Survival of transfused alpha 2-plasmin inhibitor in a patient with its congenital deficiency

Open-heart surgery in a patient with heterozygous alpha 2-antiplasmin deficiency. Perioperative strategies in the first reported case

alpha 2-Antiplasmin deficiency is a serious coagulation disorder that results in unrestrained fibrinolytic activity. Clinically, it is manifested by instability of the fibrin hemostatic plug and prolonged or delayed bleeding, which is more serious in patients who are homozygous for this trait. A patient scheduled for aortic valve replacement and coronary bypass presented with a history of repeated episodes of postoperative bleeding. Hemostatic laboratory evaluation revealed that the patient had the heterozygous form of alpha 2-antiplasmin deficiency with a serum concentration of 52 percent (normal, greater than 65 percent of the activity of pooled plasma). He underwent preoperative plasmapheresis with administration of 3,000 ml of fresh frozen plasma, which resulted in an increase in the preoperative level of alpha 2-antiplasmin to 78 percent. Although postoperative blood loss was greater than normal, it was easily managed. Preoperative identification of this rare coagulation abnormality permitted appropriate treatment and probably prevented a postoperative death from hemorrhage.

Lysis time and FDP immunoprecipitation by soluble and immobilized urokinase

Urokinase (UK) was immobilized to the lumen of dacron-reinforced fibrocollagenous tubes (UK-FCT) using a glutaraldehyde entrapment process, in an effort to develop a fibrinolytic small diameter (i.e., 4 mm i.d.) vascular graft. Soluble and immobilized urokinase were evaluated for their ability to lyse synthetic clots made from purified physiologic substrates, alpha 2 plasmin inhibitor (alpha 2PI) mediated whole canine blood (WCB) and alpha 2PI-depleted WCB by measuring lysis time and fibrin degradation product (FDP) formation. Lysis times were orders of magnitude lower and FDP formation rates were orders of magnitude higher with synthetic clots compared with either alpha 2-mediated or alpha 2-depleted WCB clots as a substrate, using both soluble and immobilized UK. However, both soluble and immobilized UK catalyzed FDP formation at an enhanced rate for alpha 2PI-depleted WCB compared with the inhibitor-mediated substrate. These results suggest that both soluble and immobilized UK behave similarly when treated with either standard clots, alpha 2PI-mediated WCB and alpha 2PI-depleted WCB as substrates and the use of urokinase-bound fibrocollagenous tube may prove suitable as a fibrinolytic vascular prosthesis.