26. ETHANOL GELATION TEST AND PROTAMINE SULPHATE TEST IN DIAGNOSIS OF INTRAVASCULAR COAGULATION

2009 ◽  
Vol 8 (S13) ◽  
pp. 197-202
Author(s):  
V. Musumeci
1973 ◽  
Vol 29 (02) ◽  
pp. 363-374 ◽  
Author(s):  
F. K Beller ◽  
W Theiss

SummaryPlasma fibrinogen, circulating fibrinmonomers (as indicated by a positive ethanol gelation test), fibrinolysis breakdown products and plasma hemoglobin were assayed in 122 rats subjected to endotoxin injection or infusion. The results were correlated with the quantitative measurement of glomerular fibrin deposition. Based on these data four groups were determined : consumption coagulopathy and three stages of increasing severity of disseminated intravascular coagulation (DIG).Consumption coagulopathy was defined by a decrease in plasma fibrinogen and a positive ethanol gelation test in the absence of glomerular fibrin deposition. Plasma hemoglobin and fibrinolysis breakdown products were normal or only slightly increased.DIG as characterized by glomerular fibrin deposition was defined as moderate (1 to 20% glomeruli showing fibrin strands), intermediate (21 to 80%), and severe (81 to 100%). Decrease in plasma fibrinogen and frequence of a positive ethanol gelation test in all stages of DIG were only slightly different from the findings in consumption coagulopathy. However, a sharp increase in plasma hemoglobin levels was noted when glomerular fibrin deposition did occur even in small amounts. At this time only a moderate increase was noted in fibrin(ogen) breakdown products. These two parameters increased only slightly in the group of intermediate DIG. Severe DIG was characterized by a massive increase in fibrin (ogen) breakdown products and high levels of plasma hemoglobin.


1972 ◽  
Vol 27 (03) ◽  
pp. 365-376 ◽  
Author(s):  
G Fedder ◽  
Elisabeth M. Prakke ◽  
J Vreeken

SummarySince the conception of intravascular coagulation has been introduced in clinical medicine, the interest of clinicians in the early detection of this syndrome is continuously increasing. Therefore small amounts of thrombin and thromboplastin were infused into rabbits and special parameters, such as presence of an activated form of factor V and occurrence of a positive fibrin monomer test, were checked. As it turned out, activation of factor V (proaccelerin, accelerator globulin or AcG) was an earlier sign of intravascular coagulation than the appearance of a positive gelation test, which may occur without changes in fibrinogen or the number of blood platelets. These experiments could be of value for the early detection of intravascular coagulation in man.


1974 ◽  
Vol 31 (02) ◽  
pp. 299-308 ◽  
Author(s):  
W. B. J Gerrits ◽  
Elisabeth M Prakke ◽  
J van der Meer ◽  
J Vreeken

SummaryThe clinical value of the ethanol gelation test (EGT) in diagnosing diffuse intravascular coagulation (DIC) has been questioned because of the occasional finding of a negative test, while other laboratory data pointed to DIC. Therefore, the behaviour of the EGT during thrombin infusions in rabbits was studied, with special reference to the fibrinogen level and activation of fibrinolysis. Fibrinolytic activity was inhibited or induced by synchronous infusion of epsilon-aminocaproic acid or plasmin respectively. The results obtained show that apart from severe depletion of fibrinogen strong activation of fibrinolysis can cause a negative EGT during thrombin infusions in rabbits. This phenomenon could not be ascribed to high levels of fibrin degradation products (fdp); it might be due to plasmin digestion of fibrin monomers. In vitro studies with human plasma confirmed that the EGT becomes negative at a fibrinogen level of less than 20 mg per 100 ml or by plasmin activity in the presence of a normal fibrinogen level.Whereas a positive EGT is highly specific for DIC, these studies show that a negative EGT does not exclude the presence of DIC.


1979 ◽  
Author(s):  
A.H. Sutor

A scoring system for diagnosis of DIC is proposed which encludes anam estic, clinical and laboratory criteria. From anamnestic criteria triwerinp event which lead to microeirculatory disturbances, like peripheral stasis (hysovolaemia, cardia; insufficiency) thrombin-inducers (septicaemia, haemolysis) and vascular damage (haemolytic-uraemic-syndrome, g ant haemangioma) score1 point as well as a positive etnanol gelation test. Clinical parameters include all organs which show sirns of a throrr. ho-haemormafic syndrom. They represent shock-orpans and can be diagnosed clinically by simultaneous appearance of bleeding symptoms and microthromrosis, like oliguria and haematuria (shock-orean kidney) or purpura and “Intravital death sports” (shock-orfran skin) or haemoptoe and hyaline membrane (shock-organ lunps). Laboratory parameters of DIC include the annearanee of helmet cells, of leuko- or neutropenia, of thrombocytopenia and of the demonstration of consumption coagulopathy (low F I, II, V, XIII) and of fibrinolysis (increased FDP, low plasminogen, low Antithrombin III). From our experience a score of 7 points or more is compatible with DIC.


1975 ◽  
Author(s):  
E. Coeugniet

Disseminated intravascular coagulation (DIC) occured during severe infections with: gram-negative bacteria (24 cases), gram-positive bacteria (3 cases), acute hemolysis (11 cases), pneumonias with hypoxic syndrome (16 cases). Adjuvant factors: Hypo-volaemia and metabolic acidosis (34 cases), malnutrition and hypoproteinaemia (32 cases). 38 patients were boys. Early clinical symptoms: alteration of the general state, impossibility of blood collectings because of hypercoagulability, bleeding after injections, haematemesis, melena, purpura, renal failure. Rapid laboratory diagnosis: ethanol test, paracoagulation with protamine sulphate, decrease of thrombocytes number, thrombin clotting time. The most important differential diagnosis is hypoprothrombinaenra by vit. K deficiency or by liver failure which could also complicate DIC (6 cases). During “critical” periods of diseases usually complicated by DIC the DIC prophylaxis is proposed (heparin 100–200 i.u./kg/day i.v. + dipyridamole 5 mg/kg/day i.v. or orally. The treatment of DIC: heparin 1000 i.u./kg/day i.v. or, in order to decrease the risk of secondary bleedings because of heparin an association: heparin 400 i.u./kg day i.v. + dipyridamole 5—10 mg/kg/day i.v. or orally.


1972 ◽  
Vol 28 (02) ◽  
pp. 268-279 ◽  
Author(s):  
U Hedner ◽  
I. M Nilsson

SummaryThe following tests were performed in 305 persons with one or other of the following conditions: malignant disease, postoperative complications, sepsis or multiple fractures, liver disease, pregnancy, the puerperium, renal disease, dysproteinaemia and different blood disorders : 1. fibrinogen degradation products (FDP) with Niléhn’s immunochemical method; 2. the thrombin time; 3. the Reptilase time; 4. the ethanol gelation test; 5. the protamine sulphate precipitation test. It was found that a prolonged thrombin time or Reptilase time in a given case was not necessarily a sign of the presence of FDP. Thus, neither determination of the thrombin time nor of the Reptilase time can substitute for specific determination of FDP. A positive ethanol gelation test was found in only 5 out of 17 patients with a low platelet count, low P & P test, low factor V, low fibrinogen and clinical signs of disseminated intravascular coagulation such as shock, disturbance of the periphery circulation, oliguria or anuria. No association was found between a positive ethanol gelation test and the presence of FDP. The protamine sulphate precipitation test was positive in only one of the 305 patients.


1972 ◽  
Vol 28 (03) ◽  
pp. 342-350 ◽  
Author(s):  
Y. P Konttinen ◽  
L Kemppainen ◽  
O Turunen

SummaryPerformance and applicability of ethanol-induced gelation and protamine-induced paracoagulation for the demonstration of soluble fibrin monomer complexes and fragment Xo complexes was studied by using 1. fibrin monomer plasma prepared by adding small amounts of thrombin to plasma, 2. clot lysis products, and 3. thrombin -treated mixture of fibrinogen degradation products and plasma. To increase the specificity of the protamine tests only visible fibrin strand formation was recorded as positive. In addition to qualitative tests the amount of paracoagulable material was measured by a spectrophotometric method.The ethanol gelation test proved very simple, reproducible and considerably more sensitive than the protamine tests in demonstrating soluble fibrin monomer complexes, irrespective of whether fibrinogen degradation products were present or not. On the other hand, the protamine tests were clearly superior for demonstration of clot lysis products (fragment Xo complexes). Therefore it seems advisable to perform both types of tests when screening for intravascular coagulation.


1977 ◽  
Vol 37 (03) ◽  
pp. 444-450 ◽  
Author(s):  
T Mandalaki ◽  
A Dessypris ◽  
C Louizou ◽  
I Bossinakou ◽  
C Panayotopoulou ◽  
...  

SummaryBlood coagulation and fibrinolysis were assessed in 13 Finnish amateur runners aged 31 to 48, and one 65-year old taking part in a non-competitive marathon (42.2 km). After the run the mean values of partial thromboplastin time showed a very significant shortening, whereas the mean values of the prothrombin time and of plasma fibrinogen were not significantly altered. The mean values of euglobulin lysis time were significantly shorter and the mean values of fibrin degradation products increased highly significantly. After the run, protamine sulphate was positive or strongly positive in all subjects, whereas the ethanol gelation test was negative in all runners; no cryofibrinogen was detected in any participant. Thus, running a marathon race affects the haemostatic balance and activates the fibrinolytic mechanism. The effects of training and physical fitness on the above parameters are discussed.


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