Investigating hypercoagulability in brain cancer patients by studying the viscoelastic and ultrastructural properties of whole blood

Abstract

Brain cancer is a condition with a relatively high rate of loss of life, regardless of patient demographics. The location and malignancy of the tumour are both determinants of this mortality rate, however there are complications associated with the disease that also contribute to this mortality rate. One of these complications are coagulopathies which may lead to thrombotic events. Thrombosis is a reality for many brain cancer patients which may contribute to a poor prognosis. This study analysed the contribution of different components that may contribute to the overactivation of the coagulation pathway in this patient group. Brain cancer in South Africa has an incidence rate of about 1.5/100000. There is also a strong association of coagulopathy in cancer patients that may be attributed to morphological changes in red blood cells, inflammation, as well as the influence of inflammation on the release of certain procoagulants. This study aimed to investigate the morphological and viscoelastic changes during coagulation in patients with brain cancer by studying the components involved in coagulation and their contribution to hypercoagulability in these patients. This was done using ultrastructural and viscoelastic techniques. Light microscopy was used to determine the deformability of red blood cells by calculating the axial ratios. Scanning electron microscopy was used to study the ultrastructural properties of clots as well as red blood cells, and platelets. Lastly, the viscoelastic properties of whole blood were quantitatively analysed using thromboelastography®. This provided insight into the contributing factors to coagulopathy in brain cancer patients. When these factors are analysed and understood, insights into the clot formation in brain cancer patients may contribute to understanding the thrombotic risk in these patients and possible interventions based on the effects of the contributing factors. From the results it was established that the red blood cell deformability, ultrastructural properties of fibrin fibres, and viscoelastic profiles during clot formation of this patient group are changed to develop denser and faster forming clot types. This research therefore contributed to the field by providing information that can guide understanding about the relationship between primary brain cancer and coagulation of whole blood. By using this research alongside current knowledge, targeted monitoring of the contributing coagulation factors, such as changes in fibrin formation, and subsequent intervention can be applied to treat brain cancer-associated thrombotic risk.