Hemostatic function in hyperfibrinolytic disseminated intravascular coagulation
Hemostatic function in hyperfibrinolytic disseminated intravascular coagulation
复制标题
纤溶亢进弥散性血管内凝血中的止血功能
DOI：
10.1111/ped.13919
复制
发表时间：
2019
影响因子：
1.4
通讯作者：
Shima Midori
中科院分区：
文献类型：
--
作者：
Ishihara Takashi;Nogami Keiji;Onishi Tomoko;Ogiwara Kenichi;Ochi Satoshi;Yamazaki Masaharu;Shima Midori
背景弥散性血管内凝血（DIC）患者的止血机制目前尚不清楚.有几个DIC的诊断标准的基础上，整体或全球止血mechanism.MethodsWe评估了详细的动态全球止血变化，使用凝血酶和纤溶酶生成试验（T/P-GA），凝块纤维蛋白溶解波形分析（CFWA）和非活化旋转血栓弹性测定（NATEM），在一个年轻的女孩与DIC相关的急性髓细胞白血病（AML）。内源性凝血酶电位（T-EP）和纤溶酶滞后时间（P-LT）相对于正常血浆的比值来源于健康志愿者在T/P-GA上的合并正常血浆。结果氨甲环酸（TXA）治疗前的P-LT比值的倒数大于T-EP比值（分别为1.1-2.8和0.83-1.2）。在TXA治疗后观察到反向P-LT比率（0.084-1.3）显著降低。CFWA患者从凝血到纤溶开始的时间（纤溶滞后时间：FLT）明显短于对照组（74.2-91.6 s vs 109 s），表明纤溶增强。来自急性早幼粒细胞白血病相关DIC成人的数据也连续显示了高的P-LT比值（2.1）和缩短的FLT（83.7 s）。在严重鼻出血发作期间，使用NATEM模式，患者全血的凝血时间显着缩短，无法控制，但在添加抗组织因子（TF）单克隆抗体后恢复正常。结论血管内TF的释放有助于持续激活凝血功能和随后的纤维蛋白溶解活性在这位患有急性髓性白血病相关弥散性血管内凝血的患者中，在这些情况下，T/P-GA可以提供比常规测定更好的定量数据。
BackgroundGlobal hemostatic mechanism(s) in patients with disseminated intravascular coagulation (DIC) are poorly understood. There are few diagnostic criteria of DIC based on overall or global hemostatic mechanisms.MethodsWe have assessed in detailed the dynamic global hemostatic changes using thrombin and plasmin generation assay (T/P‐GA), clot fibrinolytic waveform analysis (CFWA) and not‐activated rotational thromboelastometry (NATEM), in a young girl with DIC associated with acute myeloid leukemia (AML). The ratios of endogenous thrombin potential (T‐EP) and plasmin lag time (P‐LT) relative to normal plasma was sourced from pooled normal plasma from healthy volunteers on T/P‐GA.ResultsThe inverse P‐LT ratio prior to tranexamic acid (TXA) treatment was greater than the T‐EP ratio (1.1–2.8 and 0.83–1.2, respectively). Significant reduction in inverse P‐LT ratio (0.084–1.3) was observed after TXA treatment. The interval from clotting to the initiation of fibrinolysis (fibrinolysis lag time: FLT) in CFWA was significantly shorter than the control at onset (74.2–91.6 s vs 109 s), indicating enhanced fibrinolysis. Data from an adult with acute promyelocytic leukemia‐associated DIC also supportively showed a high inverse P‐LT ratio (2.1) and shortened FLT (83.7 s). The clotting time in patient whole blood using NATEM‐mode during an episode of severe epistaxis markedly shortened beyond control, but returned to normal after the addition of an anti‐tissue factor (TF) monoclonal antibody.ConclusionThe release of intravascular TF contributed to sustained activation of coagulation and subsequent fibrinolytic activity in this patient with AML‐associated DIC, and T/P‐GA could provide better quantitative data than conventional assays in these circumstances.