Muhammad Hanif Mengal, Hina Abbas, Kiran Aamir, Aamir Ramzan


Background: Thrombophilia is a common risk factor for venous thromboembolism. The objective of this study was to determine prevalence of inherited protein C and protein S deficiency in renal transplant candidates of Sindh Province, Pakistan.
Material & Methods: This cross-sectional study was conducted in Department of Pathology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan from 16-10-2010 to 15-4-2011. 300 renal transplant candidates were selected. Candidates with acquired thrombotic disorders, women taking oral contraceptives and patients taking anti-coagulants during previous one week were excluded. Venous blood samples were collected before starting dialysis procedure or at least two days after last dialysis session. Platelet-poor plasma (PPP) was parted using plastic pipettes and protein C and protein S were processed on coagulation analyzer. Sex, age groups (<40 and ≥ 40years), presence of protein C deficiency and presence of protein S deficiency were nominal variables and analyzed by count and percentage along with population parameters.
Results: 300 renal transplant candidates included 199 (66.33%) men and 101 (33.67%) women and 238 (79.33%) in age group <40 years and 62 (20.67%) cases in age group ≥40 years. Prevalence of protein C deficiency was 6.66% (20/300) and of protein S deficiency was 4% (12/300). Prevalence of PC deficiency was higher in men 5.33% than women 1.33%. Also prevalence of PS deficiency was higher in men 3.0% than women 1.0%. Prevalence of PC deficiency was higher in age group <40 years 5.67% than ≥40 years 1.0%. Also prevalence of PS deficiency was higher in age group <40 years 3.33% than ≥40 years 0.66%.
Conclusion: More prolonged and follow-up studies are needed to define the true significance of deficiency of protein C and S (coagulation inhibitors) in post-transplant settings.


Thrombophilia, Protein C, Protein S, Protein C deficiency; Protein S deficiency; Venous Thromboembolism; Oral Contraceptives; Dialysis; End-stage Renal Disease; Renal Transplantation.

Full Text:



Hoffbrand AV, Moss PA. Thrombosis and antithrombotic therapy. In: Hematology. 6th ed. Oxford: Wiley-Blackwell; 2011.p. 363-80.

Tasneem RA, Kaleem M, Butt MK, Zaheer K, Ashraf HS. Experience of renal transplantation. Ann King Edward Med Uni 2000 Oct-Dec; 6(4): 374-5.

Dick AA, Lerner SM, Boissy AR, Farrell CE, Alfrey EJ. Excellent outcome in infants and small children with thrombophilias undergoing kidney transplantation. Pediat Transplant 2005 Feb; 9(1): 39-42.

Heit JA. Thrombophilia: common questions on laboratory assessment and management. Hematology Am Soc Hematol Educ Program 2007; 127-35.

John U, Ken touché K, Nowak G, Schubert, Miseluitz J. Successful renal transplantation in a patient with heterozygous prothrombin gene, factor V leiden mutation and heparin induced thrombocytopenia using r-hirudin as anticoagulant. Pediat Transplant 2006; 10: 114-8.

Todeschini P1, La Manna G, Dalmastri V, Feliciangeli G, Cuna V, Montanari M. Incidence of late deep venous thrombosis among renal transplant patients. Trans Proc 2013;45(7):2666-8.

Shen MC, Lin JS, Tsay W. High prevalence of antithrombin III, protein C and protein S deficiency, but no factor V Leiden mutation in venous thrombophilic Chinese patients in Taiwan. Thromb Research 1997 Aug 15;87(4):377-85.

Nampoory MR, Das KC, Johny KV, Al-Hilali N, Abraham M, Easow S, et al. Hypercoagulability, a serious problem in patients with ESRD on maintenance haemodialysis, and its correction after kidney transplantation. Am J Kidney Dis 2003; 42: 797-805.

Pai A. Protein C. Medscape [updated 2014 Jan 15, accessed 2018, Aug 12]. Available at

Pai A. Protein S. Medscape [updated 2014 Jan 15, accessed 2018, Aug 12]. Available at:

Raosoft® sample size calculator [internet]. Seattle, WA, USA: Raosoft Inc.; 2004. [accessed 2018 Jan 13]. Available at: http://www. raosoft. com/samplesize.html

Dugalic S, Petronijevic M, Stefanovic A, Stefanovic K, Perovic M, Pantic I, et al. Perinatal complications related to inherited thrombophilia: review of evidence in different regions of the world. J Maternal-Fetal Neonat Med 2019 Sep 23:

Srivastava S. Understanding genetic variations as risk factors for development venous thrombo-embolism (VTE). Adv Genet Eng 2016; 5(2):2-7.

Bauer A, Limperger V, Nowak-Göttl U. End-stage renal disease and thrombophilia. Hämostaseologie 2016; 36 (02): 103-7.

Rattazzi M, Villalta S, De Lucchi L, Sponchiado A, Galliazzo S, Faggin E, et al. Chronic kidney disease is associated with increased risk of venous thromboembolism recurrence. Thromb Research 2017 Dec 1; 160: 32-7.

Lu HY, Liao KM. Increased risk of deep vein thrombosis in end-stage renal disease patients. BMC Nephrol 2018 Dec 1;19(1):204.

Sarı F, Taşkapan H, Sığırcı A, Akpınar B. Evaluation of risk factors for arteriovenous fistula failure in patients undergoing hemodialysis. Erciyes Med J 2016 Mar 1; 38(1). 12-9.

Mannucci PM, Franchini M. Classic thrombophilic gene variants. Thromb Haemost 2015; 114(5): 885-9.

Satpanich P, Rojnuckarin P. Risk factors for venous thromboembolism (VTE) recurrences in Thai patients without cancer. Hematology 2019 Jan 1;24(1):159-65.

Shoaib M, Shamsi TS, Naz A. Arteriovenous thrombosis in chronic renal failure patients receiving renal replacement therapy. J College Physicians Surg Pak 2008 Jul 1; 18(7):418-23.

Ben-Tal O, Zivelin A, Seligsohn U. The relative frequency of hereditary thrombotic disorders among 107 patients with thrombophilia in Israel. Thromb Haemost 1989 Feb; 61(1): 50-4.

Weingarz L, Schwonberg J, Schindewolf M, Hecking C, Wolf Z, Erbe M, et al. Prevalence of thrombophilia according to age at the first manifestation of venous thromboembolism: results from the MAISTHRO registry. British J Haematol 2013 Dec; 163(5): 655-65.

Lee SY, Kim EK, Kim MS, Shin SH, Chang H, Jang SY, et al. The prevalence and clinical manifestation of hereditary thrombophilia in Korean patients with unprovoked venous thromboembolisms. PloS One 2017 Oct; 12(10): e0185785.

Paschôa AF, Guillaumon AT. Impact of screening on thrombophilia for patients with venous thrombosis. Int Angiol 2006 Mar ;25(1):52-9.

White RH. The epidemiology of venous thromboembolism. Circulation 2003 Jun 17; 107(23 Suppl 1): I4-8.

Anderson FA Jr., Wheeler HB, Goldberg RJ, Hosmer DW, Patwardhan NA, Jovanovic B, et al. A population-based perspective of the hospital incidence and case-fatality rates of deep vein thrombosis and pulmonary embolism. The Worcester DVT Study. Arch Intern Med 1991 May; 151(5): 933-8.

Chen WH, Lan MY, Chang YY, Chen SS, Liu JS. The prevalence of protein C, protein S, and antithrombin III deficiency in non-APS/SLE Chinese adults with noncardiac cerebral ischemia. Clin Appl Thromb Hemost 2003 Apr; 9(2): 155-62.

Sakata T, Okamoto A, Mannami T, Tomoike H, Miyata T. Prevalence of protein S deficiency in the Japanese general population: the Suita Study. J Thromb Haemost 2004 Jun; 2(6): 1012-3.

Silverstein MD, Heit JA, Mohr DN, Petterson TM, O'Fallon WM, Melton 3rd LJ. Trends in the incidence of deep vein thrombosis and pulmonary embolism: a 25-year population-based study. Arc Intern Med 1998 Mar 23; 158(6): 585-93.

Cushman M, Tsai A, Heckbert SR, White R, Rosamund W, Enright P, et al. Deep vein thrombosis and pulmonary embolism in two cohorts: the longitudinal investigation of thromboembolism etiology. Am J Med 2004 Jul 1; 117(1): 19-25.

US Renal Data System: Reference tables D.6 and D.9. In: 2018 USRDS Annual Data Report: Epidemiology of kidney disease in the United States, Bethesda, MD. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, 2018 [accessed 2018 October 25]. Available at:



  • There are currently no refbacks.

Copyright (c) 2020 Muhammad Hanif Mengal, Hina Abbas, Kiran Aamir, Aamir Ramzan

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.