Laboratory tests for coagulation system monitoring in a patient with β-thalassemia

Abstract

Sensitive methods for assessment of the hemostatic state are essential for providing adequate therapy to patients with β-thalassemia. The present study was designed to monitor the changes in the hemostatic state of a patient with β-thalassemia at the primary stage and under heparin treatment following splenectomy. The hemostatic state of the patient was assessed using conventional tests (activated partial thromboplastin time, prothrombin index, thrombin time), fibrinogen and D-dimer assays, thromboelastography (TEG), thrombin generation test, and a novel thrombodynamics clot growth assay. Thrombodynamics parameters indicated the hypercoagulation state on the primary evaluation which progressed after splenectomy: stationary clot growth velocity increased from 32 to 38 μm/min (normal range 20-30 μm/min). Hypercoagulation state was confirmed by Doppler echocardiography, which detected portal vein thrombosis on day 23 after surgery. The results of the other tests' parameters were in the normal ranges before splenectomy. The TEG parameters were sensitive to low molecular weight heparin (LMWH) injections; but the values were close to the normal ranges before and after injections. The thrombodynamics assay demonstrated a high sensitivity to LMWH injections, and registered a decrease of the hypercoagulability in the course of therapy (P < 0.05). TGT was not performed during LMWH therapy. This clinical case demonstrates the potential of the thrombodynamics assay to serve as a sensitive method for coagulation system monitoring and prediction of prothrombotic tendencies in patients with hemolytic anemias.

Spatial aspects of blood coagulation: Two decades of research on the self-sustained traveling wave of thrombin

“…It also remains unclear whether the self-sustained propagation of coagulation really occurred in the subsequent series of works by the same group [60,61,63,64], where the authors attempted to verify the medical applicability of a test based on the in vitro detection of spatial clot growth. Yet, the references [61][62][63][64] also lack any mention of the addition of phospholipids to PFP.…”

“…Data of the experimental measurements only strengthen the doubts of whether the results of [58][59][60][61][62][63][64] can be appropriately interpreted within the framework of the concept of self-sustained travelling wave of thrombin. For instance, the relation curves of the clot size and time obtained in [58,59,[61][62][63][64] show that the propagation of the coagulation front in those studies does not proceed 9 «The clot growth rate decreased with a decrease in TF density (Fig.…”

“…For instance, the relation curves of the clot size and time obtained in [58,59,[61][62][63][64] show that the propagation of the coagulation front in those studies does not proceed 9 «The clot growth rate decreased with a decrease in TF density (Fig. 3 B).…”

“…The majority of the work on self-sustained travelling waves of coagulation was performed by two research groups. The first one is the group of Prof. Ataullakhanov that after the initial publications [21,[33][34][35] continued to explore the processes of clot growth in non-convective systems in vitro [46-51, [56][57][58][59][60][61][62][63][64]. The second one is the group of Prof. Ismagilov that carried out a series of significant research works using the microfluidics technique [52][53][54][65][66][67][68][69][70][71].…”

Integrated laboratory coagulation tests in hypercoagulation diagnosis and thrombosis risk assessment. Part II. The sensitivity of integral tests to hypercoagulable states

“…Спонтанное свертывание и увеличение скорости роста сгустка на-блюдались у пациентов с известным риском тромбоза, страдающих лимфомами, лимфогранулематозом, тромбофилией, гемолитической анемией, острым лейкозом, инфарктом миокарда [70]; то же самое по-лучено в подробном исследовании множественной миеломы [73]. В исследовании клинического случая была показана возможность обнаружения состояния гиперкоагуляции с использованием теста тромбоди-намики при β-талассемии [74]; тромбоз воротной ве-ны развился через несколько недель после того, как у пациента было выявлено ускорение роста сгуст-ка. В некоторых из упомянутых работ проводилось сравнение результатов тромбодинамики с ТГТ и ТЭГ, которые не обнаружили гиперкоагуляции в большин-стве случаев.…”