Shape and Spreading of Platelets from the Blood of Patients with Acute Myocardial Infarction

The shape of platelets in circulating blood and alterations of this shape after the contact of platelets with glass surfaces, as well as spontaneous platelet aggregation, were examined in patients with acute myocardial infarction (AMI) and in controls.

The shape of circulating platelets were studied by scanning electron microscopy and the spreading - by differential interference contrast microscopy.

Most platelets circulating in the blood of the patients with AMI had non-activated discoid shape; the percentage of these nonactivated platelets was similar to that in the control group. However, these platelets of many AMI patients acquired an increased ability to undergo morphological changes after contact with glass. The percentage of spread platelets in controls was never higher than 50%. In contrast, this percent was higher than 50% in 73% of patients with AMI. Increased spontaneous platelet aggregation was determined only in 30% of AMI patients.

[Significance of the determination of B2-glycoprotein-1 antibodies in recognizing the thrombogenicity in antiphospholipid syndrome]

According to the recent data, the determination of the higher titer of antibodies to beta2-glycoprotein-I (beta2-GP-I) that is included in a complex compound with negative phospholipid membranes determinates the thrombogenicity in antiphospholipid syndrome (APS). To specify this regularity, the authors examined 86 patients with primary APS and 20 patients with venous and arterial thrombosis without APS. With increased beta2-GP-I antibody levels, the incidence of thrombotic events was established to w significantly higher than in APS without the increased titer of beta2-GP-I antibodies. In primary APS-associated persistent miscarriage, the increased titer of beta2-GP-I is much more infrequently encountered.

[Diagnostic procedure for thrombophilia due to factor VIII hyperproduction]

The range of factor Vlll (FVlll) is known to be very wide and its elevated concentration is a risk factor of thromboses. This paper describes a simple and available laboratory method for determining the high level of coagulation FVlll. Moreover, the results of determination of FVlll levels in 102 patients were used to study the incidence of thrombophilia due to FVlll hyperproduction in a region of Western Siberia.

[Laboratory monitoring of recombinant factor VIIA effects]

Recombinant activated factor Vll originally proposed to prevent and arrest bleedings in patients with the inhibitory form of hemophilia has been shown to be a universal hemostatic agent that is effective in arresting and preventing a broad spectrum of spontaneous and postoperative hemorrhages. Procedures for monitoring the action of this agent on the hemostatic system have not been studied so far. The paper presents the results of a study of various parameters of the hemostatic system in patients with profuse hemorrhages before and after the use of recombinant activated factor VII. It has been ascertained that monitoring of the pharmacokinetics of the agent can be achieved when the prothrombin test with bovine thromboplastin is carried out.

[Phlebothrombosis and pulmonary thromboembolism in patients with thrombophilia]

A study was made of the course of phlebothrombosis ana pulmonary thromboembolism in 54 patients with thrombophilia. Of these, 23 patients had factor la resistance to protein C, 15 presented with antiphospholipid syndrome, four with protein C deficit, one with protein S deficit, three with antithrombin III deficiency, and three patients with hyperhomocysteinemia. Five patients presented with the following combined forms of thrombophilia: thrombophilia due to protein C deficit and antiphospholipid syndrome; protein C deficit and hyperhomocysteinemia; protein C and antithrombin III deficit; factor Va resistance to protein C and hyperhomocysteinemia; antiphospholipid syndrome and hyperhomocysteinemia. Thrombosis of the inferior vena cava (IVC) was present in 52 and PTE in 27 patients, The recurrence of phlebothrombosis was recorded in 40 (76.9%), that of PTE in 12 (44.4%) patients. The time elapsed between disease exacerbations accounted for one month to nine years, the number of recurrences constituted two to 6. Initially, thrombosis in three patients was located in lower limb saphenous veins, in 18 in the tibial and femoral veins, in 29 in the femoral and iliac veins; two patients presented with femoroiliocaval phlebothrombosis. The recent control examination revealed thrombosis of the saphenous veins in two patients. In ten patients, thrombosis was located in the tibiofemoral segment, in 19 patients, it was discovered in the femoroiliac and in two cases, in the femoroiliocaval segment. During observation period, venous thrombosis in the previously intact lower limb developed in nine (16.7%) patients. Thrombosis of other vessels inclusive of the organ ones was present in 14 (25.9%) patients. Of these, seven patients had thrombosis of the arteries of the upper and lower limbs: in four cases, it was located in the system of the IVC and in two cases, in the mesenterial arteries; ischemic stroke was recorded in two cases, thrombosis of the portal vein in one, and myocardial infarction was also marked in one case. In view of different hemostatic changes underlying the development of venous thromboses and PTE, we carried out differentiated therapy applying anticoagulants, platelet inhibitors, and transfusions of quickfrozed plasma. In acute femoroiliac and caval thromboses and PTE, 40 patients were provided implantation into the IVC of the cava filter <<volan>>. After cava filter implantation 16 patients developed tnrombosis of the IVC. Embolism to the cava filter occurred in seven patients. In three cases, it terminated in occlusion of the IVC and in the remaining cases, in its recanalization. Over the period one to six years, occlusive thrombi of the IVC underwent recanalization in 11 patients. Analysis of the course of phiebothrombosis and PTE in patients with thrombophilia made it possible to define situations that require its goal-oriented search. It is demonstrated that it is advisable to implant the cava filter <<volan>> to the permanent position in thromboses of the femoral, iliac veins and of the IVC as well as in PTE.

[Changes of platelet aggregation in cancer patients]

Aggregation function of platelets was investigated in 119 patients with breast cancer, 17--gastric cancer and 11--cancer of large bowel. Levels of spontaneous and induced aggregation were abnormally high thus contributing to thrombophilic potential. Also, they were a factor of tumor progression and metastatic spread. Risk of thrombotic complication can be reduced and survival improved by administration of antiaggregants.

[A new method for determination of antithrombin III and its diagnostic significance]

A new assay based on using an original chromogenic substrate (z-Ala-Ala-Arg-pNa) and designed for the determination of antithrombin III is described in the paper. It was used in examinations of patients with malignancy after surgery. The content of antithrombin III was detected to be lower in 12% of cases in 2 days after surgery. Additionally, patients with DIC, as complications after surgery, were examined to find out that the antithrombin III content was decreasing in them.

[Biochemical characteristics of liver involvement in patients with antiphospholipid syndrome]

The incidence of hepatitis B and C virus and cytomegalovirus infection is high in patients with the antiphospholipid syndrome (APS). The specific features of virus infection in APS patients are determined by the activity of APS. During clinically manifest stage, the activities of aminotransferases, lactate dehydrogenase (LDH), and alkaline phosphatase increase, while during remission only aspartate aminotransferase and LDH levels remain high, for this latter enzyme high activities of isoenzymes LDH5 and LDH4 being recorded. These data indicate that the pathological process in APS involves not only the liver, but the sinusoidal endothelium as well. This seems to account for some other clinical and laboratory manifestations of APS, such as increased level of circulating immune complexes, dysfunction of physiological anticoagulants, etc.

[A method for determining plasminogen with a Russian chromogenic substrate and its diagnostic significance]

Measurement of plasminogen, the key component of fibrinolysis system, is one of the basic methods for estimation of fibrinolysis. Methods based on the use of chromogenic substrates are often used in diagnosis. Plasminogen measurements are important for laboratory diagnosis of thrombophilia caused by deficiency or abnormalities of this fiber, for detection and evaluation of the DIC syndrome, and for monitoring the treatment by fibrinolytic preparations (streptokinase, t-PA, urokinase, etc.). An original chromogenic substrate having no foreign analogs has been created at Institute of Genetics and Selection of Industrial Microorganisms and Research Center of Hematology (Moscow). Unlike previously described plasmin substrates, pNa has been obtained by microbiological methods with Russian commercial enzymes subtilisine 72 and megaterine. This paper presents the results of plasminogen measurements in patients with DIC with the use of the original chromogenic substrate. The results were compared with those of tests with Berihrom-Plasminogen diagnostic kit (Behringwerke AG).

Safety of low-molecular-weight heparin in pregnancy: a systematic review

Unfractionated heparin (UFH) remains the anticoagulant of choice during pregnancy. Low-molecular-weight heparins (LMWH) are an attractive alternative to UFH due to their logistic advantages and their association with a lower incidence of osteoporosis and HIT. We reviewed all published clinical reports concerning the use of LMWH during pregnancy. In addition, participants of an international interest group contributed a cohort of pregnant women treated with LMWH. Pregnancies were divided into two groups; those with and those without maternal comorbid conditions. The number of adverse fetal outcomes and the occurrence of maternal complications were evaluated in the two groups. In the group of women with comorbid conditions (n = 290), 13.4% of the pregnancies were associated with an adverse fetal outcome. In contrast, in the group of women without comorbid conditions (n = 196), 3.1% were associated with an adverse outcome, which is comparable to that seen in the normal population. We conclude that LMWH appear to be a safe alternative to unfractionated heparin as an anticoagulant during pregnancy.

[Comparative data on the use of a cryosupernatant and fresh-frozen plasma in the therapy of a protracted infectious-septic syndrome of disseminated intravascular coagulation]

AIM

To compare therapeutic effectiveness of cryosupernatant plasma fraction (CSP) and fresh-frozen plasma (FFP) in long-term infectious-septic DIC syndrome arising in acute abscess and gangrene of the lung.

MATERIALS AND METHODS

106 and 131 patients with infectious-septic DIC syndrome were treated with CSP and FFP, respectively. The results of the treatment were compared clinically and hemotopogically.

RESULTS

Clinical response to both treatments was evident from positive changes in XIIa-dependent fibrinolysis, lowering of fibrinogen level and enhanced activity of antithrombin III. CSP treatment brought about a decrease in the number of thromboses, lethal cases, unfavorable outcomes.

CONCLUSION

The cryosupernatant can be used instead of fresh-frozen plasma in combined treatment of long-standing infectious-septic DIC syndrome.

[Prevalence, diagnosis and clinical significance of thrombophilia caused by Va factor resistance to activated C protein]

Examining 26 patients with early recurrent venous thrombophilias and ischemic attacks revealed that 6 cases had Va factor resistance to activated C protein. The latter suggests that thrombophilia associated with hereditary C- protein resistance is recorded in the Russian population, among the residents of West Siberia in particular.

[Use of elimination of plasma phospholipid membranes for detection of "lupus anticoagulant" effects]

The coagulation activity of plasma phospholipid membranes (PM) was measured in plasma depleted for platelets (PDP) in 50 normal subjects and 33 patients with the antiphospholipid syndrome (APS) and the "lupus anticoagulant" in the plasma. The normal value for phospholipid activation of clotting was 99.8 +/- 3.5% (from 75 to 125%), whereas in patients with APS and lupus anticoagulant it was 42.1 +/- 8.2% (p < 0.001). Addition of PM from patients' PDP to normal plasma free from PM did not normalize clotting. Addition of PM from normal plasma to patients' PDP normalized the clotting time. Therapy with discrete plasmapheresis increased the phospholipid activation value in the patients from 42.1 to 73.3% (p < 0.01), which was due to removal of the PM-antiphospholipid antibody complex from PDP. The proposed microfiltration method can be used in the complex of tests for detecting the lupus anticoagulant in patient's plasma.

[Comparative analysis of various methods of determination of fibrinogen in the plasma]

Fibrinogen was measured in the plasma of normal subjects and patients with various hemostasis disorders by gravimetric methods with thromboplastin coagulation and coagulation with Echis multisquamatus snake venom. Coagulation was assessed using optic Coag-Mate HM (Netherlands) and roll Amelung KC4A (Germany) coagulometers during coagulation with thrombin after Klauss and with the above venom. The results were compared with those of fibrinogen measurements by radial immunodiffusion using Behring antifibrinogen serum. The data of all methods coincided if the initial levels of fibrinogen were normal, whereas in manifest hypo- or hyperfibrinogenemia Klauss' method was the most accurate and informative.

[Initial experience in the diagnosis of thrombophilia due to activated protein C resistance]

The authors describe the first in Russia cases of thrombophilia caused by factor Va resistance to activated protein C. This abnormality was diagnosed in 6 of 25 patients (24%) with recurrent early thrombosis. The diagnosis was conducted according to a modified method implying the addition of protac (activator of protein C) to normal platelet poor plasma (PPP) free of factor V containing 100% of protein C. Protac dose was adjusted to increase the activated partial thromboplastin time (APTT) 2.4-2.8-fold in mixing PPP of the examinee with plasma containing activated protein C. The indices were estimated indicative of insufficient prolongation of APTT in response to activated protein C. Of 6 patients, 2 had apparent and 4 strong resistance to activated protein C. Treatment policy in this variant of thrombophilia is discussed.

[Methods and clinical significance of paracoagulation phenanthroline test]n

Experiments with fibrin monomers isolated from the plasma revealed that o-phenanthroline causes the paracoagulation phenomenon. Based on this phenomenon, phenanthroline test has been developed, which enables measuring fibrin monomer and its complexes in the blood plasma. High reliability and reproducibility of this test have been confirmed in examinations of 912 patients with the DIC syndrome, thrombosis, thromboembolism, and other hemostasis disorders.

[Trials of a method for assessing thromboplastic activity of monocytes in the newborn]

Trials of a method for assessment of thromboplastic activity of monocyte macrophages in 58 healthy full-term babies in the first days of life, when the hemostasis system undergoes essential changes, revealed an appreciable reduction of the basal thromboplastic activity of monocytes and of its level after 4-hour incubation of these cells on days 3-5 after birth, this reduction being paralleled by progressive hypocoagulation (as shown by coagulogram). The degree of reduction of the thromboplastic activity of monocytes was directly proportional to an increase in the level of fibrin-monomer complexes and fibrinogen degradation products in the blood plasma and serum. This indicates a possible decrease of the production of vitamin-K-dependent coagulation factors not only in the liver, but in monocytes as well. On the other hand, the detected shifts indicate that reduction of thromboplastic activity of monocytes in parallel with increased thrombin formation in the blood are biologically justified, for this decrease equilibrates the thrombogenic shifts in the system of neonatal hemostasis.

[Disorders of the hemostasis system in patients with mitral valve prolapse]

Mitral prolapse is frequently encountered in association with other manifestations of mesenchymal dysplasia (skin hyperelastosis, joint hypermobility, dislocations, etc.) and occasional bleedings. Of 35 cases reported, 17 had petechiae and ecchymoses, 1 had hematuria, the rest suffered from bleedings: nasal (22 cases), profuse menstrual (19 cases), long-term extraction and cut bleedings (9 cases), gastrointestinal (3 cases). Hemorrhages of different sites often occurred in combination. Hemostatic investigations revealed: platelet aggregation dysfunction, Willebrand syndrome, end coagulation disturbances, lack or anomalies of factors VII, X and II (14, 17, 12 and 4 patients, respectively).

[The ability of low-molecular heparin (Fraxiparin) to overcome the action of exogenous coagulases--a fundamental difference from nonfractionated heparin]

A new previously unknown activity of the low molecular-weight heparin Fraxiparin (Sanofi) has been discovered. This is its ability to reduce the plasma clotting action of snake venom coagulases at final concentration of more than 12.5 anti-Xa U/ml, while the unfractionated heparin does not possess this property. The experiments demonstrated that Fraxiparin the action of Echis carinatus prothrombin-activating venom to a greater degree and Agkistrodon halys halys thrombin-like coagulase to a lesser degree. Unlike the unfractionated heparin, Fraxiparan also prevents the death of white rats from acute toxic hemocoagulant shock caused by the intravenous injection of DL100 Echis carinatus venom.

[Antiphospholipid syndrome and resistance to replacement therapy in hemophilia]

The paper described the appearance of lipoid anticoagulant (LA) in the presence of hepatitis B virus in the blood of hemophilia A patient. Profuse and long-term bleeding after the extraction of the tooth that failed to be treated with big doses of cryoprecipitation was noted. Intense replacement therapy resulted in the appearance of factor VIII inhibitor in a titre of 4.5 units per ml in the patient's blood. Big-dose prednisolone therapy helped an immediate arrest of the bleeding and a rapid decrease in LA titration. The levels of factor VIII inhibitor preserved in the same values. The study exhibited the ability of LA to impede the arrest of the bleeding and the response to the replacement treatment in hemophilic patients.

[Effect of heparin on erythrocyte damage in various toxicogenic DIC syndromes]

In experiments in vitro it has been established that heparin does not have a direct hemolyzing action, but it significantly reduces red blood cell resistance to acid. In experiments in vivo heparin significantly intensifies red blood cell resistance to the action of acid hemolytics. Hemolysis during intoxication with the toxins studied is, to a greater extent, secondary in relation to the intravascular blood coagulation.

[Substantiation, tactics and effectiveness of frozen plasma-enzyme inhibitor therapy in septicemia and infectious-destructive processes]

Nonvalidated transfusions of fresh frozen plasma (with the aim of blood loss substitution, for parenteral feeding, etc.) are widely used in the current clinical practice. In disseminated intravascular coagulation syndrome (DICS) its use is undoubtedly indicated, but only by jet-injection, combined with low doses of heparin, and simultaneous administration of high doses of protease inhibitors (kontrikal, etc.); such treatment should be conducted at the early stages of the process, and not in the period of complete noncoagulation and profuse hemorrhage. The treatment was applied to 194 patients with sepsis and 147 patients with acute infectious-destructive diseases of the lungs; in 12 patients plasmapheresis was used simultaneously. More rapid, than in the compared group, arrest of fever and decrease of intoxication, recovery of microcirculation in the organs, increased accessibility of the infection foci for antibiotics, more than twofold reduction of lethality were recorded during this treatment. The data obtained have evidenced that infectious-septic DICS is an indication for cryoplasma-antienzyme therapy. Expenditure of fresh frozen plasma for many other purposes could be significantly diminished.

[Plasmapheresis in combined treatment of severe forms of abscesses and gangrene of the lungs]

With an adjuvant course of plasmapheresis, a combined treatment of severe acute abscesses and gangrene of the lungs brought about a marked short-term clinical response in 48 out of 50 treated patients. The responders had their temperature returned to normal, amount of sputum significantly reduced. They recovered good appetite and gained weight. There was also attenuation of DIC syndrome and endotheliosis, improvement of cellular and humoral immunity. Upon the discharge 35 patients had complete or partial response, 10 patients developed a chronic process. Lethal outcomes reached 10%.

[Use of equipment for external fixation and rehabilitation of patients with hemophilia]

External fixation apparatus (EFA), hing-distraction and compression-distraction, were used in 30 hemophiliacs for the treatment of hemophilic arthrosis, intra-articular and extra-articular fractures, contractures, dislocations, as well as after synovectomy. The treatment was conducted under cryoprecipitate protection, the dose of which was significantly decreased after granulation around the pins was completed. Immediate and late results of the treatment showed its higher effectiveness as compared to other correction methods (gypsum etc). After correction with EFA repeated hemorrhage and trauma were less frequent, and mean annual cryoprecipitate expense decreased five-fold. No severe complications were recorded. EFA enable successful treatment of such diseases of the locomotor system that are unaffected by other therapeutic measures.

[Effect of heparin on fibrinogen formation during experimental toxic syndrome of disseminated intravascular coagulation]

The formation of circulation components of fibrinogen pool in toxigenic syndrome of disseminated intravascular blood coagulation (DBC-syndrome) caused by the Vipera lebetina turanica venom has been examined by the gel-filtration method. Simultaneously it has been studied what components of fibrinogen pool are removed in paracoagulation tests and with addition of the coagulating enzymes (thrombin, reptilase and the Echis multisguamatus venom) to the plasma. The preliminary heparinization of animals poisoned by Vipera lebetina turanica venom was found to prevent the fibrinogen formation mainly at the fibrin-monomer formation stage. Besides, the effect of polymerization inhibition was revealed in the plasma of such animals.