Studies on abnormalities of blood coagulation, fibrinolysis and their inhibitors in neoplasmas of blood and blood forming organs:Reference to F. VIII activity, F. VIII-related antigen and the ratio of F. VIII activity/F. VIII antigen
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A hemorrhagic tendency is a common feature in patients with leukemia and may occur in other forms of hematological malignancy. Bleeding in these diseases is generally associated with thrombocytopenia, but cases in which the hemorrhagic tendency was ascribed to pathological fibrinolytic activity or DIC have been described.From this point of view, the investigation on hemostatic abnormalities was carried out in 32 patients with acute leukemia (11 AML, 16 APL, 2 AM0L and 3 ALL), 31 with malignant lymphoma (stage III and IV), 13 with multiple myeloma and 20 with myeloproliferative disorders (10CML, 4CLL, 1 myelofibrosis, 3 primary thrombocythemia and 2 polycythemia vera).The diagnosis of DIC in neoplasmas of blood and blood forming organs is to be attentive because the finding in basic diseases themselves accompanied with thrombocytopenia.We studied F. VIII activity (F. VIII act.), F. VIII-related antigen (F. VIII ant.) and the ratio of F. VIII act./F. VIII ant. with other 18 hemostatic parameters: platelet count, PTT, prothrombin time, thrombotest, hepaplastintest, F. I, F. V, and F. VII were measured for coagulation system, STT (30'), FDP (HIT), plasminogen (single radial immunodiffusion method) and paracoagulation test (protamine sulphate test, ethanol gelation test and cryofibrinogen) for fibrinolytic system. Antithrombin III, alpha 1 antitrypsin and alpha 2 macroglobulin were also measured for their inhibitors by single radial immunodiffusion method.We observed a poor correlation between F. VIII act, and F. VIII ant. levels in neoplasmas of blood and blood forming organs in which the elevation of the F. VIII ant. was significantly higher than that of the F. VIII act.In most cases of DIC, F. VIII act, was various, but F. VIII ant. increased significantly, and therefore, the ratio of F. VIII act./F. VIII ant. was markedly low. A discrepancy between F. VIII act. and F. VIII ant. may be explained by consumption of F. VIII act. and accumulation of F. VIII ant., destruction of F. VIII act. and degradation of F. VIII ant. caused by plasmin, differences in the degree of catabolism of two components and so on.A discrepancy between F. VIII act. and F. VIII ant. disappered with improvement of DIC. It is suggested that the ratio of F. VIII act./F. VII ant. may be one of the most valuable parameters, not only for diagnosis but also prognosis of DIC.
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