engleski

Immune-mediated coagulation disorders in cancer patients

Cancer patients express a diversity of coagulation disorders, sometimes as a first sign of malignancy. The incidence of subsequent occult cancer is 13% in the group of patients with symptomatic idiopathic venous thromboembolism. Procoagulative activity results from neoangiogenesis related to the tumour growth, and tumour induced extrinsic coagulation pathway activation. It is characterised with increased production of fibrinogen and other coagulation cascade components, followed by enhanced fibrinolytic system activity. An increased platelet activation and turnover are commonly observed. A liver dysfunction due to adjuvant chemotherapy, radiotherapy, postoperative hypoproteinemia, and defective myelopoiesis in several neoplastic processes may further pronounce coagulation disbalance, resulting in hypercoagulability and/or bleeding. The association between autoimmune coagulation disorders and neoplastic diseases, especially lymphoproliferative neoplasm is well known. Elevated antiphospholipid antibodies levels, a reliable marker of cancer activity, were found in 40 % of patients with non-Hodgkin's lymphoma at diagnosis. Autoimmune haemolytic anaemia, immune thrombocytopenia, thrombotic thrombocytopenic purpura and lupus anticoagulant may be characteristic complications in patients with malignancies. These are somewhat different than other cancer related coagulopathies, usually correlating with poor survival. A successful treatment or surgical removal of underlying malignancy may result in improvement of coagulation disorder. This article discusses biochemical base, clinical presentation, diagnostics, and complications of immunologically linked coagulation disorders in cancer patients.

autoimmune coagulation disorders, cancer patients

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