Increased releasable vascular plasminogen activator and a bleeding diathesis.

Area of Science:

• Oncology
• Hematology
• Pharmacology

Background:

• Metastatic prostatic carcinoma treatment often involves hormone therapy, such as diethylstilbestrol (DES).
• Estrogen therapy, including DES, can influence hemostasis and coagulation parameters.
• Surgical interventions like orchiectomy may be necessary to manage advanced prostate cancer.

Observation:

• A 66-year-old man on high-dose diethylstilbestrol therapy experienced extensive postoperative ecchymosis after orchiectomy.
• The patient had a history of frequent bruising and skin blistering with minor trauma.
• Routine coagulation tests were normal, but specific fibrinolytic markers were abnormal.

Findings:

• Elevated alpha2-antiplasmin (132%) and fibrinogen (293 mg/dl) were noted.
• Fibrin split products were slightly elevated at 4 µg/ml.
• A significantly high level of releasable vascular plasminogen activator (3.6 CTA units/ml) was detected prior to surgery.

Implications:

• High levels of vascular plasminogen activator may predispose patients on estrogen therapy to bleeding complications, even with normal routine coagulation.
• This case highlights the importance of assessing fibrinolytic activity in patients with unexplained bleeding during hormone therapy.
• Further research is warranted to understand the relationship between estrogen, plasminogen activator, and bleeding risk in prostate cancer patients.