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Órgano oficial de difusión de la Federación Mexicana de Patología Clínica, AC y de la Asociación Latinoamericana de Patología Clínica/Medicina de Laboratorio

2000, Number 4

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Rev Mex Patol Clin Med Lab 2000; 47 (4)

Primary abnormal fibrinolysis in patients with chronic liver disease

Pizzuto CJ, Reyes NMA, Meillón GL, Montiel MMG, Dehesa VM, Patiño GAG

Language: Spanish
References: 34
Page: 219-227
PDF size: 69.72 Kb.


ABSTRACT

Hiperfibrinolysis is a frecuent cause of bleeding in patients with chronic liver disease (CLD) and specially in those who have had a surgical procedure. Such disease is not always present therefore it cant’ be found through the routine coagulation tests, situation that is dangerous for CLD patients going to surgery because surgical stress stimulates its appearance, its appearance might also be stimulated by a subcutaneous injection of adrenaline. Therefore we studied this possibility in 43 patients (28 men, 15 women; age 32-82 fr) with different CLD types divided into three subgroups (A, B and C) on the basis of Child-Pugh classification; 12, 18 and 13 cases respectively in each group. In all cases the blood samples were taken just before and an hour after a subcutaneous injection of 0.4 mL of adrenaline (Ad-Test). The Ad-test was practiced again only in those patients with abnormal fibrinolysis (AF) positive results after one hour of belng treated with a two hour continous I.V. infusion of 5g of Amicar (aminocaproic acid). The laboratory test practiced in all patients before and after the Ad-test were mainly the ones related to abnormal fibrinolysis: euglobulin lysis time (ELT) fibrinogen degradation products (PDF), plasminogen, A2 AP, thrombin time and platet count (PlatC). Results: The positively of ELT increased with the Ad-test from 7.7% to 64% (P=0.001), the FDP from 53% to 66% (P=0.02 ) and the PlatC average raised from 84 to 98 X 10 /dL (P=0.002) in the 43 studied patients. Twenty of them were treated again with another Ad-test and 5g of Amicar, the ELT remained positive in only 1 case (5%; P=0.001) and became negative when Amicar was increased to 10g; the FDP reamined positive in 4 (19%; P=0.002) and the PlatC turned to its initial levels. The abnormalities observed in the other tests and in those belonging to the three Child subgroup patients, old not show any significant defferences. DIC did not develop in the Ad-test with and Amicar. Conclusions: The Ad-test may be a simple and affective way to induce AF in CLD patients as well as Amicar I.V. to prevent it. Therefore it might be useful to analyze and study the practice of this test in CLD patients who are going to be exposed to any surgical procedure in order to reduce the risk of bleeding.


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