scholarly journals THE IMPORTANCE OF THROMBOELASTOMETRY IN THE HEMOSTATIC DISORDERS DIAGNOSIS IN INTENCIVE CARE PATIENTS WITH TRAUMAS (CLINICAL CASE)

2021 ◽  
Vol 1 (5(69)) ◽  
pp. 38-45
Author(s):  
O. Kostrova ◽  
I. Stomenskaya ◽  
N. Timofeeva ◽  
N. Buryachenko ◽  
I. Cherkasov ◽  
...  
Keyword(s):  
Degradation Products ◽  
High Sensitivity ◽  
Fold Increase ◽  
Traumatic Shock ◽  
Normal Limits ◽  
Fibrin Degradation Products ◽  
Craniocerebral Injuries ◽  
Angle Alpha ◽  
Male Patients ◽  
Hemostatic Disorders

thromboelastometry and coagulogram in patients with polytrauma. Materials and methods. The results of thromboelastometry (TEM) and standard coagulogram of 12 patients aged 18 to 74 years with a diagnosis of trauma were analyzed. Analysis of thromboelastometry was performed using a ROTEM delta blood analyzer (Tem Innovations GmbH, Germany), which evaluates the physical properties of a clot. Patients' blood stabilized with sodium citrate was placed in special disposable microcuvettes with the addition of various activators of coagulation reactions. The following indicators of thromboelastometry were determined: CT, CFT, angle alpha (α), MCF, A5, A10 in the tests INTEM, EXTEM and FIBTEM. The determination of coagulogram parameters was carried out according to a standard method. The following parameters were identified: APTT, INR, fibrinogen A content, serum fibrin degradation products (SFDP) concentration. Results. Coagulogram and thromboelastometry data at different stages of treatment were compared. In patients with the development of traumatic shock, coagulogram indices were changed to varying degrees depending on the stage of a shock. At the first stage of shock, the analysis showed only a 2-fold increase in SFDP and a slight increase in fibrinogen in dynamics. In a patient with a third stage of traumatic shock, the coagulogram indices were within normal limits, but according to TEM (EXTEM and FIBTEM tests), hypocoagulation was observed due to platelets. Only a coagulogram was evaluated in dynamics, hypocoagulation was observed in parameters of internal and external hemostasis pathways (prolongation of APTT, decrease in IPT and increase in INR), increase in fibrinogen A and SFDP. In the group of male patients with closed craniocerebral injuries, an increase in SFMC in the coagulogram had always been combined with changes in the FIBTEM test during TEM. Conclusion. Thus, in most patients, there is no change in classic coagulogram tests immediately after the injury. At the same time, rotational thromboelastometry makes it possible to fill this deficiency at an earlier date, which indicates a high sensitivity of the method.

Changes in Peritoneal Coagulation and Fibrinolysis after Discontinuation of Chronic Peritoneal Dialysis

2002 ◽  
Vol 22 (2) ◽  
pp. 178-183 ◽  
Author(s):  
Sumiko Homma ◽  
Yoshinori Masunaga ◽  
Megumi Kurosu ◽  
Makoto Inoue ◽  
Toshihiro Sakurai ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Degradation Products ◽  
Tertiary Care ◽  
Cell Mass ◽  
Mesothelial Cell ◽  
Fold Increase ◽  
University Hospital ◽  
Chronic Peritoneal Dialysis ◽  
Cancer Antigen 125 ◽  
Fibrin Degradation Products

♦ Objectives To study changes in peritoneal function after transfer from chronic peritoneal dialysis (CPD) to hemodialysis (HD), especially the effects on peritoneal coagulation, fibrinolytic markers, and mesothelium. ♦ Design Prospective observational study. ♦ Setting A tertiary-care university hospital. ♦ Patients Nine patients who transferred from CPD to HD were enrolled in the study after giving fully informed consent. ♦ Methods After transfer to HD, the peritoneal cavity was lavaged with low glucose PD solution once per day through PD catheters left in place. Thrombin–antithrombin III complex (TAT) was measured serially as a marker of peritoneal coagulation. As fibrinolytic markers, fibrinogen/fibrin degradation products (FDP) and plasmin–α2-antiplasmin complex (PIC) were assessed. Cancer antigen 125 (CA125) was measured as a marker of mesothelial cell mass. ♦ Results Levels of peritoneal TAT and FDP were much higher than plasma levels, indicating high local fibrin turnover. Transfer to HD induced a significant fall in mean peritoneal TAT, from 115.8 ± 52.1 to 60.7 ± 21.8 ng/mL, p < 0.05. Except for 1 patient with a 20-fold increase, mean peritoneal FDP decreased significantly, from 43.6 ± 11.1 to 19.6 ± 3.5 μg/mL, p < 0.05. Mean peritoneal PIC increased significantly, from 1.9 ± 0.4 to 3.9 ± 0.6 μg/mL, p < 0.05. Peritoneal CA125 increased from 156.4 ± 57.3 to 1426.2 ± 389.4 U/mL, p < 0.05. ♦ Conclusions Peritoneal fibrin turnover was accelerated on CPD and stabilized after transfer to HD. Transfer to HD also induced mesothelial regeneration.

scholarly journals Time-to-event assessment for the discovery of the proper prognostic value of clinical biomarkers optimized for COVID-19

2021 ◽  
Author(s):  
Jose Raniery Ferreira ◽  
Victor Henrique Alves Ribeiro ◽  
Marcelo Cossetin ◽  
Marcus Vinicius Mazega Figueredo ◽  
Carolina Queiroz Cardoso ◽  
...  
Keyword(s):  
Interleukin 6 ◽  
Prognostic Value ◽  
Degradation Products ◽  
Open Data ◽  
High Sensitivity ◽  
Lactic Dehydrogenase ◽  
Time To Event ◽  
Reactive Protein ◽  
Fibrin Degradation Products ◽  
Clinical Biomarkers

In the early days of the pandemic, clinical blood-originated biomarkers for COVID-19 have been investigated to predict patient mortality. A straightforward decision tree with three variables, i.e., lactic dehydrogenase (LDH), high-sensitivity C-reactive protein (CRP), and lymphocyte percentage, has been proposed previously, with more than 90% accuracy. In this work, we highlight the importance of the cohort made publicly available, especially at the beginning of the pandemic where open data were still limited, and complement the findings by incorporating further evaluation. Results confirmed poor short-term prognosis to abnormal levels of some laboratorial indicators, such as LDH, CRP, lymphocytes, interleukin-6, and procalcitonin. Our findings could also provide insights into COVID-19 research, such as key levels of fibrin degradation products, which are directly associated with the Dimerized plasmin fragment D and could indicate active coagulation and thrombosis. Still, we highlight here the prognostic value of interleukin-6, a cytokine that induces inflammatory response.

APPLICATIONS OF PLASMA ASSAYS OF CROSSLINKED FIBRIN DEGRADATION PRODUCTS (XLFDP) IN THE DIAGNOSIS OF THROMOEMBOLIC DISEASE

1987 ◽  
Author(s):  
A N Whitaker ◽  
P Masci ◽  
B Rowbotham ◽  
P Reasbeck ◽  
S M Guerrini ◽  
...  
Keyword(s):  
Lower Limb ◽  
Degradation Products ◽  
High Sensitivity ◽  
Surgical Patients ◽  
Screening Tests ◽  
Reference Level ◽  
Intravascular Thrombosis ◽  
Fibrin Degradation Products ◽  
Abdominal Operations ◽  
Latex Test

The presence of XLFDP in plasma, a consequence of the balance between fibrin generation and dissolution, is an indirect index of the presence of fibrin and raised levels accompany intravascular thrombosis. The potential of an enzyme immunoassay (EIA) for XLFDP, using the monoclonal antibody DD-3B6/22 was evaluated in 104 patients with suspected DVT receiving lower limb venography. Using a reference level of 400 ng/ml of XLFDP, all patients with a positive venogram had elevated levels (sensitivity 100%), although levels were also elevated due to causes other than DVT in some patients with negative venograms (specificity 52%). Higher elevations of XLFDP occurred in proximal than in calf DVT.A second study of another 48 patients receiving venography for suspected DVT confirmed the sensitivity of EIA while the complementary latex "Dimertest", also based upon DD-3B6/22, was positive in 19 and negative in 3 patients with confirmed DVT. In an ongoing study, 130 patients have been followed after abdominal operations with 125I-fibrinogren leg scanning and venography when appropriate. Levels of XLDFP (EIA) were elevated in all patients developing thrombosis. Latex assays were positive in 42/48 patients with positive leg scans. While elevated levels of XLDFP do not specifically define the location or even the presence of a thrombus they reliably indicate the possibility of thrombosis in patients without antecedent medical or surgical illnesses. In complicated surgical patients,an arbitrary cut-off of 1000 ng/ml is more appropriate for screening for the possibility of DVT. A positive latex test is also suggestive, although it is negative in some patients with calf thrombi. Measurements of XLFDP, with high sensitivity but moderate specificity, are potentially valuable in selecting patients for invasive investigations such as venography, and combinations with other noninvasive screening tests for require evaluation

A Monoclonal Antibody-Based Enzyme Immunoassay for Fibrin Degradation Products in Plasma

1988 ◽  
Vol 59 (02) ◽  
pp. 310-315 ◽  
Author(s):  
P W Koppert ◽  
E Hoegee-de Nobel ◽  
W Nieuwenhuizen
Keyword(s):  
Enzyme Immunoassay ◽  
Degradation Products ◽  
Blood Clot ◽  
Tissue Type ◽  
Fibrin Degradation Products ◽  
Type Plasminogen Activator ◽  
Strong Positive Reaction ◽  
Sandwich Type ◽  
Capture Antibody

SummaryWe have developed a sandwich-type enzyme immunoassay (EIA) for the quantitation of fibrin degradation products (FbDP) in plasma with a time-to-result of only 45 minutes.* The assay is based on the combination of the specificities of two monoclonal antibodies (FDP-14 and DD-13), developed in our institute. FDP-14, the capture antibody, binds both fibrinogen degradation products (FbgDP) and FbDP, but does not react with the parent fibrin(ogen) molecules. It has its epitope in the E-domain of the fibrinogen molecule on the Bβ-chain between amino acids 54-118. Antibody DD-13 was raised using D-dimer as antigen and is used as a tagging antibody, conjugated with horse-radish peroxidase. A strong positive reaction is obtained with a whole blood clot lysate (lysis induced by tissue-type plasminogen activator) which is used as a standard. The EIA does virtually not detect FbgDP i. e. purified fragments X, Y, or FbgDP generated in vitro in plasma by streptokinase treatment. This indicates that the assay is specific for fibrin degradation products.We have successfully applied this assay to the plasma of patients with a variety of diseased states. In combination with the assay previously developed by us for FbgDP and for the total amount of FbgDP + FbDP (TDP) in plasma, we are now able to study the composition of TDP in patients plasma in terms of FbgDP and FbDP.

Plasma Thrombospondin as an Indicator of Intravascular Platelet Activation in Patients with Vasculitis

1987 ◽  
Vol 58 (03) ◽  
pp. 850-852 ◽  
Author(s):  
M B McCrohan ◽  
S W Huang ◽  
J W Sleasman ◽  
P A Klein ◽  
K J Kao
Keyword(s):  
Platelet Activation ◽  
Plasma Levels ◽  
Half Life ◽  
Degradation Products ◽  
Plasma Concentrations ◽  
Primary Source ◽  
Positive Correlation ◽  
Activation Marker ◽  
Fibrin Degradation Products ◽  
The Mean

SummaryThe use of plasma thrombospondin (TSP) concentration was investigated as an indicator of intravascular platelet activation. Patients (n = 20) with diseases that have known vasculitis were included in the study. The range and the mean of plasma TSP concentrations of patients with vasculitis were 117 ng/ml to 6500 ng/ml and 791±1412 ng/ml (mean ± SD); the range and the mean of plasma TSP concentrations of control individuals (n = 33) were 13 ng/ml to 137 ng/ml and 59±29 ng/ml. When plasma TSP concentrations were correlated with plasma concentrations of another platelet activation marker, β-thromboglobulin (P-TG), it was found that the TSP concentration inei eased exponentially as the plasma β-TG level rose. A positive correlation between plasma levels of plasma TSP and serum fibrin degradation products was also observed. The results suggest that platelets are the primary source of plasma TSP in patients with various vasculitis and that plasma TSP can be a better indicator than β-TG to assess intravascular platelet activation due to its longer circulation half life.

A Prospective Study of Haemostatic Tests at 28 Weeks Gestation as Predictors of Pre-Eclampsia and Growth Retardation

1989 ◽  
Vol 61 (02) ◽  
pp. 243-245 ◽  
Author(s):  
J G Thornton ◽  
B J Molloy ◽  
P S Vinall ◽  
P R Philips ◽  
R Hughes ◽  
...  
Keyword(s):  
Discriminant Analysis ◽  
Prospective Study ◽  
Fetal Growth ◽  
Growth Retardation ◽  
Degradation Products ◽  
Fetal Growth Retardation ◽  
Fibrin Degradation Products ◽  
A Prospective Study ◽  
Primiparous Women ◽  
Significant Model

SummaryA panel of haemostatic tests was perfomed on 400 primiparous women at 28 weeks to test whether one or more could predict the development of pregnancy complications. Fifteen women subsequently developed pre-eclampsia with significant proteinuria and 13 delivered growth retarded infants. There were no significant differences between mothers in the pre-eclampsia group and 22 randomly selected controls. A stepwise logistic discriminant analysis of the data did not produce a significant model. In the growth retarded group only beta thromboglobulin levels were significantly lower than in the controls (p <0.05), although in the logistic discriminant analysis the inclusion of both beta thromboglobulin and fibrin degradation products led to a borderline significant improvement in fit of the model. We conclude that the haemostatic variables studied are not significantly changed at 28 weeks nor clinically useful predictors of either pre-eclampsia or fetal growth retardation.

Is Quantitative Determination of Fibrin(ogen) Degradation Products and Thrombin-Antithrombin III Complexes Useful to Diagnose Deep Venous Thrombosis in Outpatients?

1989 ◽  
Vol 62 (04) ◽  
pp. 1043-1045 ◽  
Author(s):  
Paul F M M van Bergen ◽  
Eduard A R Knot ◽  
Jan J C Jonker ◽  
Auke C de Boer ◽  
Moniek P M de Maat
Keyword(s):  
Quantitative Determination ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Antithrombin Iii ◽  
Degradation Products ◽  
Family Doctor ◽  
Diagnostic Value ◽  
Impedance Plethysmography ◽  
Fibrin Degradation Products

SummaryWe studied the diagnostic value of recently introduced ELISA’s for the determination of thrombin-antithrombin III (TAT) complexes, fibrin degradation products (FbDP), fibrinogen degradation products (FgDP) and total degradation products (TDP) for deep venous thrombosis (DVT) in plasma of 239 consecutive outpatients, suspected for DVT by their family doctor. DVT was confirmed by impedance plethysmography in 60 patients. Using the 95th percentile range of 42 healthy volunteers the sensitivity for the detection of DVT was: 37% for TAT, 95% for TDP, 92% for FbDP and 90% for FgDP. Specificity was: 88% for TAT, 16% for TDP, 20% for FbDP and 25% for FgDP.We conclude that these assays are of little value in the diagnosis of DVT in outpatients.

A Plasma Clot Lysis Assay Based on the Release of Fibrin Degradation Products: Application to the Diagnosis of Hypofibrinolytic States

1990 ◽  
Vol 63 (01) ◽  
pp. 076-081 ◽  
Author(s):  
Pascale Gaussem ◽  
Sophie Gandrille ◽  
Pascale Molho-Sabatier ◽  
Loïc Capron ◽  
Jean-Noël Fiessinger ◽  
...  
Keyword(s):  
Degradation Products ◽  
Venous Occlusion ◽  
Lower Limbs ◽  
Clot Lysis ◽  
Plasma Clot ◽  
Vein Thrombosis ◽  
Fibrin Degradation Products ◽  
Before And After ◽  
Euglobulin Clot Lysis Time ◽  
Pai 1

SummaryUsing a monoclonal antibody-based assay, we measured the fibrin degradation product release in the supernatant of plasma clots obtained before and after venous occlusion (VO) in 30 patients with definite or suspected vascular thrombosis (19 definite and 2 suspected deep vein thrombosis, 6 recurrent superficial thrombophlebitis, 3 arterial occlusions of lower limbs). tPA and PAI-1 concentrations were determined using ELISA assays; the post-occlusion values were corrected for haemoconcentration. The increase in tPA during VO was correlated with haemoconcentration (r = 0.74), but 3 patients had ineffective VO (<2% increase in proteins). The fibrinolytic response to VO was evaluated using the shortening of the time necessary for the release of 200 μg of fibrin degradation products per mg of fibrinogen (Δ T 200). Two among the 27 patients with effective VO were bad responders with a Δ T 200 <3 h (whereas all the others had Δ T 200 >10 h). These patients had respectively a deficient tPA release (Δ tPA = 1 ng/ml) and an elevated PAI-1 level at rest (33 ng/ml). Several other patients were bad responders in terms of tPA release or of shortening of the euglobulin clot lysis time but they had a normal Δ T 200. This plasma clot test reflects the ability of free tPA to bind to fibrin (the amount of which depends on the level of tPA and PAI-1), and may be useful in the diagnosis of a hypofibrinolytic state.

Influence of Acute Myocardial Infarction and rt-PA Therapy on Circulating Fibrinogen

1993 ◽  
Vol 69 (04) ◽  
pp. 321-327 ◽  
Author(s):  
E Seifried ◽  
M Oethinger ◽  
P Tanswell ◽  
E Hoegee-de Nobel ◽  
W Nieuwenhuizen
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Thrombolytic Agent ◽  
Degradation Products ◽  
Maximum Plasma ◽  
Normal Range ◽  
Fibrinogen Degradation Products ◽  
Fibrin Degradation Products ◽  
Rebound Phenomenon ◽  
The Mean

SummaryIn 12 patients treated with 100 mg rt-PA/3 h for acute myocardial infarction (AMI), serial fibrinogen levels were measured with the Clauss clotting rate assay (“functional fibrinogen”) and with a new enzyme immunoassay for immunologically intact fibrinogen (“intact fibrinogen”). Levels of functional and “intact fibrinogen” were strikingly different: functional levels were higher at baseline; showed a more pronounced breakdown during rt-PA therapy; and a rebound phenomenon which was not seen for “intact fibrinogen”. The ratio of functional to “intact fibrinogen” was calculated for each individual patient and each time point. The mean ratio (n = 12) was 1.6 at baseline, 1.0 at 90 min, and increased markedly between 8 and 24 h to a maximum of 2.1 (p <0.01), indicating that functionality of circulating fibrinogen changes during AMI and subsequent thrombolytic therapy. The increased ratio of functional to “intact fibrinogen” seems to reflect a more functional fibrinogen at baseline and following rt-PA infusion. This is in keeping with data that the relative amount of fast clotting “intact HMW fibrinogen” of total fibrinogen is increased in initial phase of AMI. The data suggest that about 20% of HMW fibrinogen are converted to partly degraded fibrinogen during rt-PA infusion. The rebound phenomenon exhibited by functional fibrinogen may result from newly synthesized fibrinogen with a high proportion of HMW fibrinogen with its known higher degree of phosphorylation. Fibrinogen- and fibrin degradation products were within normal range at baseline. Upon infusion of the thrombolytic agent, maximum median levels of 5.88 μg/ml and 5.28 μg/ml, respectively, were measured at 90 min. Maximum plasma fibrinogen degradation products represented only 4% of lost “intact fibrinogen”, but they correlatedstrongly and linearly with the extent of “intact fibrinogen” degradation (r = 0.82, p <0.01). In contrast, no correlation was seen between breakdown of “intact fibrinogen” and corresponding levels of fibrin degradation products. We conclude from our data that the ratio of functional to immunologically “intact fibrinogen” may serve as an important index for functionality of fibrinogen and select patients at high risk for early reocclusion. Only a small proportion of degraded functional and “intact fibrinogen”, respectively, is recovered as fibrinogen degradation products. There seems to be a strong correlation between the degree of elevation of fibrinogen degradation products and the intensity of the systemic lytic state, i.e. fibrinogen degradation.

Hemostatic Disorder of Uremia: The Platelet Defect, Main Determinant of the Prolonged Bleeding Time, Is Correlated with Indices of Activation of Coagulation and Fibrinolysis

1996 ◽  
Vol 76 (03) ◽  
pp. 312-321 ◽  
Author(s):  
Diego Mezzano ◽  
Rodrigo Tagle ◽  
Olga Panes ◽  
Marcos Pérez ◽  
Patricio Downey ◽  
...  
Keyword(s):  
Renal Failure ◽  
Bleeding Time ◽  
Degradation Products ◽  
Plasminogen Activator Inhibitor ◽  
Primary Hemostasis ◽  
Prolonged Bleeding Time ◽  
Fibrin Degradation Products ◽  
Von Willebrand ◽  
Pai 1 ◽  
Coagulation And Fibrinolysis

SummarySeveral parameters of primary hemostasis and markers of activation of coagulation and fibrinolysis were measured in 48 patients with severe (creatinine clearance <20 ml/min) chronic renal failure (CRF) without dialysis and diseases or drugs affecting hemostasis. Bleeding time (BT) was prolonged in 25/48 patients, and was correlated with age of patients, severity of renal failure, hematocrit, impairment in platelet aggregation-secretion and decrease in platelet ATP content. Defects in von Willebrand factor played no role in the prolongation of the BT. Multivariate analysis showed that only platelet dysfunction and severity of renal disease were independent predictors of the BT in uremia. The platelet functional disorder was significantly correlated with a reduction in platelet ATP and ADP.High levels of plasma thrombin-antithrombin complexes (TAT), prothrombin fragment F1+2, fibrinogen and factor VIIc were observed in patients with CRF, as described in prethrombotic states. Plasmin-antiplasmin complexes (PAP), fibrinogen and fibrin degradation products (FgDP, FnDP) were significantly increased, and the activity of plasminogen activator inhibitor (PAI-1) was slightly reduced, denoting an activation of fibrinolysis.A negative correlation was found between platelet levels of ATP and ADP with plasma TAT, F1+2 and PAP. Furthermore, plasma PAI-1 activity was negatively correlated with the BT and was lower in patients with prolonged BT as compared with controls and patients with normal BT. These links between primary hemostasis and activation of coagulation and fibrinolysis suggest that increased intravascular generation of thrombin and/or plasmin is an important mediator of the defects in primary hemostasis, prolongation of the BT and, probably, bleeding in CRF.

Sign in / Sign up

Export Citation Format

Share Document