Biomedical Research

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Prospective study on Clotting Factors in selected non-hematological malignancies.

A hypercoagulable or prothrombotic state of malignancy occurs due to the ability of tumor cells to activate the coagulation system by producing and secreting procoagulant substances and inflammatory cytokines, and also by the physical interaction between tumor cell and blood cells (monocytes, platelets, and neutrophils) or vascular cells. A total of 190 Patients with carcinoma with and without metastasis from Surgical Gastroenterology, Radiation oncology Department, and from Pulmonary Medicine KGMU UP India, were studied in order to evaluate the presence and extent of hemostatic abnormalities in case of gastrointestinal carcinoma, lung carcinoma. The average prothrombin time in patients of gastrointestinal carcinoma, Lung carcinoma was less compared with control. Similarly, the average activated partial prothrombin time was also found to be less as compared to controls. The mean level of Protein S ranged from 45% to 98%. The mean level of Protein C ranged from 53% to 95%. The Protein C level was significantly lower (p<0.0001) in Protein C deficient patients with metastasis subjects without metastasis. Similarly, the Protein S level was significantly lower (p<0.0001) in protein S deficient patients with metastasis as compared to subjects without metastasis. The Protein C and protein S levels were also lower in those who were deficient with metastasis. Our study infers that epithelial malignancies have a subclinical prothrombotic state, progressing to thrombotic events that contribute significantly to morbidity and mortality in metastatic patients and we conclude that apart from hyperactive coagulation mechanism (as evidenced by relative shortening of PT and APTT). Protein C and Protein S deficiency also have a potential contributory role in promoting metastasis and thereby contributing to morbidity of cancer and its role in predicting thrombosis. . However, further studies are needed to strengthen the proposed mechanism.

Author(s): Mohd. Yusuf, Ashutosh Kumar, Rashmi Kushwaha, Madan Lal Brahma Bhatt, Abhijit Chandra,Surya Kant, Zainab Siddiqui