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Blood, 15 December 2000, Vol. 96, No. 13, pp. 4261-4266
HEMOSTASIS, THROMBOSIS, AND VASCULAR BIOLOGY
Polymorphonuclear leukocyte activation and hemostasis in patients
with essential thrombocythemia and polycythemia vera
Anna Falanga,
Marina Marchetti,
Virgilio Evangelista,
Alfonso Vignoli,
Marina Licini,
Mara Balicco,
Stefano Manarini,
Guido Finazzi,
Chiara Cerletti, and
Tiziano Barbui
From the Hematology Division, Ospedali Riuniti,
Bergamo; and the Mario Negri Institute for Pharmacological Research,
Consorzio Mario Negri Sud, S. Maria Imbaro, Italy.
Thrombohemorrhagic complications are a major cause of morbidity and
mortality in patients with essential thrombocythemia (ET) and
polycythemia vera (PV). The pathogenesis of these complications is not
completely clarified. Several studies have described abnormalities of
red blood cells and platelets in these patients. However, no studies
are available on changes in the polymorphonuclear leukocytes (PMNs),
which can play an important role in the activation of the hemostatic
system. In patients with ET (n = 37) and PV (n = 34), a series of
PMN activation parameters (PMN membrane CD11b and leukocyte alkaline
phosphatase [LAP] antigen expression, cellular elastase content,
plasma elastase, and myeloperoxidase levels) was evaluated
simultaneously with the levels of plasma markers of endothelial damage
(thrombomodulin and von Willebrand factor antigen) and hypercoagulation
(thrombin-antithrombin complex, prothrombin fragment 1 + 2, and
D-dimer). The results show the occurrence of PMN activation in both
groups of patients compared with a control group of healthy subjects.
An increase in CD11b and LAP expression by PMN membrane was observed,
together with a significant increase in cellular elastase content,
plasma elastase, and myeloperoxidase levels. In addition, patients had
high plasma levels of endothelial and hypercoagulation markers compared
with controls. For the first time, these data show that in ET and PV, 2 hematologic conditions that place patients at increased risk for
thrombosis, an in vivo leukocyte activation occurs and is associated
with laboratory signs of endothelium and coagulation system activation.
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