New neonatal problems of blood coagulation and fibrinolysis. I. The change of plasmin inhibitor levels in the newborn infant.
"Hemorrhage in the newborn" has long been recognized as merely a result of vitamin K deficiency. However, it is also recognized that fibrinolysis, especially the correlation between the plasminogen-activator and plasmin-inhibitors, play an important role in this disease during the neonatal period. With this in mind, we compared thromboelastograms (TEG) from samples with and without urokinase (plasminogen-activator). In 13 out of 15 newborn infant blood-samples (prior to and after addition of urokinase) the thromboelastogram showed the pattern of a consumption coagulopathy. The change in the concentration of plasmin-inhibitor during the neonatal period was also measured using alpha2-macroglobulin, alpha1-antitrypsin and antithrombin III with M-partigen-plates. The value of alpha2-macroglobulin showed normal adult levels but the value of alpha1-antitrypsin and antithrombin III did not even reach half of the adult level. During the newborn period, the plasmin-inhibitor shows a remarkable lowering tendency and it may be surmised that with such a lowering tendency plasmin-inhibitor may constitute an exceptionally large handicap when the activator is working. This is especially true in the case of lung hemorrhage since the activator arises from a severe pathological state in the lungs and in addition because this is complicated by the lowering of plasmin-inhibitor. These results indicate that the low level of plasmin-inhibitors work synergistically with the high value of activator. The low level of antithrombin III could be the reason for coagulation disorders such as disseminated intravascular coagulation, (DIC).
D000991:Antithrombins / Q000097:blood; D001777:Blood Coagulation; D004211:Disseminated Intravascular Coagulation / Q000097:blood; D005260:Female; D005341:Fibrinolysin / Q000037:antagonists & inhibitors*; D005342:Fibrinolysis; D006801:Humans; D006819:Hyaline Membrane Disease / Q000097:blood; D007231:Infant, Newborn; D012127:Respiratory Distress Syndrome, Newborn / Q000097:blood; D013916:Thrombelastography; D014568:Urokinase-Type Plasminogen Activator; D000515:alpha 1-Antitrypsin; D000511:alpha-Macroglobulins
D000991:Antithrombins; D000515:alpha 1-Antitrypsin; D000511:alpha-Macroglobulins; D005341:Fibrinolysin; D014568:Urokinase-Type Plasminogen Activator