Low-dose heparin in the management of acute myelocytic leukaemia.

The effectiveness of heparin in acute leukaemia complicated by disseminated intravascular coagulation (DIC) is still controversial. In this regard low-dose heparin was found to be therapeutically effective in three patients suffering from acute myelocytic leukaemia and DIC. With respect to the contraindication of high-dose heparin in these conditions the low dose regimen appears to be a valuable alternative.     

Use of alpha-adrenoceptor antagonist dihydroergotoxin in experimental anticoagulant and fibrinolytic therapy

The thrombolytic action of commercial plasmin-Fibrinolysin, heparin and complex Fibrinolysin-heparin in thecom bination with the alpha-adrenoceptor agent DET was studied in rats. The induction of venous thrombosis is accompanied by the manifestations of disseminated intravascular coagulation (DIC). The most efficient thrombolytic action in the hypercoagulemic stage of DIC had the complex Fibrinolysin-heparin in the combination with DET. The alpha-adrenoceptor antagonist blocked the compensatory reaction on plasmin excess, liberated vascular plasminogen activator and thus increased and prolonged thrombo- and fibrinolytic effects of this complex. Administration of this complex in the combination with DET resulted in a steady hypocoagulation and hyperfibrinolysis in blood stream.     

2 cases of acute disseminated intravascular coagulation in normal pregnancy and as the first symptom of acute promyelocytic leukemia

Two cases of the acute disseminated intravascular coagulation (DIC) are presented. DIC in the first case was diagnosed in healthy pregnant woman without any obstetric pathology. This patient recovered completely. The acute DIC in another patient preceded the acute promyelocytic leukemia. The patient died despite a control of DIC. DIC therapy included antifibrinolytic agents and additionally corticoids in pregnant patient. Heparin was not administered because of post partum period and foreseen cytostatic therapy in the leukemic patient.     

Disseminated intravascular coagulation in acute monoblastic leukemia: response to heparin therapy.

A 27-year-old man with acute monoblastic leukemia had clinical and laboratory evidence of disseminated intravascular coagulation (DIC), which was exacerbated by induction chemotherapy. Heparin therapy, adjusted according to the patient''s clinical status and the results of coagulation studies, rapidly controlled the manifestations of DIC.     

Disseminated intravascular coagulation and the balance between blood coagulation and fibrinolysis

The dynamic haemostatic balance between blood coagulation and fibrinolysis and its influence on the development of disseminated intravascular coagulation are described. The effects of heparin and antithrombin-III are illustrated by clinical cases.     

Massive pulmonary hemorrhage in neonatal infection.

Of 35 newborn infants who died from an infection 19 had postmortem evidence of massive pulmonary hemorrhage. All but 1 of the 19 had evidence of antimortem formation of intravascular fibrin clots in lung tissue. Seventeen infants had low platelet counts. Of the 11 infants in whom coagulation studies were done, 8 had evidence of disseminated intravascular coagulation (DIC) during life. Vasculitis in the lungs, associated with fibrin clots and hemorrhages, was detected in two infants. It is postulated that sepsis is an important cause of hemorrhage in the newborn, probably as a result of the development of DIC.     

Mechanisms of Thrombocytopenia in Malignant Tertian Malaria

The mechanism of thrombocytopenia in six patients with falciparum malaria has been studied. All the patients recovered after antimalarial therapy, and cerebral malaria was not a feature. Radioactive-labelled platelets and fibrinogen were injected into the patients during the phase of thrombocytopenia. In all cases recovery of injected platelets was notably subnormal, indicating excessive splenic pooling of platelets. Platelet life span was moderately shortened in all patients, and platelet turnover increased approximately two-fold. Fibrinogen catabolism was moderately increased in all patients, but coagulation tests failed to reveal evidence of disseminated intravascular coagulation. The results suggest that in uncomplicated cases of malaria thrombocytopenia is the result of splenic pooling of platelets aggravated by a moderate decrease in platelet life span. In such cases thrombocytopenia is thus not the result of disseminated intravascular coagulation (D.I.C.), and heparin therapy is not indicated unless there is unequivocal ancillary evidence of D.I.C.     

Haemostatic defect in non-immune patients with falciparum malaria: no evidence of diffuse intravascular coagulation.

Nine non-immune patients with imported falciparum malaria were examined for signs of diffuse intravascular coagulation (DIC). Although all had thrombocytopenia initially and some later had a decline in plasma fibrinogen concentrations, DIC was never detected, even in severely affected patients with coma and kidney damage. None of the patients were given heparin and all recovered without residual symptoms. Heparin administration should probably be considered only when clear-cut DIC, which possibly never occurs in falciparum malaria, has been demonstrated.     

On the causes of intra- and post-operative consumption coagulopathies and postoperative thromboembolism]

The determination of the onset of a disseminated intravascular coagulation (DIC) is examined shortly after its intraoperative andpost-operative dissolution with the help of easily performable haematological and physiological clotting tests in 20 patients. In this connection the operation is appreciated as a model even for other processes defined at the beginning, where DIC can be observed. Whereas the aethanol test, the determination of fibrinogen split products (FSP) and the euglobulin lysis time indicate the beginning of DIC more clearly in the form of average values, the aethanol test, partial thromboplastin time and thrombin time have a prognostic value for each patient. As it is too time consuming to determine FSP, the counting of basophilie granulocytes may be used for the diagnosis. In the initial phase of and post-operative DIC will determine the essential share of predisposition to post-operative thromboembolism.     

Heparin and phenprocoumon inhibit kappa-carrageenin induced thrombosis in rats

The tail thrombosis after kappa-carrageenin injection in rats was significantly inhibited by heparin and phenprocoumon. Heparin was yet effective at doses as low as 150 IU/kg. The present data point to an involvement of blood coagulation in this new model. Injection of cobra venom factor with complement depletion caused no thrombosis inhibition. The differences between the present kappa-carrageenin induced thrombosis model and a disseminated intravascular coagulation after lambda-carrageenin are discussed.     

Activation of the blood kallikrein-kinin system in disseminated intravascular coagulation in rats. The significance of the pulmonary component and an attempt at correction with aspirin

It has been shown that the development in animals of disseminated intravascular coagulation (DIC) caused by long-term intravenous infusion of thrombin was accompanied by appreciable activation of the kallikrein-kinin system, being characteristic of acute pathological processes. In the initial stages of the process development, prekallikrein and kallikrein inhibitor were observed to be secreted from the lungs to arterial blood. Further development of DIC led to the depletion of the reserves of the kinin system. Pretreatment with a single low dose of acetylsalicylic acid considerably reduced the total animals' lethality and postponed blood kinin system activation determined by the development of DIC.     

Fibrin Degradation Products in Normal and Abnormal Pregnancy and Parturition

The levels of fibrin, fibrinogen degradation products (F.D.P.) in the serum were investigated in normal pregnancy and parturition, after caesarean section, and in patients with abruptio placentae, eclampsia, intrauterine death, and post-partum haemorrhage. No significant change occurred during normal pregnancy, but a highly significant increase was found during labour and again during the first week after normal delivery. After caesarean section the levels of F.D.P. were increased two to four hours after operation, and substantially higher levels were found three to eight days after operation than after normal delivery. High levels of F.D.P. were associated with abruptio placentae and eclampsia, and increased levels after intrauterine death and post-partum haemorrhage.An excess of F.D.P. with diminished or normal systemic fibrinolytic activity suggests that local intravascular fibrin deposition and fibrinolysis occur in normal parturition and in these complications of pregnancy. The very high levels of F.D.P. found in abruptio placentae will be important in the pathogenesis of the defective haemostasis that may accompany this complication.     

Animal experiments on direct drug effects on disseminated intravascular coagulation (DIC) in asphyxic shock

In a total of 41 rabbit fetus it could be demonstrated in an asphyxia model to what extent disseminated intravascular coagulation may be influenced by directly applying drugs in the foetal circulation. Administration of heparin or streptokinase in the umbilical vessels led to a decrease of fibrin sediments in the areas of terminal coagulation, whereas an increase was caused by injecting noradrenalin or PAMBA.     

细菌性败血症引起鲫凝血障碍的研究

以嗜水气单胞菌感染体重７０ｇ左右的鲫并检测了感染鱼和对照鱼的血液学及播散性血管内凝血判定指标等参数。结果表明细菌性败血症病鱼严重贫血,存在明显的凝血障碍,在疾病发展过程中存在播散性血管内凝血现象。这一些象导致了病鱼全身性出血,并在疾病的病理生理过程中起了重要作用。     

Experimental generalized herpes simplex in guinea pigs with retrobulbar infection

Modelling of generalized herpetic infection of Guinea pigs is described. It took the course in the form of acute or subacute recurring process with either involvement of separate internal organs, or disseminated involvement of all visceral organs, or principal involvement of subcortical structures of the brain, or involvement of the brain and spinal marrow and marked vegetative failures. Signs of vasculitis; development of disseminated intravascular coagulation (DIC) syndrome and CNS demyelinization are detected in animals during the terminal period.     

Experience with disseminated intravascular coagulation in a children's hospital

A study was initiated to determine the frequency and significance of disseminated intravascular coagulation (DIC) in the pediatric age group. With the aid of a scoring system, DIC was diagnosed in 48 patients in a period of slightly over one year in a pediatric referral centre with 7000 annual admissions. Sixty percent of all DIC occurred in infants under one month of life. Sixty-six percent of all DIC was associated with sepsis, usually from gram-negative infections. Seventy-nine percent of affected neonates were septic. Laboratory findings of diagnostic importance were anemia with red cell fragmentation, thrombocytopenia, elevated titres of fibrin split products, abnormal thrombin time, and low factor V activity. Mortality was 64% in all ages regardless of cause. Results of management of DIC by treatment of the underlying disease with or without anticoagulation were disappointing.     

Plasma exchange therapy for thrombotic microangiopathies

Thrombotic microangiopathies (TMAs) are syndromes associated with thrombocytopenia and multiple organ failure. Plasma exchange is a proven therapy for primary TMA such as thrombotic thrombocytopenic purpura (TTP). There is growing evidence that plasma exchange therapy might also facilitate resolution of organ dysfunction and improve outcomes for secondary TMAs such as disseminated intravascular coagulation (DIC) and systemic inflammation-induced TTP. In this review, we survey the current available evidence and practice of plasma exchange therapy for TMAs.     

脓毒症致凝血异常发生机制的研究进展

脓毒症是由感染引起的全身炎症反应综合征,其病情凶险,死亡率高。凝血异常是脓毒症的主要特点之一,是多方面因素共同作用的结果。在脓毒症的发生发展过程中,炎症因子既可以激活凝血级联反应又可以抑制抗凝系统和纤维蛋白溶解系统,最终导致其凝血活性增强,炎症诱导的凝血紊乱进一步促进和加重炎症反应。而脓毒症患者的高凝状态可导致静脉血栓栓塞甚至DIC的发生,引起了研究者们的广泛关注。本文将就脓毒症致凝血异常发生机制的研究进展做一综述。     

Detection of soluble fibrin monomer complexes. Comparison of a haemagglutination assay with the ethanol gelation test

Hypercoagulability and disseminated intravascular coagulation (DIC) are characterized by the presence of circulating fibrin monomer complexes in plasma. In 342 patients with possible DIC fibrin monomers, fibrinogen, Reptilase Time, antithrombin III and other coagulation parameters were determined at frequent intervals. Testing of soluble fibrin monomer complexes was performed using a sensitive and reliable hemagglutation assay with red cells sensitized by fibrin monomers (FM-Test) and the ethanol gelation test (EGT). Method comparison regarding the influence of fibrinogen levels and fibrin degradation products shows that high fibrinogen levels lead to false-positive results with EGT. The same effect is observed for fibrin degradation products and EGT whereas no influence of fibrinogen level and fibrin degradation products on the FM-Test occurs. It is well-known that during DIC AT III level decreases caused by proteolytic activity. In this study it could be shown that fibrin monomer increases parallel to the decrease of AT III. The same effect does not occur due to fibrin degradation products.     

Comparative evaluation of whole blood D-dimer test to plasma D-dimer test for diagnosis of disseminated intravascular coagulation

Three rapid D-dimer test methods were compared for the diagnosis of acute disseminated intravascular coagulation (DIC). These were (a) SimpliRED, an autologous red cell agglutination assay. (b) DIMERTEST latex agglutination assay, containing monoclonal antibody DD-3B6/22(6), and (c) D-DI latex agglutination assay containing mouse anti-human D-dimer monoclonal antibodies. The D-DI latex method having higher sensitivity (100%) and specificity (81%) in clinically acute DIC was postulated as the gold standard and compared with the other two methods. The results suggest that D-DI latex agglutination assay containing mouse anti-human D-Dimer monoclonal antibodies are the better assay methods amongst all the three kits analyzed. It is advisable to look for the nature of the antibody used to coat the latex particles in plasma based kits. In emergency setting RBC kits may be of some use as rapid diagnosis is advantageous.