Risk factors detection in chronic thromboembolic pulmonary hypertension, a tool for risk quantification?

BACKGROUND

Chronic thromboembolic pulmonary hypertension (CTEPH) is characterized by chronic thromboembolic obstruction in the pulmonary bed. The definitive pathogenesis remains incompletely explained, although multiple risk factors of CTEPH have been identified. The purpose of the study was to evaluate the risk profile of patients with CTEPH and the representativeness of risk factors, identify possible new CTEPH risk factors and specify the epidemiology of CTEPH in our country.

METHODS

In 81 patients with CTEPH, well known risk factors were analyzed, and a detailed analysis of selected hematological parameters was investigated at a specialized hematology laboratory.

RESULTS

CTEPH risk factors were identified as follows: pulmonary embolism (PE), deep vein thrombosis (DVT), thyreopathy, blood type other than "0", inflammatory bowel disease, malignancy, splenectomy, pacemaker. When compared to healthy controls, the following was observed: a significant decrease in platelet count, higher mean platelet volume, higher spontaneous platelet aggregation, increase in von Willebrand factor and fibrinogen. The median of risk factors representativeness was 3 (PE, DVT, blood type other than "0"). The prevalence of CTEPH in adult population in our country is estimated to be 1.8 per 100,000 inhabitants.

CONCLUSION

In the study we confirmed multiple established risk factors of CTEPH, set their representativeness, identified some platelet abnormalities which could be a potential new risk marker and specified the prevalence of CTEPH (Tab. 5, Ref. 35).

General changes in hemostasis in gastric cancer

Disorders of haemostasis and haemocoagulation are often seen in patients with cancer as a part of paraneoplastic syndrome. Thrombotic and/or haemorrhagic complications are the second most common cause of mortality in patients with cancer. The evaluation of the haemostatic parameters of 67 patients with gastric cancer have indicated tendency to thrombophilia and activation of intravascular coagulation, of which 31.3% showed tendency to hypercoagulation and 47.8% disseminated intravascular coagulation (DIC). Only 7.5% of subjects have yielded normal laboratory findings while 5.9% of patients had DIC with remarkable hypocoagulation. Thrombocytosis, platelet hyperaggregability and elevation of beta-thromboglobulin are the indicators of changes in primary haemostasis and elevation of thrombomodulin indicates vascular wall damage. Lower antithrombin III levels, C-protein and S-protein in plasma have indicated lower antithrombotic potential in patients with gastric cancer. It can be concluded that patients suffering from gastric cancer are at higher risk of thromboembolism as for haemorrhagic diathesis (20.1% thromboembolism, 11.94% fatal thromboembolic events vs 5.9 % haemorrhagic diathesis) (Tab. 5, Ref. 22). Full Text (Free, PDF) www.bmj.sk.

Local changes in hemostasis in patients with gastric cancer

Disorders of haemostasis and haemocoagulation are often seen in cancer patients as a part of the paraneoplastic syndrome. This study describes a novel compound that activates coagulation and also inhibits fibrinolytic system and fibrin degradation products in the gastric juice of 33 patients with gastric cancer. Similar, but less pronounced changes have been found in gastric juice of patients with gastric precancerosis. Procoagulant activity, induced by pathologically changed cells or monocytes, macrophages from tumor stroma, indicates the activation of local coagulation with the production of fibrin. It can be concluded that the local changes of coagulation and fibrinolysis may precede coagulopathies in cancer patients (Tab. 2, Ref. 15). Full Text (Free, PDF) www.bmj.sk.

Diagnostic approach to hypercoagulable states

The primary hypercoagulable states are inherited thrombotic disorders, resulting from mutations in genes encoding a plasma protein component of one of the coagulation mechanisms. The anticoagulant pathways most frequently involved include antithrombin III, protein C, and protein S deficiencies and activated protein C (APC) resistance. Around 80 % of all individuals with APC resistance carry a mutation of the factor V gene. Abnormalities in procoagulant pathways mostly concern elevated levels and/or function of procoagulant factors. Elevation in plasma prothrombin (FII) levels is associated with a FII gene mutation. Hyperhomocysteinemia as a risk factor for thrombosis is determined by genetic or dietary factors. The acquired or secondary hypercoagulable states consist of a heterogeneous group of disorders with an increased risk for developing thrombosis. Many underlying conditions (e.g., malignancies) may induce changes in the coagulation system. The risk of thrombosis is increased in individuals with antiphospholipid antibodies. They are found in about one-half of patients with systemic lupus erythematosus, but also in the course of infections, neoplastic diseases, and sometimes in apparently normal subjects. A definite molecular abnormality of hypercoagulable states can be identified in the special coagulation laboratory, using two types of molecular risk factors for thrombosis (genetic factors and abnormal laboratory phenotypes). Its recognition is useful for a prevention and/or therapy of thrombosis (Tab. 4, Ref. 10).

Serum transferrin receptor in diagnosis of iron deficiency

OBJECTIVE

The aim of the present study is to assess the diagnostic value of the serum transferrin receptor in distinguishing IDA (iron deficiency anemia) from ACD (anemia of chronic diseases) and combination of IDA and ACD (COMBI anemia) as compared to conventional laboratory tests of iron metabolism.

BACKGROUND

Serum iron and serum ferritin are tests most commonly used for the detection of iron deficiency, however their values may be falsely changed. Serum fransferrin receptor (sTfR) has been introduced as a new tool, and its values are not affected by an increase in cytokine production in ACD patients.

METHODS

In the retrospective study, 39 patients with IDA, 29 patients with ACD and 25 patients with COMBI, were evaluated using iron status tests including sTfR assay. The control group consisted of 33 healthy adults.

RESULTS

Serum iron values in IDA, ACD and COMBI groups were not significantly different. Serum ferritin values distinguished IDA from ACD reliably but the diagnostic usefulness of ferritin measurements in ACD and COMBI patients is limited for their large variation breadth. Serum TfR concentrations were elevated in the vast majority of the IDA and COMBI patients and distinguished them from the ACD group. The distinguishing of IDA from COMBI of the single basis of iron status is still difficult. However, the detection of iron deficiency in COMBI patients is very useful for the initiation of replacement therapy.

CONCLUSION

We conclude that sTfR measurement is a valuable non-invasive tool for the diagnosis of iron depletion and an attractive supplement to more conventional laboratory tests in the detection of depleted iron stores. (Tab. 2, Fig. 3, Ref. 25.).