Estimation of Protein C and Measurement of Coagulation Changes among Sudanese Patients with Solid Malignancy

Background: Activation of the coagulation cascade frequently occurs in cancer by a number of mechanisms, including the generation of tumor necrosis factor, tumor pro-coagulant and tissue factor.

Aim: The purpose of this study was to investigate the plasma level of PC, FIB, DD and evaluate the PT, INR, APTT, and platelets count in Sudanese patients with some solid malignant tumors.

Methods: A total of 165 individuals (both sex 52% male and 48% female) of Sudan origin 125 patients diagnosed as solid malignant tumors (40% Breast, 24.8% Prostate, 10.4% uterine cervix, 7.2% rectum, 5.6% ovarian, 4,8%esophageal, 4.8% lungs and 2.4% colon) and 40 apparently healthy control subjects were prospectively enrolled in the study. The exclusion criteria of the study were the presence of a medical history of hematological malignancies or coagulation-related diseases, severe hepatic and/or renal insufficiency, significant cardiovascular disease, or receiving any anticoagulant therapy. Platelets were count by Sysmex Kx21, XRC used for PT, PTT, FIB, Snibe maglumi 2000 was used for D-dimer and ELISA was used for PC.

Results: There were significant statistical differences between the study parameters in the patients compared with apparently healthy controls. The mean of (platelets count, PT, INR and APTT) was (295±125)cell/L, (22.9±2.82)sec, (1.49±0.206)% and (45.3±5.74) sec, in patients with solid malignant tumors vs (350±80.0) cell/L, (17.4±1.48)sec,(1.13±0.104)% and (38.0±5.28)sec in control group p-value (0.011), (0.000), (0.000) and( 0.000) respectively. Then mean of PC, FIB and D-dimer (8.20±2.81)pg/ml, (297.9±75.1)mg/dl, and (1.08±1.26) µg /ml in patients with solid malignant tumors vs (9.57±3.40) pg/ml, (288.6±57.2) mg/dl, and (0.482±0.223) µg /ml in control group p-value (0.011), (0.409), and (0.000) respectively.

Conclusion: In this study, the study variables (Platelets count, PT, INR, APTT, PC, and DD) showed significant statistical difference between the patients with solid malignant tumors and apparently healthy controls, but the FIB level results show insignificant different, our finding suggest that these study variables can play important role in pathogenesis of the hypercoagulable state in cancer patients and the significant difference in platelets count, PT and APTT may early indication of bleeding tendency, further investigations (platelets function tests and coagulation factors assay) should be done to avoid risk of bleeding.