Paraneoplastic production of heparin-like anticoagulant in a patient with metastatic transitional cell carcinoma

Fahl, Kelly N.; Poon, Stephen A.; Badani, Ketan K.; Benson, Mitchell C.

doi:10.5489/cuaj.1165

Cited by 9 publications

(7 citation statements)

References 16 publications

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“…HLE has been previously demonstrated in three clinical settings: acute liver failure during liver disease and liver transplantation [ 10 , 11 ], sepsis/SIRS [ 12 ], and cancer [ 13 ]. The mechanisms leading to the HLE are multifactorial, and include (i) failure of the liver to clear the circulating GAGs during acute liver failure [ 14 ], (ii) neutrophil-mediated injury of the hepatocytes that can release heparin sulphate [ 15 ], and (iii) the direct release of GAGs from the endothelial surface and the mast cells during sepsis/SIRS [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

Heparin-like effect in postcardiotomy extracorporeal membrane oxygenation patients

et al. 2014

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IntroductionUnfractionated heparin (UFH) is the anticoagulant of choice for extracorporeal membrane oxygenation (ECMO), but bivalirudin can be used as an alternative. The purpose of the present study is to investigate the existence of a heparin-like effect (HLE) during heparin-free ECMO.MethodsThis is a retrospective study on patients treated with ECMO and receiving bivalirudin as the sole anticoagulant. Thromboelastography (TEG) tests with and without heparinase were recorded during the ECMO duration. A total of 41 patients (22 pediatrics and 19 adults) treated with ECMO after cardiac surgery procedures and receiving only bivalirudin-based anticoagulation were studied. Based on the presence of a different reaction time (R-time) between the TEG test with heparinase or without heparinase we defined the presence of a HLE. Survival to hospital discharge, liver failure, sepsis, bleeding and transfusion rate were analyzed for association with HLE with univariate tests.ResultsHLE was detected in 56.1% of the patients. R-times were significantly shorter in tests done with heparinase versus without heparinase during the first seven days on ECMO. Patients with HLE had a significantly (P = 0.046) higher rate of sepsis (30%) than patients without HLE (5.6%) at a Pearson’s chi-square test.ConclusionsA heparin-like effect is common during ECMO, and most likely due to a release of heparinoids from the glycocalyx and the mast cells, as a consequence of sepsis or of the systemic inflammatory reaction triggered by the contact of blood with foreign surfaces.

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Section: Discussionmentioning

confidence: 99%

Heparin-like effect in postcardiotomy extracorporeal membrane oxygenation patients

et al. 2014

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“…Pathophysiologic mechanisms leading to DIC in individuals with solid tumor are not fully understood. Solid tumor cells may express procoagulant molecules, including tissue factor and cancer procoagulant, and fibrinolytic proteins, and may be associated with paraneoplastic production of heparin‐like anticoagulant . Furthermore, proinflammatory cytokines, such as IL‐6 and TNFα, have been demonstrated to contribute to DIC in cancer patients .…”

Section: Discussionmentioning

confidence: 99%

Mammary gland carcinoma in a dog with peripheral blood and bone marrow involvement associated with disseminated intravascular coagulation

Jaillardon

Barthélémy

Goy‐Thollot

et al. 2012

Veterinary Clinical Pathol

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A 7-year-old female Leonberger dog was referred to the National Veterinary School of Lyon Teaching Hospital with a 2-day history of anorexia and bleeding. A mammary mass had been removed 7 months earlier, but histologic examination was not performed. On physical examination, the dog was depressed and had pale mucous membranes and numerous petechiae and hematomas. Significant laboratory findings were moderate thrombocytopenia, prolonged prothrombin, activated partial thromboplastin, and thrombin times, hypofibrinogenemia, and increased concentration of fibrin(ogen) degradation products. A peripheral blood smear, buffy coat preparation, and bone marrow aspirate contained low numbers of large atypical cells that had moderate nuclear:cytoplasmic ratios, oval nuclei with multiple prominent nuclei, and basophilic cytoplasm with villous projections. A small nodule was found in the left inguinal mammary gland, and a fine-needle aspirate contained cells similar to those in blood and bone marrow. In samples of blood, bone marrow, and the mammary mass, the neoplastic cells were immunoreactive for cytokeratin. The diagnosis was mammary carcinoma with secondary disseminated intravascular coagulation (DIC) and disseminated tumor cells in bone marrow and circulating tumor cells in blood; this diagnosis was not confirmed by histopathologic examination. Owing to clinical deterioration and the poor prognosis, the dog was euthanized and a necropsy was not performed. This is the first report of a canine mammary carcinoma with circulating tumor cells and secondary DIC.

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“…Due to its uncommon occurrence, the treatment of HLArelated bleeding disorders is far from clear; the administration of protamine is anecdotal [9], and its efficacy equivocal [7,10,11].…”

Section: Discussionmentioning

confidence: 98%

“…Heparin-like anticoagulants have been described in a number of other diseases, including transitional cell carcinomas [6,7], breast cancer [8], multiple myeloma [9], systemic mastocytosis [10] and hepatocellular carcinoma [11].…”

Section: Discussionmentioning

confidence: 99%

An uncommon cause of postoperative bleeding

Berlot

Tartamella²,

Bussani³

et al. 2011

Blood Coagulation &Amp; Fibrinolysis

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The postoperative phase can be associated with an increased risk of thrombosis and abnormal bleeding. We report the case of a patient admitted to our intensive care unit for postoperative monitoring who developed two episodes of hemorrhagic shock. A thromboelastogram performed with heparinase I digestion demonstrated the action of endogenous heparin-like substances whose presence was subsequently confirmed at the histological examination of the tumor. Heparinase-modified thromboelastography has proven to be an effective and rapid point-of-care coagulation test and in our case allowed early detection of circulating heparinoids.

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Paraneoplastic production of heparin-like anticoagulant in a patient with metastatic transitional cell carcinoma

Cited by 9 publications

References 16 publications

Heparin-like effect in postcardiotomy extracorporeal membrane oxygenation patients

Heparin-like effect in postcardiotomy extracorporeal membrane oxygenation patients

Mammary gland carcinoma in a dog with peripheral blood and bone marrow involvement associated with disseminated intravascular coagulation

An uncommon cause of postoperative bleeding

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