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Unique Thrombotic and Hemostatic Complications Associated with Allogeneic Hematopoietic Stem Cell Transplantation

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Book cover Allogeneic Stem Cell Transplantation

Part of the book series: Contemporary Hematology ((CH))

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Abstract

Hemorrhage and thrombosis are two potential sources of morbidity and mortality of hematopoietic stem cell transplantation (HSCT). In this chapter, we will examine the incidence, pathophysiology, and treatment of bleeding and non-physiologic clot formation in the setting of HSCT. The focus of this work will be to emphasize the unique hemorrhagic and thrombotic complications associated with HSCT, and not hemorrhage and thrombosis due to intrinsic disorders.

The patient, in a constitutive anticoagulated intravascular state, responds appropriately to blood vessel damage and hemorrhage with clot formation and hemostasis, blood vessel repair and subsequent thrombolysis to return to equilibrium. Endothelial cells line and maintain the subendothelial matrix critical for blood vessel integrity. Endothelial cells and their matrix secrete shed factors, substances and proteins that are involved in regulating hemostasis and thrombosis and in maintaining the constitutive intravascular anticoagulated state (Table 39-1). Damage to endothelial cells with exposure of the subendothelium increases the risk for initial hemorrhage and subsequently, non-physiologic thrombosis as part of the repair system. One can view the hemostatic and thrombotic system that addresses the integrity of blood flow as part of the inflammatory system.

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Authors and Affiliations

  1. Department of Pathology, Case Western Reserve University and University Hospitals Case Medical Group, Cleveland, OH, USA

    Amber A. Petrolla

  2. Case Comprehensive Cancer Center, University Hospitals Case Medical Center, Cleveland, OH, USA

    Hillard M. Lazarus

  3. Division of Hematology and Oncology, Case Western Reserve University and University Hospital Case Medical Group, Cleveland, OH, USA

    Alvin H. Schmaier

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  1. Amber A. Petrolla
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  2. Hillard M. Lazarus
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Editors and Affiliations

  1. University Hospitals Case Medical Center, Cleveland, OH, USA

    Hillard M. Lazarus

  2. Case Western Reserve University, Cleveland, OH, USA

    Mary J. Laughlin

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Petrolla, A.A., Lazarus, H.M., Schmaier, A.H. (2010). Unique Thrombotic and Hemostatic Complications Associated with Allogeneic Hematopoietic Stem Cell Transplantation. In: Lazarus, H.M., Laughlin, M.J. (eds) Allogeneic Stem Cell Transplantation. Contemporary Hematology. Humana Press. https://doi.org/10.1007/978-1-59745-478-0_39

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