Assessment of the role of some haemostatic parameters in patients with cryptogenic stroke

Cryptogenic stroke [CS] is a stroke of unexplained aetiology, in 1/3 the of cases, the cause of stroke remains undetermined inspite of full investigations. Patient with CS are thought to have a state of hypercoagulablity. To unmask some of the pathogenic mechanisms underlying cryptogenic stroke through assessment of some genetic disorders including C6[77]T mutation methyl-enetetrahydrofolate reductase gene, activated protein C [APC] resistance and role of thrombin anti-thrombin complex concentration [TAT] in plasma as indicators of hypecoagulable state. The study was conducted on 20 Egyptian patients divided into 2 groups, group I included 10 patients [6 males and 4 females] with cryptogenic stroke aged less than 50 years and group II included 10 age and sex matched patients with non-cryptogenic stroke. All of the 20 cases studied were subjected to panel of investigations including routine laboratory tests and imaging studies in orders to exclude any risk factors for stroke in group I patients and to determine risk factor of stroke in group II. Both groups were investigated for C6[77]T mutation in methylenetetrahydrofolate reductase gene, activated protein C [APC] resistance and thrombin anti-thrombin complex concentration [TAT] in plasma. No statistical significant difference was found between the two groups as regard C6[77]T mutation in methylenetetrahydrofolate reductase gene, [APC] resistance and TAT concentration in plasma [p value >0.05]. However, TAT level was found to be positively correlated with the clinical severity in non-cryptogenic stroke [p value <0.05]. C6[77]T mutation in methylenetetrahydrofolate gene, [APC] resistance and TAT concentration in plasma are not independent risk factors for cryptogenic stroke. TAT could be used as indicator of clinical severity and prognosis in patient with non-cryptogenic stroke

Protein C, protein S and antithrombin III assessment in Egyptian thalassemic children

Enhanced years of survival have led to the unmasking of management related complications with the recognition of the existence of a chronic hypercoagulable state in thalassemic patients. This study aims at determining the levels of the three main antithrombophilic factors namely protein C, protein S and antithrombin III in Egyptian children with beta thalassemia major. Sixty children with beta thalassemia major with a mean age of 12.2 +/- 1.88 years and male: female ratio 1.7: 1 were enrolled in the study. They were subjected to history taking, clinical examination and laboratory investigations including levels of ferritin by IRMA, protein C, protein S, and antithromobin III by ELISA. Protein C was deficient in 16 [26.7%] of cases, protein S was deficient in 8 [13.3%] of cases while none had deficiency of antithrombin III. None of our cases had a history of thromboembolic events. These abnormalities were not related to the state of HCV infection or to the type of chelation whether oral or subcutaneous. Protein C deficiency was present more in older patients. Abnormalities in protein C, protein S are frequently observed even without manifesting hypercoagulable states in our studied thalassemia major children

Platelet aggregation and physiological anticoagulants in sickle-cell disease

During the period January 2002- December 2004, we assessed 30 sickle- cell anaemia patients admitted to hospital in Al Khobar with vaso- occlusive crisis for levels of antithrombin [AT] III, protein C [PC] and protein S [PS]. We also did platelet aggregation studies. Steady state levels were assessed during follow- up and compared with 36 adult controls. Levels of PC, PS and AT III in the group were significantly higher than in those in vaso- occlusive crisis and those in steady state control [P < 0.001]. There was a statistically significant difference between controls and patients for all platelet factors except adrenaline. There was no significant difference between the levels of PC, PS, aggregation AT III and platelet aggregation variables in patients in the steady state and in vaso- occlusive crisi

Diagnostic value of PRO C global test in patients with deep vein thrombosis

This study was carried out to evaluate pro C Global [PCG] test in clinical routine with special regard to its sensitivity and specificity for factor V [FV] leiden as well as the deficiency of protein C [PC] and protein S [PS]. 70 adult patients with documented diagnosis of deep vein thrombosis [DVT] by Doppler ultrasonography were chosen from those were attending the emergency unit of Alexandria main university hospital and Alexandria armed forces hospital in addition to 30 age and sex matched healthy controls were evaluated for PCG test in relation to gold standard tests i.e. PC activity, PS activity and activated protein C resistance [APCR]. Also determination of lupus anticoagulants [LA] was done for all subjects under study. The sensitivity and specificity of PCG test were [100% and 100%] for FV leiden, [87.5% and 82.3%] for PC and [80% and 78.5%] for PS. The negative predictive value was [100%, 98.1% and 98.1%] for FV leiden, PC and PS respectively. The positive predictive value was [100%, 38.9% and 22.2%] for FV leiden, PC and PS respectively. Also, the diagnostic accuracy was [100%, 82.9% and 78.6%] for FV leiden, PC and PS respectively. The results of LA were negative in all patients and controls. However, the normalized ratio [NR] of PCG test was decreased in [14.8%] of patients group without any detectable defect in PC system and their results were significantly lower than control group [P=0.000]. On the other side, the results were considerably higher than those for the patients with a proven defect in PC system. Pro C Global test is sensitive, specific, less time consuming and can be performed on a routine base. Because of the high negative predictive value, we recommend the use of Pro C Global test in the screening of thrombophilic patients and further determination of F V leiden, PC activity and PS activity is only indicated in case of abnormal Pro C Global results

Protein C, protein S and antithrombin III in children with complicated congenital heart diseases

This study was carried out on 40 patients with congenital heart disease [CHD] aged three months to seven years and divided into two groups: The first included 28 patients with complicated CHD and the second group included 12 patients with uncomplicated CHD. Ten healthy children were chosen as controls. A coagulation profile consisting of protein C, protein S, antithrombin III, factor V and factor VIII were evaluated in all patients and controls. The mean values of protein C, protein S, antithrombin III, factor V and factor VIII were significantly decreased in patients with complicated CHD compared with both uncomplicated cases and controls. Eighteen out of twenty-two patients with complicated CHD had low protein C levels [2 standard deviations below the normal mean value of the controls]. Of these children, three developed thrombotic complications and eight had evidences suggestive of consumption coagulopathy [decreased factors V and VIII]. It was concluded that decreased levels of coagulation inhibitors protein C, protein S and antithrombin III were observed in ill children with complicated CHD. With reduced levels of protein C, children with complicated CHD might have a tendency toward thrombotic complications

Perinatal predictive value of plasma plasminogen activator inhibitor and protein S versus other biophysical and laboratory tests in preeclampsia

This study was undertaken upon 30 preeclamptic women and 20 healthy gestational age matched controls to compare the ability of measuring plasma phasminogen activator inhibitor [PAI] and protein "S" [PS] concentrtaion to predict fetal and/or perinatal outcome. For comparison the same group underwent evaluation by well known tests of well proven predictive power, like BPS, NST, serum uric acid concentrations and hematocrite value. The study indicated that plasma PAI insignificantly higher in preeclamptic group compared to controls and plasma PS concentrations are significantly lower. However, putting a cut off levels at +/- 2 SD [standard deviation] from the mean values for controls resulted in a sensitivity and specificity in predicting fetal outcome which is less than satisfactory and not comparable to that obtained when biophysical score [BPS], NST or other biochemical tests were applied. In conclusion, wider scale studies are needed before reaching a final conclusion about the value of measuring PAI and PS in predicting fetal outcome in preeclampsia

Protein C and protein S deficiency in thalassemic patients.

To investigate the status of the protein C-protein S anticoagulant pathway in thalassemic patients, we measured protein C and protein S levels of plasma of 30 adults and 18 children with beta-thalassemia/HbE disease, beta-thalassemia major and HbE disease. Mean +/- 1 SD values of protein C, protein S and other coagulant proteins produced by the liver were as follows: protein C 50.4 +/- 17.2%; protein S 58.8 +/- 25.5%; antithrombin III 78.1 +/- 12.8%; PLG 86.4 +/- 18.4%; prothrombin 71.0 +/- 13.1%; factor VII 72.7 +/- 21.5%; and factor X 79.2 +/- 15.6%. Protein C and protein S levels of thalassemic patients were significantly lower than those of other coagulant proteins produced by the liver. Decrease in protein C level was stronger than that of proteins S. gamma-Carboxylated protein C levels of splenectomized patients were significantly lower than those of nonsplenectomized patients. Severe decrease of protein C and protein S may be responsible for occurrence of thrombosis in thalassemic patients.