Fibronectin and other DIC-related variables in septic ICU patients receiving cryoprecipitate.
In a controlled study of fibronectin supplementation in sepsis, 11 ICU patients in septic shock were scheduled to receive either cryoprecipitate from 20-40 donors (n = 6) or 250-300 ml of stored plasma (n = 5) (two infusions over 24 h). We wanted to: compare some "conventional" DIC variables in the ICU (platelet count, prothrombin complex = NT, FDP) to additional variables: Fibronectin (Fn), fibrinogen (Fg), F V, FVIII R:Ag, F VIII:C activity, F XII, plasminogen (Plg), antiplasmin (AP), antithrombin (AT), kallikrein inhibiting activity (KI) and spontaneous proteolytic activity (SPA): study the effects of cryoprecipitate or plasma infusion on three variables. Samples were taken before the first infusion, and 24 and 48 h after. At onset, high levels (p less than .001 when compared to blood donors) of Fg, VIIIR:Ag and VIII:C were seen. KI levels were within the normal range. F V was low (p less than .05). Fn, NT, XII, Plg, AP and AT were markedly low (p less than .001). SPA showed great variation. When compared to 28 patients with severe infections, but not in septic shock, the ICU group had higher VIIIR:Ag (p less than .05) and VIII:C (p less than .01), and lower XII, Plg, AP and AT (p less than .001). FDP was elevated in all ICU patients. Five patients were thrombocytopenic, and in these a pattern with low levels of Plg and AT was observed. Fn did not correlate well to the other variables measured. These results indicate a marked activation of coagulation and fibrinolysis in these severely ill patients.(ABSTRACT TRUNCATED AT 250 WORDS)
D000328:Adult; D000368:Aged; D002986:Clinical Trials as Topic; D003422:Critical Care; D004211:Disseminated Intravascular Coagulation / Q000097:blood* / Q000209:etiology / Q000628:therapy; D005169:Factor VIII / Q000032:analysis / Q000627:therapeutic use*; D005340:Fibrinogen / Q000032:analysis / Q000627:therapeutic use*; D005353:Fibronectins / Q000097:blood*; D006801:Humans; D008875:Middle Aged; D018805:Sepsis / Q000097:blood* / Q000150:complications / Q000628:therapy
D005353:Fibronectins; C026912:cryoprecipitate coagulum; D005169:Factor VIII; D005340:Fibrinogen