This study demonstrates that patients with MGUS are at increased risk for VTD. Although a clear reason for the pre-thrombotic state in these patients is not currently evident, few risk factors were identified in the group of patients examined.

Purpose: To correlate the concentration of plasma coagulation markers at baseline and during follow-up in patients with solid tumors and venous thromboembolic disease with the risk of recurrence and death.Experimental Design: Patients (N ‫؍‬ 223) with first episode of venous thromboembolic disease received oral anticoagulation with warfarin for a target international normalized ratio of 2 to 3. Plasma coagulation markers were measured before instituting warfarin and at 3 monthly intervals, thereafter.Results: The median duration of oral anticoagulation was 6.7 months (range 2 weeks to 11 months). Major bleeding episodes occurred in 18 patients (8%), and minor hemorrhagic events occurred in 15 (6.7%) patients. Patients with advanced malignancy (P ‫؍‬ 0.032), history of surgery (P ‫؍‬ 0.057), and those with poor performance status (P ‫؍‬ 0.001) were more likely to encounter major bleeding episodes. Recurrence of venous thromboembolic disease was diagnosed in 31 patients (14%). At univariate analysis, advanced stage of cancer (P ‫؍‬ 0.03), performance status > 1 (P ‫؍‬ 0.001), treatment with chemotherapy (P ‫؍‬ 0.01), the presence of metastatic liver disease (P ‫؍‬ 0.03), higher D-dimer (P ‫؍‬ 0.001), and thrombin antithrombin complex levels (P ‫؍‬ 0.01) were features predictive of recurrent venous thromboembolic disease. At multivariate analysis, poor performance status (P ‫؍‬ 0.01) and D-dimer levels (P ‫؍‬ 0.001) were predictors of recurrent venous thromboembolic disease. Persistent activation of coagulation as indicated by an upward trend in D-dimer (P ‫؍‬ 0.001) and antithrombin (P ‫؍‬ 0.001) was observed in patients who developed recurrent thrombosis. Similar upward trends in D-dimer (P ‫؍‬ 0.001), antithrombin (P ‫؍‬ 0.001), and prothrombin fragment F1 ؉ 2 (P ‫؍‬ 0.001) was observed in the 76 patients who died during the study period and in the patients who received chemotherapy.Conclusions: Successful oral anticoagulation with warfarin in patients with cancer and venous thromboembolic disease is more likely to be achieved in patients with early stage tumors and good performance status. The persistence of activation of hemostasis as shown by plasma coagulation markers is a strong predictor of recurrence and poor outcome.

Hemorrhagic disseminated intravascular coagulation (DIC) associated with the presence of underlying advanced or metastatic tumors are often difficult to control by conventional methods. We report the use of recombinant activated factor VII (rFVIIa) in patients with cancer and bleeding secondary to DIC. A total of 18 patients with cancer met pre-defined criteria for DIC. All patients had failed to respond to transfusion with blood products and treatment of the underlying malignancy prior to the introduction of rFVIIa. The median laboratory data at the time of treatment with rFVIIa were as follows: hemoglobin, 7.7 g/dl; platelets, 54 x 10(9)/l; prothrombin time, 21 s; activated partial thromboplastin time, 41 s fibrinogen, 83 mg/dl; D-dimer, 17 microg/ml; and antithrombin, 32%. The dose of rFVIIa was 90 microg/kg and the median number of doses administered was 5 (range, 3-10). Serial measurements of coagulation parameters were obtained at frequent intervals during treatment with rFVIIa. Of the 18 patients, 15 responded with cessation of bleeding and improvement in coagulation data. The prothrombin time and activated partial thromboplastin time normalized in all responding patients within 24 h of treatment. The median fibrinogen was 214 mg/dl while the median D-dimer was 6 microg/dl at 48 h following the administration of rFVIIa. No thromboembolic complications were observed following rFVIIa. Our data provide evidence that rFVIIa can be used successfully to control the hemorrhagic episodes associated with DIC. Although this type of treatment appears to be safe, close monitoring of the patients is warranted.

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Background: Public awareness regarding blood donation during life and after death is poor in many developing and developed countries. The prevalence of blood donation varies according to the demographics of the people. The objectives of this study were to assess the knowledge, attitude, practice, and barriers regarding blood donation among the general population in Kuwait. Methods: A cross-sectional study of 915 people was conducted between March and April 2016. Data were collected by using a survey questionnaire among the general people working in five randomly selected ministries including the Ministry of Health, Ministry of Finance, Ministry of Justice, Ministry of Education, and Ministry of Social Affair. An ethical approval for the study was obtained from the Ethics Committee of Faculty of Medicine in Kuwait University and from the ministries. Results: Overall, about 37% the study population ever donated blood. The proportion of life-time donors was significantly higher among males than females (57.9% vs. 25.2%, respectively, p< 0.001). However, the knowledge scores about blood donation were significantly higher among females (p= 0.035). Both knowledge scores and positive scores of attitude increased with increasing age and with higher educational levels. Of the barriers, women had significantly more fear of pain (p<0.001) and fear of seeing blood (p= 0.002) compared to men. In multivariate analysis, male gender, middle and older age, knowledge score, fear of getting new infection, and fear of anemia remained significant predictors of blood donation after controlling for the confounders. Conclusion:The study showed a low rate of blood donation in Kuwait. More community outreach programs such as blood donation campaigns should be undertaken to improve the situation, and to alleviate people's perception about the barriers.

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