Terapijski efekt fraxiparina i vrijednosti D–dimera tijekom liječenja DVT i TE u bolesnika s karcinomom

Thrombosis is a common complication in cancer patients. It often occurs as the first sign suggestive of a malignancy, and also during the treatment since surgery, chemotherapy and radiation therapy present an additional trigger for the development of thrombosis and/or thromboembolism. In the last five years at the University Hospital for Tumors, Zagreb, Croatia, 31 cancer patients, 12 males and 19 females, aged 41-80 years, were monitored and treated for deep vein thrombosis (DVT) and pulmonary embolism (PE). The patients were admitted for renal cancer 2, pancreatic cancer 2, colon cancer 4, thyroid cancer 1, ovarian cancer 3, breast cancer 7, melanoma 2, brain cancer 2, sarcoma 1, gastric cancer 1, cervical cancer 1, non-Hodgkin\u27s lymphoma 1 and esophageal cancer 4. DVT and PE were diagnosed preoperatively, during radiation therapy and in the course of chemotherapy in 7, 6 and 18 patients, respectively. To confirm the DVT diagnosis and suspected PE, Doppler US of the veins and spiral CT were performed, respectively. Samples of venous blood were collected from all patients into vacuteiner tubes coated with anticoagulant. Hemostasis tests were done on day 1, 3 and 7 of low-molecular-weight heparin (LMWH) therapy (Fraxiparine). Fraxiparine in the dose of 0.8 ml sc (20000 ICUAXa) was administered every eight hours for DVT, or every six hours for PE. The paper presents D-dimer (DD) values measured on the Behring BCS using reagents of the same brand. A significant decrease of DD levels during Fraxiparine therapy was compared with the patients’ clinical recovery. After administration of LMWH, initially high DD levels decreased for 30% and 64% on day 3 and 7, respectively. The decrease of DD levels was accompanied with clinical recovery of the patients.Tromboza je učestala komplikacija u bolesnika s karcinomom. Nastaje često kao prvi znak maligne bolesti, ali i u tijeku liječenja jer su operacija, kemoterapija i zračenje dodatni otponac za razvoj tromboze i/ili tromboembolije. U Klinici za tumore je unazad pet godina zbog duboke venske tromboze (DVT) i plućne embolije (PE) praćen i liječen 31 bolesnik (12 muškaraca i 19 žena) u dobi od 41–80 godina, s karcinomom bubrega 2, gušterače 2, crijeva 4, štitnjače 1, jajnika 3, dojke 7, melanomom 2, rakom mozga 2, sarkomom, rakom želuca, ušća maternice i ne Hodgkinovim limfomom po 1 i 4 bolesnika s tumorima ždrijela. Preoperativno su DVT i PE dijagnosticirane u 7 bolesnika, 6 u vrijeme zračenja i 18 tijekom kemoterapije. Radi potvrde dijagnoze DVT napravljen je ultrazvučni dopler vena, a kod sumnje na PE, spiralni CT. Svim bolesnicima uzeti su uzorci venske krvi u vacuteiner epruvete s antikoagulansom. Testovi hemostaze napravljeni su prvog, trećeg i sedmog dana terapije heparinom male molekularne mase (Fraxiparine). Fraxiparine je primijenjen u dozi od 0,8 ml sc (20000 ICUAXa) svakih osam sati kod DVT, odnosno svakih šest sati kod PE. U radu su prikazane vrijednosti DD mjerene ure|ajem Behring BCS s reagensima istog proizvo|ača. Znatan pad vrijednosti DD tijekom terapije Fraxiparinom uspore|en je s kliničkim oporavkom bolesnika. Visoke početne vrijednosti DD nakon primjene LMWH pale su trećega dana za 30%, a sedmoga dana za 64%. Klinički oporavak bolesnika pratio je smanjenje vrijednosti DD

Terapijski efekt fraxiparina i vrijednosti D–dimera tijekom liječenja DVT i TE u bolesnika s karcinomom

Thrombosis is a common complication in cancer patients. It often occurs as the first sign suggestive of a malignancy, and also during the treatment since surgery, chemotherapy and radiation therapy present an additional trigger for the development of thrombosis and/or thromboembolism. In the last five years at the University Hospital for Tumors, Zagreb, Croatia, 31 cancer patients, 12 males and 19 females, aged 41-80 years, were monitored and treated for deep vein thrombosis (DVT) and pulmonary embolism (PE). The patients were admitted for renal cancer 2, pancreatic cancer 2, colon cancer 4, thyroid cancer 1, ovarian cancer 3, breast cancer 7, melanoma 2, brain cancer 2, sarcoma 1, gastric cancer 1, cervical cancer 1, non-Hodgkin\u27s lymphoma 1 and esophageal cancer 4. DVT and PE were diagnosed preoperatively, during radiation therapy and in the course of chemotherapy in 7, 6 and 18 patients, respectively. To confirm the DVT diagnosis and suspected PE, Doppler US of the veins and spiral CT were performed, respectively. Samples of venous blood were collected from all patients into vacuteiner tubes coated with anticoagulant. Hemostasis tests were done on day 1, 3 and 7 of low-molecular-weight heparin (LMWH) therapy (Fraxiparine). Fraxiparine in the dose of 0.8 ml sc (20000 ICUAXa) was administered every eight hours for DVT, or every six hours for PE. The paper presents D-dimer (DD) values measured on the Behring BCS using reagents of the same brand. A significant decrease of DD levels during Fraxiparine therapy was compared with the patients’ clinical recovery. After administration of LMWH, initially high DD levels decreased for 30% and 64% on day 3 and 7, respectively. The decrease of DD levels was accompanied with clinical recovery of the patients.Tromboza je učestala komplikacija u bolesnika s karcinomom. Nastaje često kao prvi znak maligne bolesti, ali i u tijeku liječenja jer su operacija, kemoterapija i zračenje dodatni otponac za razvoj tromboze i/ili tromboembolije. U Klinici za tumore je unazad pet godina zbog duboke venske tromboze (DVT) i plućne embolije (PE) praćen i liječen 31 bolesnik (12 muškaraca i 19 žena) u dobi od 41–80 godina, s karcinomom bubrega 2, gušterače 2, crijeva 4, štitnjače 1, jajnika 3, dojke 7, melanomom 2, rakom mozga 2, sarkomom, rakom želuca, ušća maternice i ne Hodgkinovim limfomom po 1 i 4 bolesnika s tumorima ždrijela. Preoperativno su DVT i PE dijagnosticirane u 7 bolesnika, 6 u vrijeme zračenja i 18 tijekom kemoterapije. Radi potvrde dijagnoze DVT napravljen je ultrazvučni dopler vena, a kod sumnje na PE, spiralni CT. Svim bolesnicima uzeti su uzorci venske krvi u vacuteiner epruvete s antikoagulansom. Testovi hemostaze napravljeni su prvog, trećeg i sedmog dana terapije heparinom male molekularne mase (Fraxiparine). Fraxiparine je primijenjen u dozi od 0,8 ml sc (20000 ICUAXa) svakih osam sati kod DVT, odnosno svakih šest sati kod PE. U radu su prikazane vrijednosti DD mjerene ure|ajem Behring BCS s reagensima istog proizvo|ača. Znatan pad vrijednosti DD tijekom terapije Fraxiparinom uspore|en je s kliničkim oporavkom bolesnika. Visoke početne vrijednosti DD nakon primjene LMWH pale su trećega dana za 30%, a sedmoga dana za 64%. Klinički oporavak bolesnika pratio je smanjenje vrijednosti DD

Vrijednosti D-dimera u bolesnika s metastatskim karcinomom jetre prije i poslije kirurškog zahvata

Vein thrombosis is a common complication in patients with cancer. Tumor cells produce or have expressed on their surface many procoagulant factors such as tissue factor and cancer procoagulant. Besides procoagulant activity of the tumor cells, surgical procedure, chemotherapy treatment, immobility and disease stage are additional factors for thrombosis development. Laboratory test used in diagnosis of thrombosis is D-dimer level measurement. Because of its high negative predictive value it has been used to exclude deep vein thrombosis in patients presented with deep vein thrombosis symptoms. Since its levels could be increased in patients with cancer, using this test in cancer population should be taken with caution. The aim of this study was to asses D-dimer levels in a specific group of patients with metastatic liver cancer before and after surgery, and determine the difference between these two measurements. The study included 43 patients of both sexes, average age 68 (46 – 80) years, with metastatic liver carcinoma. Concentrations of D-dimer after surgery were higher than before surgery accounting for 2851 (617 – 3650) μg/L and 364 (229-615) μg/L, respectively, P < 0.001. The lowest difference between measurements was 51 μg/L and the highest one was 10644 μg/L. We confirmed the trend in D-dimer levels before and after surgery reported in the literature and showed that these values can vary in a wide range.Venska tromboza česta je komplikacija u bolesnika s karcinomom. Tumorske stanice proizvode ili su im na površini izraženi brojni prokoagulcijski faktori poput tkivnog faktora i tumorskog prokoagulanta. Uz prokoagualcijsku aktivnost tumorskih stanica, kirurški zahvat, kemoterapija, nepokretnost i stadij bolesti dodatni su faktori koji utječu na nastanak tromboze. Mjerenje koncentracije D-dimera laboratorijska je pretraga koja se provodi u dijagnostici venske tromboze. Zbog svoje visoke negativne prediktivne vrijednosti, primjenjuje se kako bi se isključilo postojanje duboke venske tromboze u bolesnika s tim simptomima. S obzirom na to da vrijednosti D-dimera mogu biti povećane u bolesnika s karcinomom, rezultate ove pretrage u toj populaciji bolesnika valja oprezno razmotriti. Cilj ovog ispitivanja bio je procijeniti vrijednosti D-dimera u odre|enoj skupini bolesnika s metastatskim karcinomom jetre prije i poslije operacije te utvrditi razliku između ta dva mjerenja. Ispitivanje je obuhvatilo 43 bolesnika oba spola, prosječne dobi od 68 (46-80) godina, s metastatskim karcinomom jetre. Koncentracija D-dimera nakon operacije bila je veća nego prije operacije, tj. nakon operacije iznosila je 2851 (617 – 3650) μg/L, a prije operacije 364 (229-615) μg/L, P < 0,001. Najmanja razlika izme|u dva mjerenja iznosila je 51 μg/L, a najveća 10644 μg/L. Potvrdili smo kretanje koncentracije D-dimera prije i poslije kirurškog zahvata kao što je opisano u literaturi te pokazali da vrijednosti mogu varirati u velikom rasponu

Does rotation thrombelastometry (ROTEM) improve early prediction of coagulopathy in breast tumor?

Background and purpose: Breast Cancer is the second most common cancer among women after skin carcinoma. Incindence in Croatia in 2012 was 2227 new cases per year with mortality 1033 women per year. One of the most pronaunced caracteristics of cancers in general are changes in coagulation factors. Except usual coagulation factors there is thrombelasometry which is dynamic method for evaluation of coagulation factors. We have been used thrombelastometry to see differences in coagulation factors for carcinomas and benign breast diseases. Materials and methods: We included 132 patients with benign and malignant breast diseases in Institute of Thumors, Clinical Hospital Center “Sisters of Mersy”, Zagreb, Croatia gathered in prospective study in 2012/2013. We compared differences in coagulation parameters with thrombelastometry and usual coagulation factors in earlier mentioned two groups of patients with Mann-Whitney U test what is graficly described with Box and Whiskers plots and correlatio coefficients are described in table with Spearman correlation coefficients. Results: A5,A10,A15,A20,A25 and A30, MCF and AUC intem are significatly higher in malignant breast disease patients. Significant trend of elevation of these values is present in both patients groups, but those are sigificantly higher in patient group with malignant tumors. While in patients group with malignant tumors almost every correlation coefficients between A5-A30, MCF and AUC intem and cogulation markers are significant, those correlations among patients with benign diseases are not significant. Those values suggests that A5-A30, MCF and AUC intem are significatly correlated with most common used coagulation markers only in patients with malignant diseases. Conclusions: There are differences in coagulation factors in patients with benign and malignant breast diseases. Trend of elevation of markers of coagulation values is present in both disease, but significantly higher values are in malignant tumor. Our results are based on small numbers and larger number of patients with precise data of coagulation parameters are still needed

Pojavnost kolorektalnog karcinoma i ABO sustav krvnih grupa

The distribution of the AB0 blood group system (A, B, 0 or AB) and Rhesus type (Rh-positive or Rh negative Rh+ or Rh-) was studied retrospectively in 981 patients with colorectal cancer. The distribution of ABO and Rh blood groups among the observed patients was similar to the distribution among the normal population in Croatia. No specific relationship has been established between the blood group type and colorectal cancer. There were significant differences in the proportions of the various ABO blood groups in Rh-positive and Rh-negative patients (chi-square = 15.18; p = 0.0017), with the A/O ratio of 1.15 and 0.75 in Rh-positive and Rh-negative patients, respectively. Further analysis confirmed that these significant differences were due to the O Rh-negative blood group. No significant difference could be found in the ABO distributions with regard to tumor stage.U ovoj studiji retrospektivno je proučavana raširenost ABO i Rh krvnih grupa u 981 bolesnika oboljelih od kolorektalnog karcinoma. Raširenost ABO i Rh krvnih grupa u bolesnika bila je slična raširenosti krvnih grupa u zdravoj populaciji u Hrvatskoj. Nije utvrđena posebna povezanost između krvnih grupa i kolorektalnog karcinoma. Značajne razlike pronađene su u udjelima različitih ABO krvnih skupina u Rh pozitivnih i Rh-negativnih bolesnika (hi-kvadrat = 15,18, p = 0,0017) s A/O omjerom 1,15 u Rh+ i 0,75 u Rh- bolesnika. Daljnja analiza potvrdila je da je uzrok značajnim razlikama O Rh-negativna krvna grupa. Nije se mogla utvrditi povezanost između krvnih grupa i stadija bolesti

Povezanost ABO krvne grupe, Rh faktora i raka dojke u bolesnika liječenih u Klinici za tumore

The study is a retrospective review of 407 female patients with primary breast cancer and 320 female patients with benign breast changes who were surgically treated in the University Hospital for Tumors during calendar year 2009. We investigated a possible link between the ABO blood group and breast cancer. All patients had their blood group (ABO antigen and RhD) determined, as a part of preoperative treatment, at the Department for Transfusion Medicine of the University Hospital for Tumors. Erythrocyte antigens were determined using the plate and microcard technique. The mean age of all patients was 62.1 years (range 30 – 95 yrs). No statistically significant differences were found between patients who have cancer and those who have not in the frequency of certain blood groups (χ = 2.525, df = 3, p = 0.471). Also, there was no statistically significant difference between patients with cancer and those without cancer in the frequency of Rh (χ = 2.343, df = 1, p = 0.076). We found a statistically significant but slight correlation between Rh factor and HER2/neu (p=0.038), r=0.106. According to the correlation coefficient, the correlation between these two variables is none or slight. The causal relationship between the two parameters remains unknown and should be tested in a larger study.Ispitivanje je retrospektivno obuhvatilo 407 bolesnica s primarnim rakom dojke i 320 bolesnica s dobroćudnim promjenama u dojci koje su kirurški liječene u Klinici za tumore u 2009. godini. Proučavali smo moguću povezanost između ABO krvne grupe i raka dojke. Krvna grupa (ABO antigen i RhD) utvrđena je svim bolesnicama u okviru prijeoperacijske obrade u Službi za transfuzijsku medicinu Klinike za tumore. Antigeni na površini eritrocita određivani su na pločama i u mikrokarticama. Prosječna dob bolesnica iznosila je 62;1 godina (raspon 30 – 95 godina). S obzirom na učestalost određenih krvnih grupa nisu utvrđene statistički značajne razlike između bolesnica koje imaju rak i onih koje ga nemaju (χ = 2;525; df = 3; p = 0;471). Statistički značajnih razlika u učestalosti Rh faktora između bolesnica s rakom i onih koje ga nemaju; također; nije bilo (χ = 2;343; df = 1; p = 0;076). Otkrivena je statistički znakovita; iako slaba korelaciju između Rh faktora i HER2/neu (p=0;038); r=0;106. Prema koeficijentu korelacije između te dvije varijable korelacije ili nema ili je slaba. Uzročna povezanost između ta dva parametra i dalje je nepoznata i treba je ispitati na većem uzorku

Duboka venska tromboza gornjih ekstremiteta kod onkoloških bolesnika – prikaz slučaja

Upper extremity deep venous thrombosis (UEDVT) makes approximately 4% to 20% of all venous thromboembolism (VTE). Cancer is the most relevant acquired thrombotic risk factor of VTE, because of its myriad of prothrombotic molecules released by neoplastic cells. In our case report we presented deep venous thrombosis (DVT) of the upper limb that is not associated with central venous catheter (CVC) or receiving chemotherapy or hormonal therapy. A 55-year old female patient was admitted to our Department of Transfusion Medicine because of the swelling and pain in the left arm. One month earlier she underwent left segmentectomy and axillary dissection because of the breast cancer. Physical examination revealed left arm swelling and pressure pain. D-dimers were 770 μg/L (normal range 170-500 μg/L). Duplex ultrasound revealed thrombogenic mass in the left brachial vein, without total obstruction. She was treated with low molecular mass heparin (LMWH) and warfarin. This uncommon presentation of hypercoagulable state in cancer patient points out one more time the importance of prophylactic use of anticoagulants in any hospitalized cancer patient receiving anticancer therapy. In University Hospital for Tumors we recommend anticoagulation prophylaxis for all cancer patients undergoing surgery. We use low doses of LMWH eight hours after surgery and once daily until discharge.Na duboku vensku trombozu gornjih ekstremiteta (DVTGE) otpada 4% - 20% svih slučajeva venskog tromboembolizma (VTE). Maligna bolest je značajniji stečeni rizični factor za razvoj VTE zbog protrombotskih tvari koje otpuštaju neoplastične stanice. U ovom radu prikazali smo slučaj bolesnice koja je razvila duboku vensku trombozu (DVT) ruke koja nije povezana sa središnjim venskim kateterom, aplikacijom kemoterapije ili hormonske terapije. 55 - godišnja bolesnica primljena je na Zavod za transfuzijsku medicinu zbog otekline i boli u lijevoj ruci . Mjesec prije bila je podvrgnuta kirurškom zahvatu zbog karcinoma dojke, učinjena je segmentektomija s disekcijom aksile. Fizikalnim pregledom nađe se otok lijeve ruke. Vrijednost D- dimera kod prijema bila je 770 g / L (normalni raspon 170-550 g / L). Obojanom ultrazvučnom obradom nađu se trombogene mase u lijevoj brahijalnoj veni, bez potpune opstrukcije. U terapiju je uveden niskomolekularni heparin (LMWH), a potom varfarin. Ovakva rijeđa posljedica hiperkoagulabilnog stanja kod onkoloških bolesnika još je jedna potvrda važnosti procjene rizika i profilaktičke upotrebe antikoagulantne terapije.U Klinici za tumore preporuča se antikoagulantna terapija kod svih bolesnika podvrgnutih kirurškom liječenju. Koristi se LMWH osma sati nakon operacije, a potom jednom dnevno do otpusta

Duboka venska tromboza gornjih ekstremiteta kod onkoloških bolesnika – prikaz slučaja

Upper extremity deep venous thrombosis (UEDVT) makes approximately 4% to 20% of all venous thromboembolism (VTE). Cancer is the most relevant acquired thrombotic risk factor of VTE, because of its myriad of prothrombotic molecules released by neoplastic cells. In our case report we presented deep venous thrombosis (DVT) of the upper limb that is not associated with central venous catheter (CVC) or receiving chemotherapy or hormonal therapy. A 55-year old female patient was admitted to our Department of Transfusion Medicine because of the swelling and pain in the left arm. One month earlier she underwent left segmentectomy and axillary dissection because of the breast cancer. Physical examination revealed left arm swelling and pressure pain. D-dimers were 770 μg/L (normal range 170-500 μg/L). Duplex ultrasound revealed thrombogenic mass in the left brachial vein, without total obstruction. She was treated with low molecular mass heparin (LMWH) and warfarin. This uncommon presentation of hypercoagulable state in cancer patient points out one more time the importance of prophylactic use of anticoagulants in any hospitalized cancer patient receiving anticancer therapy. In University Hospital for Tumors we recommend anticoagulation prophylaxis for all cancer patients undergoing surgery. We use low doses of LMWH eight hours after surgery and once daily until discharge.Na duboku vensku trombozu gornjih ekstremiteta (DVTGE) otpada 4% - 20% svih slučajeva venskog tromboembolizma (VTE). Maligna bolest je značajniji stečeni rizični factor za razvoj VTE zbog protrombotskih tvari koje otpuštaju neoplastične stanice. U ovom radu prikazali smo slučaj bolesnice koja je razvila duboku vensku trombozu (DVT) ruke koja nije povezana sa središnjim venskim kateterom, aplikacijom kemoterapije ili hormonske terapije. 55 - godišnja bolesnica primljena je na Zavod za transfuzijsku medicinu zbog otekline i boli u lijevoj ruci . Mjesec prije bila je podvrgnuta kirurškom zahvatu zbog karcinoma dojke, učinjena je segmentektomija s disekcijom aksile. Fizikalnim pregledom nađe se otok lijeve ruke. Vrijednost D- dimera kod prijema bila je 770 g / L (normalni raspon 170-550 g / L). Obojanom ultrazvučnom obradom nađu se trombogene mase u lijevoj brahijalnoj veni, bez potpune opstrukcije. U terapiju je uveden niskomolekularni heparin (LMWH), a potom varfarin. Ovakva rijeđa posljedica hiperkoagulabilnog stanja kod onkoloških bolesnika još je jedna potvrda važnosti procjene rizika i profilaktičke upotrebe antikoagulantne terapije.U Klinici za tumore preporuča se antikoagulantna terapija kod svih bolesnika podvrgnutih kirurškom liječenju. Koristi se LMWH osma sati nakon operacije, a potom jednom dnevno do otpusta

Koncentracija feritina u serumu kod bolesnika sa solidinim tumorima

Ferritin is a positive acute phase reactant. It is produced and secreted by various cells such as hepatocytes, macrophages and cancer cells. This was a retrospective study which included 46 patients with solid tumors who were tested for ferritin level in plasma. The measured value of the ferritin concentration in plasma of patients was in the range from 5.98 to 850.78 μg/L, and the average measured value was 174.62 μg/L. For the control group, we also included 46 subjects. The measured value of ferritin in the control group was in the range from 5.94 to 351.54 μg/Ll, and the average measured value was 63.17 μg/L. There is a statistically significant difference between the two groups. Our data shows that the highest level of ferritin was measured in patient with breast cancer. By many studies done until now it is shown that iron metabolism is dysregulated in cancer, and that changes occur in both intracellular and extracellular ferritin.Feritin je reaktant akutne faze. Proizvode ga i luče različite stanice, jetrene, makrofagi i neoplastične stanice. U ovoj retrospektivnoj studiji obrađeni su podaci 46 bolesnika sa solidnim tumorima kojima je određena koncentracija feritina u serumu. Koncentracija feritina kod bolesnika kretela se u rasponu od 5,98 do 850,78 g / L, a prosječna izmjerena vrijednost je 174,62 g / L. Kontrolan skupina je 46 zdravih osoba. Izmjerena vrijednost feritina u kontrolnoj skupini kretala se u rasponu 5,94 do 351,54 g / Ll, a prosječna izmjerena vrijednost je 63.17 g / L. Postoji statistički značajna razlika između dvije skupine. Naši podaci pokazuju da je najviša razina feritina izmjerena kod bolesnice s rakom dojke. Mnoge studije učinjene do sada pokazale su da postoji poremećaj metabolizma željeza kod malignih stanja, te da dolazi do promjena i unutarstaničnog i izvanstaničnog feritina