Plasma factor XIII activity in patients with disseminated intravascular coagulation

The objective of this study was to investigate the correlation between factor XIII (FXIII) activity and disseminated intravascular coagulation (DIC) parameters and also to evaluate the clinical usefulness of DIC diagnosis. Citrated plasma from eighty patients with potential DIC was analyzed for FXIII activity. The primary patient conditions (48 male and 32 female, mean age, 51 years) were malignancy (n = 29), infection (n = 25), inflammation (n = 6), heart disease (n= 3), thrombosis (n = 2), injury (n = 2), and other miscellaneous conditions (n = 13). FXIII testing was performed using the CoaLinkTM FXIII Incorporation Assay Kit (PeopleBio Inc.). Among 80 patients who were suspected to have DIC based on clinical analysis, 46 (57.5%) fulfilled the overt DIC criteria (DIC score > = 5) according to the International Society of Thrombosis and Haemostasis. FXIII levels in the plasma were significantly decreased in overt DIC compared to non-overt DIC patients (mean 75.1% and 199.7% respectively, p < 0.0001). Interestingly, we found a significant inverse correlation between DIC scores and FXIII activity. In addition, FXIII activity significantly correlated with other hemostatic markers that included platelet count, prothrombin time, activated partial thromboplastin time, fibrinogen, and D-dimer. FXIII levels were significantly lower in patients with liver or renal dysfunction. In conclusion, FXIII cross-linking activity measurements may have differential diagnostic value as well as predictive value in patients who are suspected to have DIC.     

Plasma levels of soluble fibrin in patients with disseminated intravascular coagulation

Soluble fibrin(SF) is formed in the early-activated state of blood coagulation and quantitative measurement of SF shows high potential as a parameter for the diagnosis of suspected disseminated intravascular coagulation(DIC). The aim of the present study is to evaluate the usefulness of a newly developed SF test utilizing SF specific monoclonal antibody(F405). Among hemopoietic and non-hemopoietic tumor patients, 249 patients with suspected DIC were collected. The SF level showed a good correlation with the DIC score and the SF levels in DIC patients were significantly higher than those in s-DIC and pre-DIC patients. Receiver operating characteristic(ROC) analysis also showed that the specificity and sensitivity of the SF assay were higher than those of thrombin-antithrombin complex(TAT). In conclusion, these results indicate that the SF assay is a highly precise method for the diagnosis and screening of DIC stages.     

The disseminated intravascular coagulation syndrome in endotoxin shock

Dynamics of blood coagulation and morphological changes after the intravenous administration of Salmonella typhimurium endotoxin is studied experimentally in Chinchilla rabbits. The stages of blood coagulation are established characteristic for the above syndrome. The signs of the developing blood stasiopathy with the domination of vascular wall damage and thrombocyte aggregation are observed. No considerable consumption of the blood coagulation factors is found. It is concluded that a leading role in the pathogenesis of the endotoxin shock microcirculatory disturbances belongs to the vascular damage and aggregation thrombocytopenia and not to the coagulopathy consumption.     

弥散性血管内凝血的放射自显影研究

大白鼠注射~(125)I标记的纤维蛋白原后,再注射凝血酶,造成弥散性血管内凝血。放射自显影检查发现,同位素标记的微血栓主要位于肾小球毛细血管,直小血管之中。肺泡的毛细血管也可发现这些微血栓。肝脏和脾脏的网状内皮细胞吞噬了大量的标记物质,这些吞噬细胞定位在肝门区,而在脾脏则位于马氏小体周围。此外,在肾小管的上皮细胞内也发现有同位素,这些物质可能是通过肾小球过滤而被肾小管重吸收的标记物质。用自显影术,常规染色和纤维蛋白的特殊染色互相比较,肺的微血栓在常规和特殊染色中不能被发现,用自显影术则很易检出同位素标记的微血栓。     

Distribution patterns of microthrombi in disseminated intravascular coagulation

Distribution of microthrombi in 37 autopsy cases of untreated disseminated intravascular coagulation (DIC) was studied histologically. According to the organs predominantly involved, four patterns of distribution were distinguished: hepatic, hepatorenal, renal, and undetermined. The results suggested that these patterns indicated the course of DIC and the function of Kupffer's cells in the liver, whose role in the course of DIC was evaluated.     

Possible induction of disseminated intravascular coagulation in the mouse by group B streptococcal clumping factor

A hydrochloric acid extract, the clumping factor fraction, obtained from a clumping factor-positive strain of group B streptococci, was capable of killing mice by administration after injection of heat-killed cells of group B streptococci or Escherichia coli intravenously. In mice killed between 24 and 48 h later, fibrin thrombi were observed in the renal glomeruli, as well as in the heart, lung, liver, and pancreas. These findings suggest the possible induction of disseminated intravascular coagulation by these organisms in the mouse.     

Diagnosis of disseminated intravascular coagulation. Role of D-dimer

Detection of the cross-linked fibrin degradation fragment, D-dimer, in patients at risk for disseminated intravascular coagulation (DIC) is strong evidence for the diagnosis. D-dimer confirms that both thrombin generation and plasmin generation have occurred. Patients at risk for DIC (58) and normal controls (7) were studied. Thirty-three patients had DIC--with fragment D-dimer identified in their serum by immunoblotting. Latex agglutination measurements of fibrin(ogen) degradation products (FDPs) and D-dimer were compared with immunoblotting in the detection of D-dimer. FDP measurement was extremely sensitive but not specific. D-dimer measurement was less sensitive but highly specific. Used in tandem, screening with FDP and confirming with D-dimer, sensitivity and specificity were maximized, rendering a predictive value of a confirmed FDP of 100% in this cohort. D-dimer is a valuable adjunct for the laboratory diagnosis of DIC but is most appropriately used as a confirmatory test for the very sensitive FDP test.     

Cerebral involvement with disseminated intravascular coagulation in intestinal disease.

Over a two-and-a-half-year period at the Sheffield Royal Infirmary, six patients developed disseminated intravascular coagulation as a serious complication of intestinal disease. There was clinical evidence of cerebral involvement in all six patients, and small vessel thrombi were demonstrated in the brains of all three cases examined post mortem. Where the true significance of the cerebral disorder was not recognised, this led to delay in the diagnosis with serious risk to the patient. In the single case in which the diagnosis was made early, the intravascular coagulation was completely reversed with heparin therapy.