Thromb Haemost 2002; 88(04): 576-582
DOI: 10.1055/s-0037-1613258
Review Article
Schattauer GmbH

The Thrombogram in Rare Inherited Coagulation Disorders: Its Relation to Clinical Bleeding

Raed Al Dieri
1   Synapse Laboratory, Cardiovascular Research Institute (CARIM), University of Maastricht, The Netherlands
,
Flora Peyvandi
2   Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, IRCCS Maggiore Hospital and University of Milano, Italy
,
Elena Santagostino
2   Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, IRCCS Maggiore Hospital and University of Milano, Italy
,
Muriel Giansily
3   Laboratoire Central d’ Hematologie, Centre Hospitalier Universitaire, Montpellier, France
,
Pier Mannuccio Mannucci
2   Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, IRCCS Maggiore Hospital and University of Milano, Italy
,
Jean François Schved
3   Laboratoire Central d’ Hematologie, Centre Hospitalier Universitaire, Montpellier, France
,
Suzette Béguin
1   Synapse Laboratory, Cardiovascular Research Institute (CARIM), University of Maastricht, The Netherlands
,
H. Coenraad Hemker
1   Synapse Laboratory, Cardiovascular Research Institute (CARIM), University of Maastricht, The Netherlands
› Institutsangaben
Weitere Informationen

Publikationsverlauf

Received 11. Dezember 2001

Accepted after revision 03. Juni 2002

Publikationsdatum:
09. Dezember 2017 (online)

Summary

We investigated the relation between clotting factor concentration, the parameters of the thrombin generation curve (the thrombogram) and the severity of clinically observed bleeding in patients with congenital deficiency of prothrombin (n = 21), factor V (n = 22), factor VII (n = 22), factor X (n = 10), factor XI (n = 7) and factor XII (n = 6). The parameters used were: area under the curve (endogenous thrombin potential, ETP), peak concentration of thrombin attained and lag time before manifest formation.

Peak height and ETP varied linearly with the concentration of prothrombin. For the other factors these parameters hyperbolically approached to the 100% limit with increasing clotting factor concentration. Half normal ETP was seen at about the following concentrations: prothrombin (50%), factor V (1%), factor VII (2%), factor X (5%) and factor XI (1%). As a rule, the peak height was somewhat more sensitive to clotting factor decrease than the ETP was.

In all the patients with severe bleeding symptoms the ETP was less than 20% of normal. Bleeding tendency was absent or mild in patients with an ETP of 30% or higher. This value (except for prothrombin) is already obtained at concentrations of clotting factor of 1%-2%, which corroborates the clinical observation that a severe bleeding tendency is only seen in severe clotting factor deficiencies (less than 1%). The one exception was a patient with factor VII deficiency and severe bleeding, who showed a normal ETP value, albeit with a decreased peak height and a prolonged lag-time.

 
  • References

  • 1 Peyvandi F, Mannucci PM. Rare coagulation disorders. Thromb Haemost 1999; 82: 1207-14.
  • 2 Peyvandi F, Mannucci PM, Asti D, Abdoullahi M, Di Rocco N, Sharifian R. Clinical manifestations in 28 Italian patients with severe factor VII deficiency. Hemophilia 1997; 03: 242-6.
  • 3 Lak M, Sharifian R, Peyvandi F, Mannucci PM. Symptoms of inherited factor V deficiency in 35 Iranian patients. Br J Haematol 1998; 103: 1067-9.
  • 4 Peyvandi F, Mannucci PM, Lak M, Abdoullahi M, Zeinali S, Sharifian R, Perry D. Congenital factor X deficiency: spectrum of bleeding symptoms in 32 Iranian patients. Br J Haematol 1998; 102: 626-8.
  • 5 Lak M, Keihani M, Elahi F, Peyvandi F, Mannucci PM. Bleeding and thrombosis in 55 patients with inherited afibrinogenaemia. Br J Haematol 1999; 107: 204-6.
  • 6 Duga S, Asselta R, Santagostino E, Zeinali S, Simonic T, Malcovati M, Mannucci PM, Tenchini ML. Missense mutations in the human beta fibrinogen gene cause congenital afibrinogenemia by impairing fibrinogen secretion. Blood 2000; 95: 1336-41.
  • 7 Peyvandi F, Jenkins PV, Mannucci PM, Billio A, Zeinali S, Perkins SJ, Perry DJ. Molecular characterisation and three-dimensional structural analysis of mutations in 21 unrelated families with inherited factor VII deficiency. Thromb Haemost 2000; 84: 250-7.
  • 8 Akhavan S, Mannucci PM, Lak M, Mancuso G, Mazzucconi MG, Rocino A, Jenkins PV, Perkins SJ. Identification and three-dimensional structural analysis of nine novel mutations in patients with prothrombin deficiency. Thromb Haemost 2000; 84: 989-97.
  • 9 Montefusco MC, Duga S, Asselta R, Santagostino E, Mancuso G, Malcovati M, Mannucci PM, Tenchini ML. A novel two base pair deletion in the factor V gene associated with severe factor V deficiency. Br J Haematol 2000; 111: 1240-6.
  • 10 van Wijk R, Montefusco MC, Duga S, Asselta R, van Solinge W, Malcovati M, Tenchini ML, Mannucci PM. Coexistence of a novel homozygous nonsense mutation in exon 13 of the factor V gene with the homozygous Leiden mutation in two unrelated patients with severe factor V deficiency. Br J Haematol 2001; 114: 871-4.
  • 11 Peyvandi F, Carew JA, Perry DJ, Hunault M, Khanduri U, Perkins SJ, Mannucci PM, Bauer KA. Abnormal secretion and function of recombinant human factor VII as the result of modification to a calcium binding site caused by a 15-base pair insertion in the F7 gene. Blood 2001; 97: 960-5.
  • 12 Rijkers DT, Wielders SJ, Tesser GI, Hemker HC. Design and synthesis of thrombin substrates with modified kinetic parameters. Thromb Res 1995; 79: 491-9.
  • 13 Rosing J, Tans G, Govers-Riemslag JW, Zwaal RF, Hemker HC. The role of phospholipids and factor Va in the prothrombinase complex. J Biol Chem 1980; 255: 274-83.
  • 14 Hendrix H, Lindhout T, Mertens K, Engels W, Hemker HC. Activation of human prothrombin by stoichiometric levels of staphylocoagulase. J Biol Chem 1983; 258: 3637-44.
  • 15 Hemker HC, Willems GM, Béguin S. A computer assisted method to obtain the prothrombin activation velocity in whole plasma independent of thrombin decay processes. Thromb Haemost 1986; 56: 9-17.
  • 16 Hemker HC, Wielders S, Kessels H, Béguin S. Continuous registration of thrombin generation in plasma, its use for the determination of the thrombin potential. Thromb Haemost 1993; 70: 617-24.
  • 17 Hemker HC, Giesen PL, Ramjee M, Wagenvoord R, Béguin S. The thrombogram: monitoring thrombin generation in platelet-rich plasma. Thromb Haemost 2000; 83: 589-91.
  • 18 Wielders S, Mukherjee M, Michiels J, Rijkers DT, Cambus JP, Knebel RW, Kakkar V, Hemker HC, Béguin S. The routine determination of the endogenous thrombin potential, first results in different forms of hyper- and hypocoagulability. Thromb Haemost 1997; 77: 629-36.
  • 19 Keularts IM, Zivelin A, Seligsohn U, Hemker HC, Béguin S. The role of factor XI in thrombin generation induced by low concentrations of tissue factor. Thromb Haemost 2001; 85: 1060-5.
  • 20 Hemker HC, Béguin S. Phenotyping the clotting system. Thromb Haemost 2000; 84: 747-51.
  • 21 Azar AJ, Koudstaal PJ, Wintzen AR, van Bergen PF, Jonker JJ, Deckers JW. Risk of stroke during long-term anticoagulant therapy in patients after myocardial infarction. Ann Neurol 1996; 39: 301-7.
  • 22 Béguin S, Lindhout T, Hemker HC. The mode of action of heparin in plasma. Thromb Haemost 1988; 60: 457-62.
  • 23 Butenas S, van’t Veer C, Mann KG. “Normal” thrombin generation. Blood 1999; 94: 2169-78.