Thrombosis and coagulation abnormalities associated with cancer

Abnormalities of hemostasis and malignancy have been recognized since the 19th century. Thrombosis and hypercoagulability are reported in as many as 60 percent of patients with malignancies. Decreased levels of protein coagulation factors, circulating anticoagulants and platelet numbers, and function changes are reported. The purpose of this work is to report a case of portal thrombosis in a patient with a myeloproliferative disorder and to review protein coagulation and platelet abnormalities associated with malignancies. The clinical laboratory assessment of these abnormalities is reviewed. The patient was a 59-year-old woman who was referred to the Vanderbilt University Medical Center with a diagnosis of septic portal vein thrombosis. After evaluation, it turned out that she had a myeloproliferative disorder and portal vein thrombosis secondary to that. Hypercoagulative states have been reported with a variety of carcinomas and other neoplasms. They may or may not be associated with acquired or genetic deficiencies of antithrombin III, protein C and/or S. Factors I, V, VIII:C, IX, and XI have all been reported as being elevated and implicated in hypercoagulability in patients with neoplasms. Increased platelet turnover and decreased survival have been noted in patients with disseminated tumors. Thromboses with lysis of the thrombus may be monitored by increased levels of fibrin degradation products, D-dimer, fibrinopeptides A and B, and platelet factor IV among others. There are frequently decreases in coagulation inhibitors including antithrombin III, protein C and protein S. These changes lead to a state of low-grade disseminated intravascular coagulopathy where thrombus formation is a more frequent occurrence than is hemorrhage.(ABSTRACT TRUNCATED AT 250 WORDS)