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The Potential Role of Tissue Plasminogen Activator, Plasminogen Activator Inhibitor-1, Tumor Necrosis Factor and Interleukin-6 in the Pathogenesis of Hemostatic Complications in Lymphoma.

1Solafa Elsharawy, 3Enas Abd-Elhalim, 1Awad M and 2Sahar Elsharawy.

Departments of 1Clinical pathology (Hematology Unit), 3Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Mansoura University and 2Pediatric department, Faculty of Medicine, Zagazig University, Egypt.

Patients with malignant neoplasms including malignant lymphoma are known to have high incidence of venous thrombosis and abnormalities in haemostasis. This work was planned to clarify the role of tissue plasminogen activator (t-PA) and plasminogen activator inhibitor-1 (PAI-1) in the development of thrombotic complications and to study the possibility of alteration of fibrinolytic system by IL-6 and TNF-a .This study was conducted on 51 newly diagnosed patients with malignant lymphoma (20 Hodgkin’s lymphoma; HD and 31 non-HD; NHLs). For all patients, screening tests for haemostasis, t-PA, PAI-1 (by ELISA) as well as determination of serum levels of IL-6 and TNFa (by ELISA) were carried out. t-PA was significantly decreased, PAI-1 was significantly increased (P<0.05) in all groups with non significant difference between different histopathological types of HD and NHLs. IL-6 and TNF-a were significantly increased in all groups (P<0.05) and positively correlated with PAI-1. In conclusion, haemostatic abnormalities in malignant lymphoma are mainly due to impaired fibrinolytic system. Alteration of t-PA / PAI-1 ratio is mediated by biological and pathological processes of TNF-a and IL-6 in lymphoma. Frequent monitoring of PAI-1 level in lymphoma patients is recommended to predict the early development of thrombosis.