, influencing hemostasis.
  • Elevated EV levels and activity are observed at diagnosis in various hematological cancers.

Purpose of the Study:

  • To review the role of extracellular vesicles (EVs) in hemostasis within hematological malignancies.
  • To discuss current methods for assessing procoagulant EVs.
  • To highlight challenges in EV research and clinical translation.

Main Methods:

  • Review of clinical and experimental data on EVs in hematological malignancies.
  • Assessment of procoagulant EVs using functional assays (TF/PS-dependent), global hemostasis tests, and flow cytometry.
  • Analysis of EV-associated coagulation and fibrinolysis in leukemias, plasma cell disorders, and myeloproliferative neoplasms.

Main Results:

  • EVs express tissue factor (TF) and phosphatidylserine (PS), initiating coagulation.
  • EV procoagulant activity in acute leukemias decreases with treatment but may persist.
  • Increased platelet-derived and TF/PS-positive EVs are linked to thrombin generation in plasma cell disorders and myeloproliferative neoplasms.

Conclusions:

  • EVs are implicated in hemostasis across diverse hematological malignancies.
  • Methodological heterogeneity hinders comparability and clinical application of EV research.
  • Standardized protocols and robust clinical studies are necessary to validate EVs as biomarkers.