Retrospective Survey of Hemostatic Complications in 680 Patients Undergoing Hematopoietic Stem-Cell Transplantation (HSCT)

BACKGROUND: Hemostatic disorders are common and potentially fatal complications in patients undergoing hematopoietic stem-cell transplantation (HSCT). Limited data exist on early diagnosis and prevention of these complications. In this study, we retrospectively investigated the outcome and risk factors associated with thrombotic and bleeding complications in HSCT recipients. METHODS: From April 2004 to December 2011, 680 hematologic patients receiving HSCT were enrolled in the study, and their clinical manifestation and laboratory parameters were analyzed for evaluating the outcome of hemostatic complications and related risk factors. RESULTS: Overal incidence of thrombotic complication, which included 12 veno-occlusive diseases (VOD), 2 transplantation related thrombotic microangiopathy (TA-TMA), 1 pulmonary embolism (PE) and 1 deep vein thrombosis (DVT), was 2.4% (16 cases).  The overall mortality after thrombotic events was 68.8% (11 cases) in all HSCT recipients with thrombotic complications. A total of 510 HSCT recipients (72.5%) developed bleeding events, including minor bleeding of 67.1%, moderate bleeding of 28.4%, and severe bleeding of 3.9% of all bleeding patients. By bleeding sites, 218 patients developed hemorrhagic cystitis. Other organs of hemorrhage involved skin or mucosa (46.5%), gastrointestinal tract (21.1%), vagina (9.3%), and respiratory tract (1.3%). By risk factors analysis, CD33 mAb use and preparative regimen containing total body irradiation were significantly associated with the occurrence of thrombotic disorders (P<0.05). Thrombocytopenia, grade 2-4 acute graft-versus-host disease (aGVHD), allogeneic transplantation and infection were independent risk factors for bleeding complication (P<0.05). Polyomavirus and grade 2-4 aGVHD were risk factors for hemorrhagic cystitis (P<0.05). The number of hemorrhagic sites was significantly correlated with bleeding severity (P<0.05). Neither thrombotic nor bleeding disorders was correlated with age, disease category, gender, transplantation types, routine hemostatic parameters, or biochemical indicators. Survival rate was correlated with the bleeding site and intensity of bleeding disorders (P<0.01). Respiratory and gastrointestinal bleeding independently increased the mortality of HSCT recipients, while overal cumulative survival was decreased in patients with thrombotic complications. In addition, PAI-1 level in the HSCT recipients with thrombotic complications were significantly higher than other complications (P<0.01). CONCLUSIONS: Our study suggested that HSCT patients with thrombotic complications experienced high mortality while the HSCT recipients with bleeding disorders had high morbidity.  Hence, early diagnosis and therapy of hemostatic complications are crucial to improve the prognosis of HSCT recipients.