Fibrinolytic changes in a patient with toxic shock syndrome; release of active u-PA.
OBJECTIVE
Definition of the changes in the activators of plasminogen, u-PA and t-PA, and examination of the possible generation of plasmin in the circulation in overwhelming sepsis.


METHODS
Serial blood analysis starting 4 h after development of symptoms of toxic shock syndrome.


METHODS
Intensive care unit.


METHODS
A previously healthy woman underwent endometrial ablation and rapidly thereafter developed staphylococcal toxic shock syndrome with organ failure. MEASUREMENT AND RESULT: t-PA, PAI-1, t-PA-PAI-1 complexes, plasminogen, fibrinogen and plasmin-alpha 2-antiplasmin complexes were measured serially by ELISA and free u-PA by SDS-PAGE with zymography. The onset of symptoms was accompanied by a rise of t-PA antigen-followed rapidly by PAI-1 antigen. Plasmin-alpha 2-antiplasmin complex was generated in large amounts but disappeared within hours. From day 3, free u-PA was detectable in the circulation without plasmin generation.


CONCLUSIONS
Despite the sustained presence of active u-PA in the circulation and of t-PA antigen at the onset of symptoms, plasmin-alpha 2-antiplasmin generation was largely suppressed by high levels of PAI-1. The suppression of plasmin generation by u-PA and t-PA may ensure the persistence of fibrin in the microcirculation and so contribute to organ failure.
Haj
M A
MA
Department of Medicine & Therapeutics, University of Aberdeen Medical School, Foresterhill UK.
Robbie
L A
LA
Croll
A
A
Adey
G D
GD
Bennett
B
B
D000328:Adult; D016470:Bacteremia / Q000150:complications; D017115:Catheter Ablation / Q000009:adverse effects; D003428:Cross Infection / Q000150:complications; D005260:Female; D005340:Fibrinogen / Q000378:metabolism; D005341:Fibrinolysin / Q000378:metabolism; D005342:Fibrinolysis; D006801:Humans; D009102:Multiple Organ Failure / Q000382:microbiology; D010958:Plasminogen / Q000378:metabolism; D017395:Plasminogen Activator Inhibitor 1 / Q000097:blood; D011183:Postoperative Complications / Q000378:metabolism* / Q000382:microbiology; D012772:Shock, Septic / Q000378:metabolism* / Q000382:microbiology; D013203:Staphylococcal Infections / Q000150:complications; D010959:Tissue Plasminogen Activator / Q000097:blood; D014568:Urokinase-Type Plasminogen Activator / Q000097:blood*
D017395:Plasminogen Activator Inhibitor 1; D005340:Fibrinogen; D010958:Plasminogen; D010959:Tissue Plasminogen Activator; D005341:Fibrinolysin; D014568:Urokinase-Type Plasminogen Activator