Clinical Significance Of Determination Of Plasma Protein C, Protein S And Antithrombin ? In Patients With ?-thalassemia

Objective To detect plasma endothelial cell activation molecular markers:E-selectin;coagulation activation parameters: thrombin antithrombin complex(TAT),tissue factor(TF)and tissue factor pathway inhibitor(TFPI);platelet activation markers ?-thromboglobulin(?-TG)and P-selectin;natural anticoagulants: Protein C(PC),Protein S(PS)and Antithrombin III(AT-III);and platelet count(PLT)and fibrinogen(FIB)in patients with ?-thalassemia.To investigate the blood coagulation status and prothrombotic factors in patients with ?-thalassemia in Guangxi autonomous region,and to discuss the recommendations for thromboprophylaxis.Methods Plasma levels of E-selectin,TAT,TF,TFPI,?-TG,P-selectin,and PC,PS,and AT-III were determined by enzyme-linked immunosorbent assay in69 patients with thalassemia.69 patients with ?-thalassemia included 39 patientswith major ?-thalassemia(?-TM)and 30 patients with intermediate?-thalassemia(?-TI).Twenty-seven healthy subjects served as controls.Results 1 ?(1)PLT: The PLT of the ?-TM and ?-TI patients after splenectomy had higher platelet counts than ?-TM and ?-TI patients with uncleaved spleen(P<0.05),respectively;the PLT of the ?-TM and ?-TI without splenectomy compared with control group had no statistics differences(P>0.05).(2)FIB:Compared with fibrinogen level in ?-TI group after splenectomy,the levels of fibrinogen in plasma in ?-TM as well as in the normal control group were significantly decreased,and the difference was statistically significant.(P<0.05);FIB among other groups was not statistically significant(P>0.05).2 ? Plasma E-selectin,TAT,TF,TFPI,?-TG,P-selectin: Regardless of splenectomy,the levels of plasma of E-selectin,TAT,TF,TFPI,?-TG and P-selectin were significantly higher than the normal control group(P<0.05).(3?Plasma PC,PS,and AT-III:(1)The plasma levels of PC,PS,and AT-III in patients with ?-TM and ?-TI were significantly lower than those in the normal control group,regardless of splenectomy(P < 0.05).(2)Regardless of splenectomy,plasma levels of PC,PS,and AT-III were significantly lower in?-TI patients than in ?-TM patients(P<0.05),especially in?-intermediate patients with splenectomy.(3)The levels of plasma PC,PS,and AT-III in ?-TM group with splenectomy were significantly lower than those in?-TM group without splenectomy(P<0.05).Moreover,the levels of plasma PC,PS,and AT-III in ?-TI group with splenectomy were significantly lower than thosein?-TI group without splenectomy(P<0.05).4?Pearson correlation analysis:(1)In ?-thalassemia group,there was a significant positive correlation between plasma E-selectin and P-selectin(P<0.05).Plasma TAT,TF,TFPI and ?-TG were positively correlated among each other(P<0.05).(2)Plasma PC and PS were positively correlated with FIB,respectively.In addition,the plasma PC was positively correlated with PS.AT-III was significantly negatively correlated with PLT,TAT,TF,TFPI and?-TG(P<0.05),respectively.Conclusion Patients with ?-thalassemia had thrombocytosis after splenectomy,and the plasma fibrinogen level was decreased in patients with?-intermediate thalassemia who undergo splenectomy.Whether or not splenectomy was performed,plasma levels of E-selectin,TAT,TF,TFPI,?-TG,and P-selectin were elevated,and levels of PC,PS,and AT-III were decreased in?-thalassemia patients,especially in?-intermediate patients with splenectomy.In patients with ?-thalassemia,endothelial cells and platelets were activated,natural anticoagulants were reduced,and contributed to hypercoagulability,and splenectomy may increase the susceptibility to thrombosis in ?-TI patients.