Hemostatic function in hyperfibrinolytic disseminated intravascular coagulation.

Abstract

BACKGROUND:

Global 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.

METHODS:

We 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.

RESULTS:

The 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.

CONCLUSION:

The 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.

• Authors: Takashi Ishihara, Keiji Nogami, Tomoko Onishi, Kenichi Ogiwara, Satoshi Ochi, Masaharu Yamazaki, Midori Shima
• Journal: Pediatrics international : official journal of the Japan Pediatric Society (Pediatr Int) Vol. 61 Issue 9 Pg. 872-881 (Sep 2019) ISSN: 1442-200X [Electronic] Australia
• PMID: 31228869 (Publication Type: Case Reports, Journal Article)
• Copyright: © 2019 Japan Pediatric Society.

Chemical References

• Biomarkers

Topics

• Biomarkers (blood)
• Blood Coagulation Tests
• Child, Preschool
• Disseminated Intravascular Coagulation (blood, diagnosis, physiopathology)
• Female
• Hemostasis
• Humans