Solubility fo fibrin clots in monochloroacetic acid. A reflection of serum pepsinogen levels

Global hemostasis testing thromboelastography: old technology, new applications

Thromboelastography (TEG) as a method of assessing global hemostatic and fibrinolytic function has existed for more than 60 years. Improvements in TEG technology have led to increased reliability and thus increased usage. The TEG has been used primarily in the settings of liver transplant and cardiac surgery, with proven utility for monitoring hemostatic and fibrinolytic derangements. In recent years, indications for TEG testing have expanded to include managing extracorporeal membrane oxygenation (ECMO) therapy, assessing bleeding of unclear etiology, and assessing hypercoagulable states. In addition, TEG platelet mapping has been utilized to monitor antiplatelet therapy. Correlation between TEG platelet mapping and other platelet function tests such as the PFA-100 or platelet aggregation studies, however, has not been evaluated fully for clinical outcomes, and results may not be comparable. In general, the advantages of the TEG include evaluation of global hemostatic function using whole blood, a quick turn-around-time, the possibility of both point-of-care-testing and performance in central laboratories, the ability to detect hyperfibrinolysis, monitoring therapy with recombinant activated factor VII, and detection of low factor XIII activity. Potential applications include polycythemia and dysfibrinogenemia. Disadvantages of TEG include a relatively high coefficient of variation, poorly standardized methodologies, and limitations on specimen stability of native whole blood samples. In the pediatric setting, an additional advantage of the TEG is a relatively small sample volume, but a disadvantage is the difference in normal ranges between infants, especially newborns, and adults. In summary, TEG is an old concept with new applications that may provide a unique perspective on global hemostasis in various clinical settings.

Factor XIII: structure, activation, and interactions with fibrinogen and fibrin

Fibrin stabilizing factor (factor XIII or FXIII) plays a critical role in the generation of a viable hemostatic plug. Following exposure to thrombin and calcium, the zymogen is activated to FXIIIa that, in turn, catalyzes the formation of N epsilon(gamma-glutamyl)lysine protein-to-protein side chain bridges within the clot network. Introduction of these covalent crosslinks greatly augments the viscoelastic storage modulus of the structure and its resistance to fibrinolytic enzymes. Analysis of the individual reaction steps and regulatory control mechanisms involved in clot stabilization enabled us to reconstruct the entire physiological process. This also serves as a guide for the differential diagnosis of the variety of molecular defects of fibrin stabilization.

The influence of calcium ions on the conformation of fibrinogen fragment D: the use of chemical cross-linking agents

Fibrinogen fragment D prepared in the presence of calcium ions (fragment D[Ca++]) shows qualitatively similar cross-linking patterns with dimethyl suberimidate, dimethyl adipimidate and tetranitromethane. Fragment D prepared in the presence of EDTA (fragment D[EDTA]) gives a consistently different pattern with these reagents. In the case of fragment D[EDTA] there is much more intermolecular cross-linking suggesting that the loss of the C-terminus of the gamma-chain remnant results in fragment D adopting a more open conformation. Neither the addition of 2M urea nor EDTA to fragment D[Ca++] alters its cross-linking pattern suggesting that the proposed conformational change follows cleavage of a plasmin susceptible bond which is normally protected by the presence of calcium ions.