Background and Aims: Recently, many studies have reported that the plasma concentrations of natural anticoagulants, such as Antithrombin-III (AT-III), are altered in patients with chronic liver disease. In addition, the changes in the synthesis of AT-III occur in liver tissue and are associated with the extent of chronic hepatitis and cirrhosis. Methods: In this study, we analyzed the plasma level of AT-III and serum activity of aminotransferase in 60 participants: 20 patients with chronic hepatitis, 20 patients with cirrhosis, and 20 healthy individuals (controls). Results: Low levels of AT-III and elevated levels of aminotransferase activity were associated with both chronic hepatitis and cirrhosis. We found that among patients with elevated gamma glutamyl transferase (GGT) activity and chronic liver disease, the level of AT-III in plasma was significantly lower in patients with chronic cirrhosis than in patients with chronic hepatitis (P < 0.05) and the level of AT-III in plasma was lower in patients with liver disease in comparison to healthy participants (P < 0.001).Conclusions: The level of AT-III in patients with chronic liver disease may be used as a non-invasive factor for the laboratory diagnosis of cirrhosis.

Background & Aim: Crystalloids represent an attractive strategy to alleviate intravascular volume deficits. Studies have demonstrated that hemodilution with decrease antitrombin III is associated with hypercoagulability. However, there were not any researches about effect of different crystalloids on coagulation. The present study was undertaken to find out which of the used crystalloids has more effect on coagulation. Patients & Methods: In a prospective study on patients undergoing ACL reconstruction normal saline(NS), Ringer(R) and Ringer Lactate(RL)(n=25) were used for intravascular volume replacement based on standard protocol to compensate intravascular volume deficits. PT, PTT, BT, CT and platelet count were used at T0 (after induction of anesthesia), T1 (immediately after anesthesia), T2(6h after surgery) and T3(the morning after surgey), for comparing coagulability in groups.Results: Changes of coagulation at T1 in all groups were not significant. Mean (±SD) of coagulation tests at different times in all groups were statistically significant in PT(P=0.001), PTT(P=0.001), and CT(P=0.001) and not significant in BT & PLT(P>0.05).Conclusion: No differences between NS, R & RL were seen in coagulation tests and coagulability. However, hypercoagulability states were seen after hemodilution.

Introduction: Recurrent abortion is defined as three or more spontaneous miscarriages before first trimester of pregnancy. Protein C, S, Antithrombin III deficiency is of the min factors of this disease. The presence of antiphospholipid antibodies, such as Lupus Anticoagulant, antiphospholipid, anticardiolipineand and B2 glycoprotein can lead to recurrent abortion. This study was performed with aim to determine the serum level of these factors in women with recurrent abortion. Methods: This cross-sectional study was performed in 2017 on 80 women with recurrent abortion who had abortion at first trimester of pregnancyand had referred to gynecology clinic. Clotting method was used to determine theprevalence of deficiency of natural anticoagulant proteins. ELIZA method was used to determine the presence of antibodies ofantiphospholipidsyndrome. Data were analyzed by SPSS software (version 22) and t-test. PResults: Activated Protein C-Resistance was found in 21. 3% of cases, prevalence of PS deficiency and PC deficiency individually with 8. 8%, component PSD and PCD in 3. 7% and AT-III deficiency in 1. 3% of patients. Presence of LAC in our patients was 3. 8%. The prevalence of APA, LAC, ACA and B2 microglobulin were 2. 5%, 3. 8%, 1. 3 and 2. 5% respectively. Conclusion: APC-R was the most common deficiency of natural coagulant inhibitors in women with recurrent abortion who referred to clinical laboratory of Bagheatalah general hospital in Tehran.

Objectives: Cerebral venous sinus thrombosis (CVST) with cerebral hemorrhage is relatively rare but may result in a catastrophic outcome. Antithrombin III deficiency is an inherited disease that contributes to an increase in the occurrence of thromboembolic events during pregnancy. Case Presentation: A nulliparous, 34-year-old Chinese woman at 9 weeks of pregnancy with underlying antithrombin III deficiency was under treatment with low dose molecular weight heparin. She presented with a frontal headache and projectile vomiting. A plain computed tomography (CT) scan and magnetic resonance angiography and venography (MRAV) of the brain showed features suggestive of CVST involving superior sagittal sinus with venous infarct and right frontal and left parietal intraparenchymal hemorrhage. During admission, she developed episodes of fainting and loss of consciousness. A repeated brain CT scan showed worsening intraparenchymal hemorrhages with midline shift, subfalcine herniation and cerebral edema. An emergency bilateral craniectomy was performed to relieve the intracranial pressure. Despite the surgery and supportive measures, the patient succumbed to death. Conclusion: Due to the highly hypercoagulable state of pregnancy with concomitant antithrombin III deficiency, preconception counselling including optimization of anticoagulant dosage is crucial. In addition, the administration of antithrombin III concentrate should be considered during pregnancy for women with antithrombin deficiency.

Background: Unexplained recurrent miscarriage (RM) is still an unsolved reproductive health problem. Inheritedthrombophilias have been one of the causes. Mutation in genes encoding coagulation proteins, including prothrombin(PT G20210A) and methylenetetrahydrofolate reductase (MTHFR) genes, increase tendency for venous thromboembolism.This study aimed to evaluate association between polymorphisms in prothrombine and MTHFR genes withRM. We also evaluated association between protein C (PC), protein S (PS), antithrombin III (ATIII), and homocystienewith RM.Materials and Methods: We conducted a case-control study on women with history of miscarriages and healthycontrols. Genetic analysis was done using (TaqMan) polymerase chain reaction (PCR) technique and the othertests were performed to check general health indications and thrombophilia markers.Results: In this study, 195 RM group (group I) participants and 90 healthy controls (group II), PC, PS, ATIII deficiencyand Hyperhomocysteinemia were in 7.2, 65.6, 9.2, 10.8% of group I respectively, but was 1.1, 7.8, 2.2, 2.2% of groupII. PT G20210A showed two in group I were A/G, no A/G in group II, and no AA carrier in the either group. G allelewas observed in 99.5% of the group I and 100% of the group II, while A allele was detected in 0.5% of group I. MTHFRC677T gene showed C/T mutation in 33.3% of group I and 32.2% of group II, while T/T mutation was detected in 12.8%of group I and 8.9% of the group II. C allele was found in 70.5% of group I and 75% of group II, while T allele was foundin 29.5% of group I and 25% of group II (P=0.269).Conclusion: PT G20210A and MTHFR C677T gene mutations are not correlated with RM in the Egyptian population.However, Egyptian women with RM are strongly associated with hyperhomocysteinemia, PC, PS, and ATIII deficiencies(registration number: NCT03209063).

Background and Objectives: Thalassemia is a hereditary anemia requiring lifelong transfusion treatment with thromboembolism as one of its side effects. In the present study, we tried to determine the activity of anticoagulant proteins in thalassemic patients.Materials and Methods: This descriptive study was conducted in Adult Thalassemia Clinic in Tehran. Measurement of protein C, S, and anti thrombin III levels were done. At the same time, we did these tests on 110 normal people who were matched by age and sex as the control group. The data were analyzed with Chi-Square, Pearson and T-test by SPSS 16.Results: Out of 127 patients with the mean age of 29.4 year (SD±10.6), 114 (89.8%) were spelenectomized. Seven patients (5.5%) had history of thrombosis with 2 of them being diagnosed as major and 5 intermedia; all of them were spelenectomized. In 61.1%, 67%, and 22.5% of thalassemic patients, the levels of protein C, protein S, and anti thrombin III decreased, respectively. We did not observe any correlation between these results and the type of thalassemia except antithrombin III (p=0.001).Conclusions: In our study, we observed significant decreased activity of protein C, S, and antithrombin III in comparison to the normal population which shows that thalassemic patients are prone to the thromboembolic events.

Introduction: Acute lymphoblastic leukemia is one the most common malignancies in children and adolescents. L-asparginase (L-ASP) is one of the leading medications in treatment of ALL. L.ASP interferes with the synthesis of some coagulation proteins and therefore causing disturbance in normal coagulation. In this study, the effects of L-ASP on anticoagulant proteins (protein C, protein S, and antithrombin III) and platelet function were assessed.Material and methods: This was a before-after study on 41 patients with ALL who refered to Mahak hospital (Tehran, Iran). Before and after the injection of L.ASP, a bleeding time test was performed based on Ivy method. Protein C and protein S performance was assessed by turbidometry and antithrombin III performance was evaluated by chromogenic method.Results: 48.8% of patients were female. Mean (±SD) of age was 4.0±7.2. A significant reduction in the mean amount of protein C, antithrombin III and bleeding time was recorded. However, the reduction in protein S was not significant. No patient showed the symptoms of thrombosis.Conclusion: The results of this study showed that L. ASP drug reduced coagulation proteins (except the protein S). This decrease along with other concomitant genetic factors can lead to thrombosis in some patients with ALL during induction therapy.