Expressão de fator tecidual por monócitos em pacientes com doença falciforme

Abstract

Introduction: Sickle cell disease is a hemolytic disorder with frequent changes in the procoagulant, anticoagulant and fibrinolytic mechanisms, with a consequent thrombotic risk. Objective: To evaluate the percentage of tissue factor-positive monocytes in individuals with sickle cell disease (SCD) and to correlate with hemolysis and coagulation markers. Materials and methods: We studied 46 individuals with sickle cell disease Hb (SS, SC, Sβ and SF), in a steady state , with and without hydroxyurea treatment, and 26 donors of Hb AA blood. We evaluated tissue factor (CD142) expression on monocytes, hemolysis markers (hemoglobin, lactate dehydrogenase, reticulocytes, bilirubins) and coagulation (platelets, fibrinogen, prothrombin time, activated partial thromboplastin time and D dimer). Results: The mean age of the study population was 32 years. We observed a higher mean percentage of TF positive monocytes in patients compared to controls (16.4% versus 6.4%, p <0.0001). We also found a correlation of this factor with markers of hemolysis and coagulation, being negative with hemoglobin levels and positive with % of reticulocytes, levels of lactate dehydrogenase, ferritin, PT, indirect bilirubin, fibrinogen, platelet counting, monocytes and D dimer plasma levels. Conclusion: Patients with sickle cell disease have a prothrombotic state, even when out of crisis, and the correlations of this factor with markers of hemolysis suggest that this primary event in sickle cell disease may be related to activation and greater expression of TF in monocytes, favoring the hypercoagulability state, predisposing these patients to complications such as acute chest syndrome, stroke and pulmonary arterial hypertension as documented in these individuals, common and severe complications in the sickle cell disease.