vitamin-b-12 and Blood-Coagulation-Disorders

Acute promyelocytic leukemia (APL) is characterized by proliferation of morphologically abnormal promyelocytes and a severe bleeding diathesis. The abnormal promyelocyte is characterized by abundant, large granules, many of which are spindle-shaped. Electron microscopic appearance of the granules closely resembles that of Auer rods. The granules appear to possess tissue thromboplastin activity by both immunologic and clotting assays. Coagulation studies in APL are generally consistent with disseminated intravascular coagulation. Prolongation of the prothrombin time and elevation of fibrinogen degradation products are the tests that are most commonly abnormal. Although occasional reports indicate a favorable response of the coagulopathy to drugs that inhibit fibrinolysis, the use of prophylactic heparin appears to be the treatment of choice. The response rate of APL to chemotherapy regimens that contain an anthracycline is comparable to that of acute myelogenous leukemia. The recent description of the 15;17 chromosomal translocation which may be pathognomonic for APL is only the second example of a chromosomal marker of human neoplasia. Marked elevation of serum vitamin B12 and B12 binding proteins appears to be another characteristic feature of APL. An in vitro cell line of APL cells has been demonstrated to have the capacity to differentiate to functional polymorphonuclear leukocytes, but the cause for the maturation arrest is unknown.

Topics: Blood Coagulation Disorders; Bone Marrow; Cell Line; Chromosome Banding; Daunorubicin; Fibrinogen; Fibrinolysis; Hemorrhage; Heparin; Humans; Leukemia, Myeloid, Acute; Prognosis; Prothrombin Time; Thromboembolism; Vitamin B 12

The aim of this study was to assess the relationship between total plasma homocysteine (tHC) and several markers of endothelial function, coagulation, and pro-inflammatory status in renal transplant recipients. Our own previous study demonstrated the efficacy of folic acid (FA) and vitamin B(12) (B(12)) treatment to reduce tHC. Using 70 stable recipients, 56 of whom showed hyperhomocisteinemia (HHC) (tHC > or = 14 micromol/L) and a control group (n = 14, tHC < 14 micromol/L), we treated 29 patients in the HHC group (10 mg FA and 500 mg B(12) daily) and determined their endothelial function, inflammatory activity, and coagulation status. We assessed plasma levels of von Willebrand Factor and fibrinogen as the prothrombotic profile and C-reactive protein and plasma albumin as inflammation markers. We performed Doppler sonography of the brachial artery to assess endothelial function. The mean value of plasma tHC of 19.05 +/- 3.70 micromol/L before treatment decreased to 13.45 +/- 3.25 micromol/L after 3 months of treatment (P < .001). The vWF was significantly correlated with tHC (P < .05) and was higher in the HHC patients (P < .05). The fibrinogen mean level was also significantly higher in HHC patients (P < .05). The C-reactive protein level was significantly higher and the albumin level was lower among patients with HHC. The endothelium-dependent dilation (EDD) correlated with baseline tHC (P < .05). In preliminary data we observed that homocysteine-lowering therapy may provide cardiovascular protection by enhancing endothelial function, limiting oxidative stress, and reducing procoagulation status.

Topics: Adult; Aged; Biomarkers; Blood Coagulation; Blood Coagulation Disorders; Brachial Artery; Creatinine; Endothelium, Vascular; Female; Folic Acid; Homocysteine; Humans; Hyperhomocysteinemia; Inflammation; Kidney Transplantation; Male; Middle Aged; Postoperative Complications; Prospective Studies; Vitamin B 12

Topics: Adult; Blood Coagulation Disorders; C-Reactive Protein; Female; Folic Acid; Humans; Hyperhomocysteinemia; Male; Meta-Analysis as Topic; Middle Aged; Primary Prevention; Prognosis; Pyridoxine; Risk Factors; Sinus Thrombosis, Intracranial; Stroke; Time Factors; Vitamin B 12

Topics: Blood Coagulation Disorders; Blood Coagulation Factors; Blood Coagulation Tests; Hematologic Diseases; Humans; Iron; Liver Diseases; Vitamin B 12