Hemostatic Abnormalities in Malignancy, a
Prospective Study of One Hundred Eight Patients
Part I. Coagulation Studies
NORA C. J. SUN, M.D., WILLIAM M. McAFEE, M.Sc, GILBERT J. HUM, M.D., AND JOHN M. WEINER, D.P.H.
Sun, Nora C. J., McAfee, William M., Hum, Gilbert J., and
Weiner, John M.: Hemostatic abnormalities in malignancy,
a prospective study of one hundred eight patients. Part I.
Coagulation studies. Am J Clin Pathol 71: 10-16,1979. A prospective study of hemostatic abnormalities in 108 cancer patients was undertaken at an oncology clinic in a university
teaching hospital. Tests included Quick prothrombin time, activated partial thromboplastin time, thrombin time, platelet
count, modified Ivy bleeding time, fibrinogen, fibrin degradation products (FDP), euglobulin lysis time, protamine sulfate
test, and factor V, VII, VIII and X assays. Ninety-eight per
cent of the patients had one or more abnormal coagulation
tests. The commonest abnormalities were elevated fibrin degradation products and prolonged thrombin time. Thrombocytosis occurred in 57% of patients, hyperfibrinogenemia in
46%, thrombocytopenia in 11%, and none had hypofibrinogenemia. It is suggested that platelet count, fibrinogen concentration, and serum FDP assay are the most useful tests in
assessing the hemostatic abnormalities in cancer patients, although thrombin time, factor V assay, and bleeding time may
also be helpful. The peripheral blood smears of 53 patients
were reviewed, and only one showed microangiopathic hemolytic anemia. The data illustrate that subclinical coagulopathy
is relatively frequent in patients with malignancy. (Key words:
Disseminated intravascular coagulation; Cancer; Hypercoagulable state; Microangiopathic hemolytic anemia.)
Departments of Pathology and Internal Medicine,
USC-John Wesley Hospital, Los Angeles,
California
of clotting abnormalities in cancer patients. 36 This
study was designed to evaluate coagulation prospectively in a series of consecutive patients referred to an
oncology clinic for staging and consideration of chemotherapy for their malignant disease. The purpose was
to examine the incidence and types of hemostatic derangement in these patients by conventional methods.
The concept of "intravascular coagulation and fibrinolysis syndrome" (ICF) of Owen and Bowie26 was adopted,
and their classification of "overcompensated, compensated and decompensated I C F " was tested.
Materials and Methods
One hundred eight consecutive new patients referred
to the oncology service at the University of Southern
California-John Wesley County Hospital during a
period of one year with tissue-proven malignancy who
had relatively complete clinical and laboratory data
were included and formed the basis for the study. As
part of the initial work-up, coagulation studies included
Quick prothrombin time (FT), activated partial thromboplastin time (APTT), thrombin time (TT), platelet
count (by thrombocounter), modified Ivy bleeding time,
serum fibrin degradation products (FDP), 12 protamine
sulfate test, 17 euglobulin lysis time, 2 fibrinogen concentration (biuret method), 2 and factor V, VII, VIII, and
X assays. 2
The study group consisted of 54 men and 54 women.
Ages ranged from 16 to 86 years for men (median 61)
and from 22 to 86 years for the women (median 56).
The combined median was 59 years, and the mean was
53 years. More than half the patients (68) were in the
sixth and seventh decade of life.
The primary sites of malignant disease are listed in
Table 1. Four patients had a second primary tumor.
These included tumors of the breast (2), pancreas (1),
THE ASSOCIATION of recurrent thrombotic episodes with malignant disease was initially described by
Trousseau a century ago, 38 and migratory thrombophlebitis has been suggested as the first clinical indication
of an occult malignancy. 10 ' 40 Isolated reports of bleeding diathesis and/or thrombosis occurring in patients
with malignancy have been interpreted as secondary to
disseminated intravascular coagulation (DIC) or the
defibrination syndrome. 5,9 ' 30 A previous study by one of
us (N.C.J.S.) based on cases referred for consultation
to a coagulation laboratory disclosed a high incidence
Received November 8, 1977; received revised manuscript and accepted for publication January 9, 1978.
Supported in part by John Wesley Attending Staff Account #6002.
Presented in part at the American Society of Clinical Pathologists
Meeting, October 27, 1976, Los Angeles, California (abstract, Am J
Clin Pathol 67:206, 1977).
Address reprint requests to Dr. Sun: Department of Pathology,
Box 22, Harbor General Hospital, 1000 W. Carson Street, Torrance,
California 90509.
0002-9173/79/0100/0010 $00.85 © American Society of Clinical Pathologists
10
HEMATOSTATIC ABNORMALITIES IN MALIGNANCY
Vol. 71 • No. I
and stomach (1). The most frequent histologic types
were adenocarcinoma (53 patients), squamous-cell carcinoma (20), large-cell anaplastic carcinoma (7), myeloproliferative disorders (5), and undifferentiated smallcell carcinoma (3). Other types of solid tumor included
malignant melanoma, glioblastoma multiforme, osteogenic sarcoma, Ewing's sarcoma, embryonal carcinoma, and non-Hodgkin's lymphoma. The extent of
tumor-cell differentiation was classified according to
Broders' description.3
Eighty-seven patients (81%) had metastatic disease
determined by one or more of the following: physical
examination, roentgenography of the chest, liver scan,
bone scan, skeletal survey, bone marrow aspiration
and/or biopsy, or other tissue diagnosis. Nineteen patients (18%) were found to be free of evident metastatic
disease. Fifty-seven patients had two or more sites of
metastases. The lung was the most common location of
metastatic disease (41 patients), followed by lymph
nodes (38), bone (37), soft tissue (30), liver (27), and
brain (8). About half the patients (51) had histories
related to their malignant disease of less than four
months, and 71% of the patients had had the disease
for less than 12 months.
Other associated clinical conditions included a recent
history of thrombophlebitis (3 patients), pulmonary
embolism (2) and gram-negative septicemia (1). Six patients had slight concurrent bleeding, which was related to their malignant diseases. These were menorrhagia associated with acute myelogenous leukemia (1),
gastrointestinal bleeding from carcinoma of the colon
(2), bleeding from carcinoma of the stomach (2), and
bleeding from cancer of the oral cavity (1).
Since clotting and fibrinolytic systems are in a constant dynamic balance, Owen and Bowie suggested
the term "intravascular coagulation and fibrinolysis
syndrome" (ICF) to emphasize this relationship. Experimentally, they and others613-20-25 observed several
11
Table 1. Primary Sites of Malignant Disease
Sites
Number
Lung
Breast
Unknown primary site
Colon
Bone marrow
Prostate
Ovary, brain, skin, esophagus
Kidney, testicle, stomach, oral cavity
Liver, lymph node, middle ear, thyroid,
tongue, and bone
27
21
12
11
7
4
3 each
2 each
1 each
patterns of this syndrome, which were dependent
on the triggering mechanism, the dose and duration
of stimulus, and the compensatory abilities of bone
marrow and liver. It is generally accepted that an elevation of FDP usually indicates plasminic digestion of
fibrinogen and/or fibrin; and it is, in most circumstances,
suggestive of an ICF syndrome.14 Supplemented by
other hemostatic tests, such as platelet count or
fibrinogen level, Cooper and associates7 classified ICF
into three groups: decompensated, which is defined by
depressed fibrinogen or platelet levels along with other
hemostatic abnormalities; compensated, in which
fibrinogen or platelet values are normal, but other hemostatic tests are abnormally prolonged; overcompensated, where the platelets or fibrinogen are increased,
together with other hemostatic abnormalities. This has
also been correlated with the conventional terms: acute,
subacute, and chronic DIC with decompensated, overcompensated, and compensated ICF, respectively.1-29-33
We applied this classification to our study, and a comparative evaluation of clinical conditions and laboratory tests was made.
Results
One hundred six of the 108 patients (98%) had one
or more abnormal coagulation test results. Two patients
Table 2. Results of Coagulation Studies
Low
Test
Platelets
Bleeding time
APTT
Quick PT
Fibrinogen
FDP
Protamine sulfate test
Euglobulin lysis time
Factor VIII
Factor VII
Factor X
Factor V
TT
Normal Range
170,000-300,000/mm
< 6 min
30-43 sec
11-14 sec
0.18-0.45 g/dl
<10 j/.g/ml
Negative
>2hr
60-140%
80-155%
75-135%
88-138%
Control ± 2 sec
No.
3
Normal
%
No.
%
No.
%
34
74
74
91
58
35
97
93
44
43
54
33
33
32
73
69
84
54
32
90
87
44
43
54
33
31
62
28
25
15
50
73
11
57
27
23
14
46
68
10
—
—
23
23
12
14
75
23
23
12
14
69
12
11
—
—
—
—
—
—
9
2
0
14
33
34
34
53
0
High
8
2
0
13
33
34
34
53
0
SUN ET AL.
12
A.J.C.P. . January 1979
Table 3. Pearson Correlation Coefficient (T) among Pairs of Laboratory Results
Erythrocytes
Leukocytes
Platelets
Bleeding
time
APTT
PT
Fibrinogen
FDP
PSTt
ELTt
Factor
VIII
Factor
VII
Factor X
Factor V
ATT
.21*
.04
.18*
.16
-.05
-.00
.04
.02
.10
.01
.07
-.17*
-.00
-.08
.46*
.11
-.20*
-.08
-.09
.20*
.14
.03
-.09
.33*
-.08
-.05
.07
-.08
-.13
-.13
.09
.12
.23*
-.09
.00
-.03
-.07
.00
.07
.05
.13
Platelets
.06
.21*
-.22*
.02
Bleeding
time
-.00
.32*
.03
-.18*
.16
-.18*
.01
-.03
-.05
.02
C
WBC
ErythLeurokocytes
cytes
-.05
.25*
.14
-.02
.07
.12
-.03
.22*
.02
-.14
-.03
.11
-.01
.24*
.13
-.16
-.16
-.01
.26*
APTT
-.31*
-.26*
-.16
.05
PT
-.23*
-.06
.18*
.26*
FDP
.05
-.03
.01
.09
PSTt
.01
.10
.09
.21*
Fibrinogen
-.13
.13
-.09
-.22*
-.14
ELTt
-.16
-.11
.17*
.21*
Factor
VIII
.28*
-.02
-.21*
Factor
VII
.20*
-.02
Factor
X
.25*
Factor
V
ATT
t Euglobin lysis time.
ATT = difference between patient's TT and control's TT.
* P < 0.05.
t Protamine sulfate test.
had one abnormal test, five had two, 13 had three,
14 had four, 24 had five, 16 had six, 18 had seven,
nine had eight, five had nine, and two had ten. Two patients had normal results. One was a 62-year-old man who
had a non-Hodgkin's lymphoma, and the other was a
47-year-old woman with mammary carcinoma. Neither
had any evidence of metastatic disease. The two patients with ten abnormal clotting tests had bronchogenic
carcinoma with widespread metastases.
A summary of coagulation laboratory data from these
108 patients is shown in Table 2. Elevated FDP (68%)
and prolonged thrombin time (69%) were the most com-
mon abnormalities. These two tests also had significant
correlation (Table 3). Meaningful correlations were observed among pairs of tests, such as PT with APTT,
PT with FDP, PT with factor VII, PT with factor X,
factor X with factor VII, fibrinogen with platelets, FDP
with APTT, FDP with PT, FDP with factor VIII, FDP
with ATT, factor V with ATT. Some of the paired tests
were negatively correlated, such as PT with factor VII;
i.e., the lower the factor VII activity, the longer the
prothrombin time. None of the tests could replace
another in spite of the significant relationships, because
the correlation coefficients are not near ± 1 in value.
Table 4. Pertinent Clinical and Laboratory
Patient
Patient
Patient
Patient
Patient
Patient
Patient
Patient
Patient
Patient
Patient
Patient
2
6
7
24
31
36
65
69
84
90
93
104
* ND = not done.
t Bleeding time.
Age (Years)/Sex
Primary Tumor
52/F
59/F
73/F
52/F
42/M
61/M
64/F
62/F
56/M
76/M
55/F
50/F
Acute myelogenous leukemia
Breast
Lung
Breast
Stomach
Colon
Oral cavity
Malignant melanoma
Preleukemia
Acute myelogenous leukemia
Breast
Myelofibrosis and myeloid
metaplasia
t Protamine sulfate test.
§ Euglobulin lysis time.
Platelet
Count
(/mm3)
BTt
(Min)
APTT
(Sec)
PT
(Sec)
ATT
97 x 103
124 x 103
44 x 103
106 x 103
167 x 103
150 x 103
124 x 103
167 x 103
124 x 103
44-5.2
158 x 103
6.5
6.6
ND*
4.3
5.5
6.1
6.0
5.5
7.0
5.2
3.7
60
40
35
42
46
33
52
35
40
36
30
15
12
18
13
15
12
14
12
14
12
12
1
1
0
3
2
9
3
4
9
7
3
36 x 103
3.8
26
12
4
13
HEMATOSTATIC ABNORMALITIES IN MALIGNANCY
Vol. 71 • No. I
Fifty-seven per cent of the patients had thrombocytosis, and 11% had thrombocytopenia. Of the latter, four
had platelet counts below 100,000/mnr'1 (Table 4). Three
of these four patients had myeloproliferative disorders.
The fourth patient was a 73-year-old woman with
metastatic bronchogenic carcinoma.
There was no relationship between the histologic
type and the extent of tumor cell differentiation and
elevation of FDP, or between the duration of illness
and any of the tests.
Peripheral blood smears from 53 of the patients revealed only one instance of microangiopathic hemolytic
anemia. This patient had a metastatic mucin-producing
adenocarcinoma of the stomach.
Normal or elevated platelet counts were frequently
seen in those patients receiving radiation therapy. Seven
of nine patients recovering from operations (including
biopsy) had thrombocytosis (Table 5). All of these patients had clinical or histologic evidence of metastases.
Adopting Owen and Bowie's hypothesis, an attempt
was made to identify those key tests that might enable us to discover patients with coagulation problems.
We used FDP and platelets as the indicators and separated the patients into three groups: the patients with
no ICF (normal FDP); those with compensated ICF
(elevated FDP, but normal platelets); and those with
overcompensated ICF (elevated FDP and platelets).
The number of patients who might have a true decompensated ICF (elevated FDP and decreased platelet
count) was relatively small (Table 4), and they were
included in the compensatory ICF for the statistical
purpose. We then compared a battery of hemostatic
tests among these three groups (Table 6). Several tests
appeared to be helpful in differentiating those with no
ICF, compensated ICF, and overcompensated ICF.
These were bleeding time, fibrinogen, factor V, and
thrombin time. However, no statistically significant
difference among the clotting tests was found when
we used FDP and fibrinogen, except in the case of the
platelet count.
Thirty per cent of the patients who had bronchogenic
carcinomas showed a compensated ICF state, and 52%
overcompensated. About half (48%) of the patients
with mammary cancers did not have ICF, while 46% of
the patients with colonic carcinoma had overcompensated ICF. Those patients with unknown primary tumors were largely in the overcompensated state (58%),
and only 17% had no evidence of ICF. Sixty-seven
per cent of the patients who had bronchogenic carcinomas and 66% of those with unknown primary tumors also had hyperfibrinogenemia.
The same criteria were applied to different clinical
conditions. Patients with thrombophlebitis or pulmonary embolism also had laboratory evidence of overcompensated ICF. However, no definite pattern was
seen in the patients with current bleeding, and such
bleeding was most likely to be a result of their primary
tumors rather than a manifestation of ICF syndrome.
As might be expected, patients who had metastases
of the lung, brain, liver, and lymph nodes and those
with two or more sites of metastases were frequently
in the overcompensated ICF category.
Discussion
Viable malignant cells circulate in the blood or
lymphatic systems, or both. 16,31 Experimental studies
have demonstrated intravascular cancer localization by
the adhesion of cancer cells to the vascular endothelium
and the formation of a fibrin thrombus. 35 Laki 18 showed
that a proper fibrin network is essential for the development of blood supply for tumors. Acceleration
Findings in Patients with Low Platelet Counts
Fibrinogen
(g/dl)
Factor
VIII
Factor
VII
Factor
X
Factor
V
(%)
(%)
(%)
(%)
Bleeding
Thrombosis
FDP
PSTt
ELT§
(Hr)
_
+
+
+
+
+
-
>2
>2
>2
>2
>2
>2
>2
>2
>2
1.5
>2
100
21
250
25
50
66
ND*
85
300
135
50
86
140
23
80
30
120
ND
120
60
72
160
62
86
46
62
62
100
ND
94
100
82
100
60
52
27
36
74
41
ND
100
120
150
170
Yes
No
No
No
Yes
Yes
Yes
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
>2
ND
ND
ND
ND
No
No
230
370
180
390
210
460
250
390
510
240
320
+
+
+
—
+
+
-
860
+
_
SUNCTAZ..
14
A.J.C.P. • January 1979
Table 5. Selective Clinical and Laboratory Information about Patients
Recently Treated for Their Malignant Disease
Type of
Treatment
Patient's
Age (Years)/Sex
Radiation therapy
Patient 106
Patient 101
55/F
57/F
Patient 98
Patient 80
Patient 42*
Patient 25
Patient 5
Surgical treatment
Patient 12
Patient 19
Patient 42*
Patient 45
Patient 48
Patient 69
Patient 79
Patient 82
Patient 94
Fibrinogen
(g/dl)
Abnormal FDP
(>10/xg/ml)
410,000
0.61
Yes
728,000
450,000
380,000
585,000
300,000
345,000
0.61
0.40
0.60
0.64
0.28
0.50
Yes
Yes
Yes
No
Yes
Yes
443,000
> 1,000,000
585,000
400,000
742,000
167,000
190,000
360,000
774,000
0.38
0.26
0.64
0.19
0.67
0.39
0.19
0.38
0.32
Yes
No
No
Yes
Yes
No
Yes
No
No
Platelets
(/mm3)
Primary Tumor
56/M
34/F
58/M
50/M
60/M
Breast
Unknown (large cell
undifferentiated)
Unknown (clear cell)
Lung
Lung
Lung
Lung
59/M
48/M
58/M
34/M
51/F
62/F
67/F
79/M
22/M
Colonic
Stomach
Lung
Glioblastoma multiforme
Unknown
Malignant melanoma, skin
Unknown
Malignant melanoma, skin
Embryonal, testis
* Same patient.
of platelet and fibrinogen turnover rates, seen in patients with various kinds' of malignancy,15 have been
attributed to their increased consumption within the
tumor mass or in the process of intravascular coagulation.34 Deposition offibrin within a necrotic tumor mass
has been found histologically. Incorporation of fibrin
with tumor cells or an intravascular thrombus within
the stromal capillaries of tumor nodules also is seen.
Intravascular or intralymphatic tumor infiltration is
not uncommonly observed in the histologic sections
from surgical or autopsy specimens, and is often a
sign of early dissemination of the disease and a poor
prognosis. Thrombocytosis, hyperfibrinogenemia, and
elevation of plasma levels of factors II, V, VII, IX,
and X with acceleration of thromboplastin generation
have been described.823,28 These findings have been
interpreted as a compensatory overproduction secondary to a low-grade intravascular coagulation.
Chronic and subacute DIC are probably far more
common than the dramatic acute DIC.27 However, the
definitive diagnoses of these conditions are rather difficult; they often require kinetic studies of platelets
and coagulation factors.22 Such studies are not available in service laboratories. Thirteen routine tests were
performed in our study. The platelet count, fibrinogen
concentration, serum FDP assay, and thrombin time
determination were the tests most important in evaluation of the balance between the clotting and fibrinolytic
systems (Table 6). Microangiopathic hemolytic anemia
was uncommon in this group of patients.
A single abnormal coagulation test may not be significant, because the blood level of any one biological
substance reflects the balance between its anabolism
and catabolism. However, 88 patients had more than
four abnormal test results. This indicates that hemostatic derangement is indeed quite common in cancer
patients. The protamine sulfate test was proposed
to be very sensitive and specific for intravascular
coagulation,,732 but only 11% of our patients had a
positive value. A significant correlation betwen protamine sulfate test results and FDP was observed
(Table 3). The discrepancy in the incidences of positivity
of FDP and protamine sulfate test results might be due
to the differences in sensitivity and specificity of the
methods or the differences in the clinical stages during the time the patients were studied.
The present study indicates that coagulation abnormalities are rather common among cancer patients,
even though the incidences of hemorrhage and thrombosis were low. Most patients appeared to be in a delicate hemostatic balance (compensated ICF) or in a
hypercoagulable state (overcompensated ICF). An untoward effect might be provoked by stimuli such as
surgery, radiation therapy, or infection. Thrombocytosis19 and hyperfibrinogenemia4 in cancer patients comparable to our findings have been reported in other
studies. Interestingly, those patients who had hepatic
metastasis had normal or high fibrinogen concentrations (14/27 had normal values, and 13/27 had fibrinogen
values of more than 0.45 g/dl); 95% of the patients
with metastatic disease of the bone had normal or elevated platelet counts (12 normal, two elevated, and
two below normal). These results are consistent with
the known reserve capacities of both liver and bone
Vol. 71 • No. I
15
HEMATOSTATIC ABNORMALITIES IN MALIGNANCY
marrow, and they are probably related to the mass of
the metastases, the site of primary tumor, and the accuracy of the clinical staging evaluations.
Digestion of protein by proteolytic enzymes other
than thrombin or plasmin, the redistribution of protein
between intra- and extravascular spaces that may occur
in diseases, hemoconcentration, and fibrin deposition
around cancer cells in the extravascular space may
all contribute to the elevation or depression of fibrinogen
and platelets. The situation is further complicated by
the lack of sensitive tests for differentiating the fibrin
from fibrinogen degradation products and the difficulty
in differentiating local from disseminated intravascular
coagulation and in differentiating intravascular from
extravascular coagulation. In our opinion, FDP is the
most sensitive test for the evaluation of the ICF syndrome. Its value is enhanced when it is combined with
platelet count, fibrinogen concentration, and thrombin
time determinations and correlated with clinical and
pathologic conditions. We agree with McKay that DIC
or ICF is a syndrome and is an intermediary mechanism of the disease.21 In a proper clinical setting,
supported by certain abnormal hemostatic test results,
this syndrome should be suspected. Furthermore, precautionary measures can be taken to avoid its complications and a grave outcome.
Anticoagulants and fibrinolytic agents were utilized
in the treatment of experimental malignant tumors,
with favorable results.24-39 Clinical trials using warfarin
sodium or heparin as an adjunct to conventional chemotherapeutic agents have demonstrated that they might
have an enhancing beneficial effect."'37 Nevertheless,
more extensive clinical or experimental studies are
needed to determine their true value.
Table 6. Comparison of Laboratory Data among Different Groups of Patients
Test
Bleeding time (min)
Normal
Prolonged
APTT (sec)
Shortened
Normal
Prolonged
PT (sec)
Shortened
Normal
Prolonged
Fibrinogen (g/dl)
Low
Normal
High
Protamine sulfate test
Negative
Positive
Euglobulin lysis time (hr)
Shortened
Normal
Factor VIII (%)
Low
Normal
High
Factor VII (%)
Low
Normal
High
Factor X (%)
Low
Normal
High
Factor V (%)
Low
Normal
High
Thrombin time (sec)
Normal
High
Normal
Range
No ICF*
(Normal FDP)
Compensated ICF
(FDPf, Platelets
< 300,000/mm3)
Overcompensated ICF
(FDPj, Platelets
> 300,000/mm3)
20 (57%)
15 (43%)
22 (73%)
8 (27%)
32 (87%)
5 (14%)
5 (14%)
26 (74%)
4 (11%)
2 (7%)
20 (65%)
9 (29%)
2 (5%)
28 (67%)
12 (29%)
1 (3%)
32 (91%)
2 (6%)
0
24 (77%)
7 (23%)
1 (2%)
35 (83%)
6 (14%)
0
23 (66%)
12 (34%)
0
21 (68%)
10 (32%)
0
14 (33%)
28 (67%)
34 (97%)
1 (3%)
26 (84%)
5 (16%)
37 (88%)
5 (12%)
5 (14%)
30 (86%)
4 (13%)
27 (87%)
5 (13%)
36 (87%)
12 (36%)
17 (52%)
4 (12%)
11 (41%)
9 (33%)
7 (26%)
10 (25%)
18 (45%)
12 (30%)
5 (15%)
19 (58%)
9 (27%)
10 (37%)
11 (41%)
6 (22%)
19 (48%)
13 (33%)
8 (20%)
12 (36%)
15 (46%)
6 (18%)
9 (33%)
15 (56%)
3 (11%)
13 (33%)
24 (60%)
3 (8%)
24 (73%)
6 (18%)
3 (9%)
17 (63%)
5 (19%)
5 (19%)
12 (30%)
22 (55%)
6 (15%)
18 (51%)
17 (49%)
9 (29%)
22 (71%)
6 (14%)
36 (86%)
<6
P < 0.020
30-43
P < 0.231
P < 0.332
11-14
0.18-0.45
P < 0.003
Negative
P < 0.184
>2
P < 0.964
60-140
P < 0.271
80-155
P < 0.067
75-135
P < 0.635
88-138
P < 0.014
Control ± 2
* Intravascular coagulation and fibrinolysis syndrome.
Chi-square
Significance
P < 0.002
SUNETAL.
16
References
1. Baker LRI, Rubenberg ML, Dacie JV, et al: Fibrinogen
catabolism in microangiopathic hemolytic anemia. Br J
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