Роль форменных элементов крови в формировании гемокоагуляционных сдвигов при гипертонической болезни

BACKGROUNDHypertension is a common chronic disease that affects many people worldwide. Only a few reports related to the exploration of relevant indicators of the prethrombotic state in patients with primary hypertension (PH) in clinical settings were available.AIMTo detect prethrombotic state-related indicators in patients with PH and analyze their differences in different patient populations to provide a laboratory basis for the clinical prevention and control of hypertensive thrombotic diseases.METHODSThe general data of patients with PH who attended the Department of Cardiovascular Medicine, The First Affiliated Hospital of Jiangxi Medical College, from January 2022 to December 2022 were collected retrospectively. The patients were divided into three groups of 40 patients each according to the Grade of PH: Grade 1, Grade 2, and Grade 3 hypertension experimental group. The baseline data of 40 volunteers, who underwent physical examination in our hospital but were not diagnosed with PH during the same period, were included in the control group. The relevant indicators of prethrombotic state of the participants were compared, and mainly included inflammation-related indicators, hemorheology-related indicators, and coagulation function related indicators. The relationship between the aforementioned indicators and the progression of PH was analyzed.RESULTSNo significant differences were observed in age, sex, diabetes mellitus, smoking history, drinking history, body mass index, New York Heart Association functional classification, or the course of hypertension among the four groups (P > 0.05). The expressions of high-sensitivity C-reactive protein (hs-CRP), thrombomodulin (TM), hematocrit (Hct), erythrocyte sedimentation rate (ESR), P-selectin on platelet surface (CD62P), and fibrinogen (FIB) in the control group were < Grade 1 hypertension group < Grade 2 hypertension group < Grade 3 hypertension group, and the expressions of platelet (PLT), activated partial thromboplastin time (APTT), prothrombin (PT), and plasma thrombin time (TT) in the control group was > Grade 1 hypertension group > Grade 2 hypertension group > Grade 3 hypertension group, and the difference was statistically significant (P < 0.05). The results of the multivariate logistic regression model showed that the expression of hs-CRP, TM, Hct, ESR, CD62P, PLT, APTT, PT, TT, and FIB in the included participants was related to the progression of PH. Among these, high expression of hs-CRP, TM, Hct, ESR, CD62P, APTT, PT, and TT, and low expression of PLT and FIB were risk factors for PH (OR > 1, P < 0.05). The results of the receiver operating characteristic curve analysis showed that the area under the curve of hs-CRP, TM, ESR, CD62P, APTT, PT, TT, and FIB for the prediction of PH were > 0.80, and the prediction value was ideal. Linear correlation analysis with bivariate Spearman showed that hs-CRP, TM, Hct, ESR, CD62P, APTT, PT, and TT were positively correlated with each other (r > 0, P < 0.05); PLT and FIB were negatively correlated with hs-CRP, TM, Hct, ESR, CD62P, APTT, PT, and TT (r < 0, P < 0.05); and PLT and FIB were positively correlated (r > 0, P < 0.05). Linear correlation analysis using bivariate Spearman showed that hs-CRP, TM, Hct, ESR, CD62P, and FIB were positively correlated with each other (r > 0, P < 0.05), whereas PLT, APTT, PT, and TT were negatively correlated with hs-CRP, TM, Hct, ESR, CD62P, and FIB (r < 0, P < 0.05). There was a positive correlation between PLT, APTT, PT, and TT (r > 0, P < 0.05).CONCLUSIONThe relevant indicators of the prethrombotic state in patients with PH, such as hs-CRP, TM, Hct, ESR, CD62P, PLT, APTT, PT, TT, and FIB, showed differences. High expression of hs-CRP, TM, Hct, ESR, CD62P, and FIB, and low expression of PLT, APTT, PT, and TT are the keys to the occurrence, progression, and thrombotic state of PH. Based on the above serum indicators’ expression in patients, targeted interventions can be administered to patients with abnormal expression levels to control the progression of their disease and reduce the risk of developing a prethrombotic state.

To explore and evaluate the predictive value of coagulopathy in patients with community-acquired pneumonia (CAP) METHODS: A retrospective study was performed by investigating the prothrombin time (PT), activated partial thromboplastin time (APTT), plasma fibrinogen (FIB), thrombin time (TT), platelets (PLT), and D-dimer in 385 patients with CAP, who were admitted to the Respiratory Medical Department of the First Affiliated Hospital of Xiamen University from June, 2010 to May, 2011. The differences of the aforementioned results in patients with different prognostic risks were compared and analyzed. The Pneumonia Severity Index (PSI) was calculated to assess the severity. The serum levels of PT, TT and D-dimer in high-risk patients with CAP were (15.1 ± 1.4) s, (16.0 ± 1.8) s, (7.5 ± 8.3) mg/L, respectively. They were all increased compared with those in the low-risk group (14.5 ± 0.9) s, (15.4 ± 1.2) s, (1.6 ± 2.0) mg/L]; the differences being statistically significant (P < 0.001), while PLT, APTT, and FIB were not statistically different (P > 0.05). The difference of the abnormal rate of PLT, PT, and D-dimer in high-risk group and the low-risk group were 30% (45/148) and 20% (47/237), 18% (26/148) and 5% (13/237), 99% (146/148) and 85% (202/237), respectively, the differences being statistically significant (χ² value were 5.602, 14.609, 23.442, respectively, P < 0.05), while TT, APTT, FIB were not (P > 0.05). Rank correlation existed between D-dimer and PSI (r = 0.798, P < 0.001), while there was no correlation between PLT and PSI (χ² = 6.040, P > 0.05). D-dimer in patients with respiratory failure was (10.0 ± 9.9) mg/L, which was significantly increased compared with that in patients without respiratory failure (2.4 ± 3.6) mg/L, P < 0.001, and there was no significant difference in PLT (χ² = 3.457, P > 0.05). D-dimer was significantly higher in patients who died of pneumonia as compared to those who survived [(14.0 ± 8.8) mg/L, (2.8 ± 4.6) mg/L, P < 0.001], and there was a significant difference in PLT (χ² = 4.909, P < 0.05). The area under the receiver operator characteristic curve (ROC) of D-dimer, PSI and PLT were 0.962, 0.906, 0.583, respectively. Concerning the predictive value of mortality, both D-dimer and PSI showed ideal predictive accuracy (P < 0.001). The sensitivity of D-dimer was superior to its specificity. PLT showed poor predictive value for mortality. D-dimer was significantly higher in patients with CAP. D-dimer level was positively correlated with severity and mortality. D-dimer could be a good biomarker to assess the severity and mortality of patients with CAP.

Objective To evaluate the feasibility of anticoagulant therapy for acute proximal deep vein thrombosis without inferior vena cava filter placement for femoral neck patients before hip arthroplasty. Methods From January 2013 to August 2017, 9 femoral neck fractures patients with acute proximal deep vein thrombosis before hip arthroplasty were enrolled into this study. There were 3 men and 6 women. The average age was 76.44±5.39 years old (range, 69 to 83 years old). The average injured time before admission was 4.00±4.06 days. All patients received anticoagulant therapy without placement of inferior vena cava filter before hip arthroplasty. Four patients received Rivaroxaban 10mg, two times per day, while two patients received Enoxaparin 0.4 ml, two times per day; 3 cases received Batroxobin 0.5 ml, every other day combined with Rivaroxaban 10 mg one time per day or Enoxaparin 0.4 ml, one time per day. The size of thrombus before and after treatment, changes of coagulation markers, the outcome of thrombosis before surgery, during surgery, postoperatively and during follow-up, the related complications were recorded. Results The diagnosis time for proximal DVT was 3.89±3.01 days after admission. 8 patients showed proximal DVT combined with distal thrombus and 1 patient showed isolated proximal DVT. The average length of proximal thrombus was 10.78±6.10 cm (range, 4.0-20.0 cm). The mean duration of treatment was 14.22±7.03 days. The results showed 5 proximal DVTs have complete disappeared, 3 cases significantly improved, and 1 case had no change but showed stable. After treatment, the length of the proximal thrombus was significantly decreased (10.77±6.10 cm vs. 4.39±6.50 cm), there were statistically significant between two groups (t=3.429, P=0.009); D-dimer was significantly lower after treatment (10.47±4.87 μg/ml vs. 2.59±1.60 μg/ml) with statistical difference (t=4.970, P=0.001). However, no statistical significance was found in other coagulation parameters such as plasma prothrombin time, the international normalized ratio, activated partial thromboplastin time, thrombin time, fibrinogen. Incision exudate occurred in one patient and anticoagulant therapy was paused, however, two days later, DVT recurred and then the patient received continuous therapy with drug anticoagulation. The average time for postoperative follow-up was 8.3±7.6 months. At the latest follow-up, 4 cases had thoroughly recovered with the thrombi fully resolved; 4 cases had significantly improved including three thrombi partly locating in the muscular veins and one partly locating in the infra-popliteal vein. One case became more severe after discharge and received continuous anticoagulant therapy. No death, symptomatic pulmonary embolism, bleeding and other adverse events occurred. Conclusion Inferior vena cava filter placement for femoral neck fracture patients with acute proximal venous thrombosis before hip arthroplasty may not be potent. Anticoagulant therapy which make the proximal thrombus completely dissolved or stabilized before surgery may be effective. Key words: Femoral neck fractures; Venous thromboembolism; Vena cava filters; Thrombolytic therapy

Objective To investigate the safety and efficacy of heparin free anticoagulant continuous blood purification (CBP) in the treatment of intensive care unit (ICU) sepsis. Methods From October 2015 to October 2017, a total of 80 patients with sepsis treated in ICU with CBP in No.307 Hospital of PLA were included in this study using the random number table. Patients were divided into study group (n=40) and control group (n=40) according to the anticoagulant methods, of which the study group received heparin free anticoagulation, while the control group was given low molecular-weight heparin anticoagulation. The clinical outcome, renal function index and coagulation function were analyzed retrospectively. Paired t test was used to compare acute physiology and chronic health evaluation (APACHE) Ⅲ scores predicted mortality, urea nitrogen level, serum creatinine level, platelet count, prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT) between two groups before and after treatment. χ2 test was used in analyzing survival rates in 28 d between two groups after treatment. The procedure of this study is in accordance with the requirements of the revised World Medical Association Declaration of Helsinki in 2013. Informed consent was obtained from all participants. Results ① Before treatment, APACHE Ⅲ scores predicted mortality was (89.6±14.8)% in study group, and was (90.1±13.8)%in control group, and there was no significant difference between two groups (P>0.05). After treatment, 28 d survival rate was 40.0% in study group, and was 47.5% in control group, and there was no significant difference between two groups (P>0.05). ② After treatment, urea nitrogen level was (12.8±1.7) mmol/L, blood creatinine level was (162.5±21.7) μmol/L in study group, and all were significantly lower than those before treatment, which were (22.7±3.8) mmol/L and (276.4±35.8) μmol/L, and the differences were statistically significant (t=8.827, 9.102; P=0.002, 0.000). After treatment, urea nitrogen level was (10.7±2.9) mmol/L, and serum creatinine level was (142.4±37.0) μmol/L in the control group, and all were lower than those before treatment, which were (26.1±3.1) mmol/L, (322.3±38.9)μmol/L respectively, and the differences were statistically significant (t=8.182, 8.992; P=0.006, 0.000). And levels of urea nitrogen and blood creatinine in the 2 groups after treatment were not statistically different (P>0.05). ③ After treatment, platelet count was (67.9±18.7) ×109/L, PT was (19.6±6.7) s, APTT was (28.7±6.1) s and TT was (3.0±1.1) s in study group, and all were significantly lower than those before treatment, which were (117.5±26.8) ×109/L, (28.6±7.9) s, (61.9±15.7) s and (24.2±6.9) s respectively, and the differences were statistically significant (t=7.233, 7.527, 6.232, 7.426; P=0.012, 0.011, 0.037, 0.007). Platelets count was (72.7±16.9) ×109/L, PT was (18.6±6.8) s, APTT was (31.9±7.1) s, and TT was (3.0±1.1) s in the control group, and all were significantly lower than these before the treatment, which were (109.7±25.7) ×109/L, (25.8±6.9) s, (56.7±14.9) s, (24.3±6.9) s respectively, and the differences were statistically significant (t=9.125, 6.728, 6.426, 7.529; P=0.000, 0.029, 0.031, 0.006). Platelet count, PT, APTT and TT levels in the 2 groups after treatment were not statistically different (P>0.05). Conclusions Heparin free and low molecular-weight heparin CBP therapy both can improve the clinical symptoms and renal function index of patients with sepsis in ICU. Heparin free anticoagulation CBP could not lead to abnormal coagulation function and increase platelet consumption, and could improve safety. Key words: Anticoagulant; Heparin, low-molecular-weight; Sepsis; Heparin free anticoagulant; Continuous blood purification

The purpose of this study was to investigate the effect of glutathione (GSH) on blood coagulation. The normal plasma samples and mixed plasma samples were taken randomly, and into which the normal dose and different concentration of GSH were added. The prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (FIB) and thrombin time (TT) were detected by using coagulation method before and after treatment with GSH. The detection results of normal plasma and mixed plasma containing GSH of different concentration were compared and analyzed with linear regression. The results showed that the APTT and FIB values of the plasma containing 2.5 mg/L glutathione or more, PT values of the plasma containing 10 mg/L glutathione or more, and TT values of the plasma containing 1250 mg/L glutathione or more were significantly different from those results of normal plasma or mixed plasma (P < 0.01) . There was a linear relation between all of the detection results of PT,APTT, FIB, TT and glutathione concentrations. The results of TT, APTT, PT and FIB detection in patient plasma were statistically different (P < 0.01) before and after treatment with normal concentration GSH. It is concluded that glutathione can influence detection results of coagulation function.

Objective:To investigate the preoperative coagulation characteristics and postoperative changes in patients with primary hyperparathyroidism（PHPT）. Methods:A retrospective analysis was conducted on the clinical data of 55 PHPT patients treated at Beijing Chaoyang Hospital, including preoperative and postoperatively（1 week） serum calcium, serum phosphorus, parathyroid hormone（PTH）, 25-hydroxyvitamin D, prothrombin time（PT）, activated partial thromboplastin time（APTT）, fibrinogen（FIB）, thrombin time（TT）, D-dimer（D-Dimer）, and thromboelastography（TEG） parameters such as coagulation index（CI）, reaction time（R）, kinetic time（K）, maximum amplitude（MA）, and lysis at 30 minutes（LY30）. The preoperative coagulation status and the impact of postoperative biochemical changes on coagulation function were analyzed. Results:All 55 patients successfully underwent parathyroid tumor resection, pathological findings were 41 cases of adenoma（74.5%）, 12 cases of atypical tumor（21.8%）, and 2 cases of carcinoma（3.6%）. The median preoperative serum calcium and PTH levels were 2.67 mmol/L and 171.60 pg/mL, respectively. All patients had PT, APTT, FIB, TT, CI, MA, K, and LY30 values within normal ranges, but 11 patients（20.0%） exhibited reduced preoperative R values. Compared to the normal R-value group, the reduced R-value group had shorter APTT, higher D-Dimer, and higher CI values, with statistically significant differences（P<0.05）, suggesting a hypercoagulable state preoperatively. One week postoperatively, the median serum calcium and PTH levels significantly decreased to 2.14 mmol/L and 35.10 pg/mL, respectively（P<0.05）. Except for a slight increase in D-Dimer, PT, APTT, FIB, TT, CI, MA, K, and LY30 values remained stable within normal ranges. The differences in APTT, D-Dimer, and CI values between the reduced R-value group and the normal R-value group were no longer statistically significant（P>0.05）. Conclusion:Some PHPT patients exhibit a hypercoagulable state with reduced R values preoperatively, and surgical resection of parathyroid tumor helps improve coagulation function in these patients.

Objective To explore the effects and the related factors of tigecycline on the level of plasma fibrinogen in hospitalized patients. Methods The medical records of the patients who were hospitalized and treated with tigecycline in Peking Union Medical College Hospital from January first 2015 to December 31th were collected. The patients′ age, sexuality, primary disease, infection site, days in ICU, situation of using tigecycline, situation of drug combination, the results of tests of fibrinogen (FIB), prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), total bilirubin (TBil), and alanine aminotransferase (ALT) before and after medication were recorded. The patients were divided into FIB decreasing group (FIB<1.8 g/L) and non FIB decreasing group according to the test results of FIB during the medication. The risk factors of FIB decreasing after administration of tigecycline were analyzed by the Logistic regression method. Results A total of 121 patients were enrolled into the analysis. There were 59 cases in the FIB decreasing group and 62 cases in the non FIB decreasing group, respectively. The age of patients, the proportion of cases number of primary disease as shock, dysfunction of blood coagulation or bleeding, the proportion of cases of medication time over 14 days in the FIB decreasing group were higher than those in the non FIB decreasing group [(66±13)years vs. (58±16) years, P=0.004, 76.3% (45/59) vs. 56.4%(35/62), P=0.021, 44.1% (26/59) vs. 21.0% (13/62), P=0.007, 42.4% (25/59) vs. 17.7% (11/62), P=0.003]. The number of kind of combination with other antibiotic or antiviral drugs in the FIB decreasing group were more than those in the non FIB decreasing group [3(2, 4) vs. 2(1, 3), P=0.038]. The valley value of FIB during the medication in the FIB decreasing group [1.4(1.1, 1.6) g/L] was obvious lower than those before medication [3.5(2.8, 4.4) g/L] and after drug withdrawal [1.8(1.5, 2.3) g/L] (all P<0.01 ). The peak values of PT, APTT, TT, and TBil during the medication in the FIB decreasing group were obvious higher than those before medication [17(16, 21) s vs. 14(13, 16) s, 57(47, 81)s vs. 39(33, 46) s, 23(21, 26) s vs. 17(16, 20) s, 26(15, 73) μmol/L vs. 15(10, 25) μmol/L, all P<0.01]. All the indices above-mentioned were returned to the levels before medication after drug withdrawal except TT[20(18, 21) s]. The results of Logistic regression analysis showed that the age (OR=1.043, 95%CI: 1.012-1.074, P=0.006), dysfunc-tion of blood coagulation or bleeding (OR=2.843, 95%CI: 1.151-7.022, P=0.024), and medication time over 14 days (OR=3.570, 95%CI: 1.317-9.876, P=0.012) were the risk factors of FIB decreasing after using tigecycline. Conclusions The incidence of FIB decreasing in hospitalized patients after using tigecycline is about half. The age, dysfunction of blood coagulation or bleeding and medication time over 14 days are the risk factors of FIB decreasing after using tigecycline. Key words: Fibrinogen; Hospitalized patient; Tigecycline

The purpose of the study reported here was to evaluate the haemostatic function in calves with suspected septic shock and to reflect the occurrence of disseminated intravascular coagulation (DIC). Twenty-six calves suspected of having septic shock (experimental group) and 10 clinically healthy calves (control group) were used. On admission, the experimental group of calves had been ill for an average of 2 days. Therapy was applied to the experimental group of calves. The packed cell volume (PCV), haemoglobin (Hb), white blood cell (WBC), red blood cell (RBC) and platelet (PLT) counts were determined. Blood smears for toxic neutrophil and schistocyte intensity were evaluated. For the coagulation profile, plasma activated partial thromboplastin time (APTT), prothrombin time (PT), thrombin time (TT), fibrinogen and fibrin/fibrinogen degradation products (FDPs) values were determined. Toxic neutrophils in blood smears were observed in 12 calves of the experimental group. APTT was prolonged in the experimental group compared with the control group (p < 0.05). Fibrinogen concentration was found to be higher in the experimental group than in the control group (p < 0.001). Total leukocyte counts were higher in the experimental group compared with the control group (p < 0.01). Platelet counts in the experimental group were lower than the control group (p < 0.001). However, when the individual values of coagulation profiles of each calf were evaluated, 8 calves had at least three abnormal coagulation profiles (APTT >72 s, PT >34.5 s, TT >33.7 s, FDPs >5 microg/ml, PLT < or = 150 x 10(3)/mm(3)) and abnormal erythrocyte morphology (schistocytes > or = 1). The most common abnormal tests in the coagulation profile were APTT and PT (7 cases), FDPs (6 cases), thrombocytopenia (4 cases), and schistocytes in blood smears (8 cases) in these 8 calves. The results of this study indicate that DIC might be a significant risk factor for mortality in calves with suspected septic shock.

To determine the relationship between coagulation system markers and hyperbilirubinaemia in full-term neonates. This retrospective case-control study enrolled full-term neonates with hyperbilirubinaemia and healthy control full-term neonates. Prothrombin time (PT), thrombin time (TT), fibrinogen (Fbg), activated partial thromboplastin time (APTT) and international normalized ratio (INR) were recorded. The correlation between INR and total bilirubin and between INR and indirect bilirubin was analysed by linear regression analysis. Receiver operating characteristic curve analysis was used to assess the efficacy of INR to identify neonates with hyperbilirubinaemia. This study enrolled 40 full-term neonates with hyperbilirubinaemia and 30 healthy controls. PT, INR and APTT were significantly higher in the neonates with hyperbilirubinaemia compared with the healthy controls. There was a significant positive correlation between INR and the level of total bilirubin in neonates with hyperbilirubinaemia (R = 0.3327). There was also a significant positive correlation between INR and the level of indirect bilirubin in neonates with hyperbilirubinaemia (R = 0.3406). INR in neonates with hyperbilirubinaemia significantly achieved an area under the curve of 0.800 (95% confidence interval, 0.6288, 0.9712; cut-off value, 1.060; specificity, 71.43%; sensitivity, 80.00%). These findings suggest that INR is a novel biomarker for the diagnosis of neonatal hyperbilirubinaemia in full-term neonates.

Bleeding is a major cause of death in patients with traumatic injuries. Recently, thrombelastography (TEG) has been suggested as an additional means of evaluating coagulation in trauma patients. We hypothesized that TEG data would aid in defining the coagulopathy of trauma in patients with penetrating traumatic injuries. A retrospective study was performed of patients (n = 44) with penetrating injuries admitted to a combat support hospital during a 2-month period in 2004. Recorded data included standard laboratory data, TEG parameters, and blood product use in the first 24 hours after admission. Values were compared with clinically accepted ranges and those obtained from the Haemoscope Corporation. At admission, International Normalization Ratio, prothrombin time, and partial thromboplastin time were increased in 39% (>or=1.5), 31% (>16 seconds), and 37% (>40 seconds) of patients, respectively, suggesting hypocoagulation, but these variables did not correlate with the use of blood products (p > 0.05). TEG values obtained within 24 hours of admission (6 hours +/- 5.7 hours; median of 4.5 hours) demonstrated hypocoagulation based on delayed propagation of the clot (increased K time and reduced alpha-angle) and decreased clot strength (reduced maximal amplitude [MA]). MA correlated (r = 0.57, p < 0.01) with blood product use as well as platelet count (r = 0.61, p < 0.01). Patients with reduced MA (n = 23) used more blood products and had reduced platelet counts and hematocrit. Thrombelastography was a more accurate indicator of blood product requirements in our patient population than prothrombin time, partial thromboplastin time, and International Normalization Ratio. Thrombelastography enhanced by platelet count and hematocrit can guide blood transfusion requirements.

Objective To study the effects of hypothermia therapy on coagulopathy in neonates with hypoxic-ischemic encephalopathy(HIE) of different degrees. Methods Twenty-five newborns with HIE were divided into 2 groups (moderate HIE group and severe HIE group) by amplitude integrated electroencephalogram(aEEG). The platelet (PLT) count, activated partial thromboplastin time (APTT), prothrombin time(PT), thrombin time(TT), fibrinogen (Fbg) and international normalized ratio (INR) were measured before hypothermia therapy and those after 24 hours, 48 hours, 72 hours after hypothermia therapy were collected.The hematological parameters of 2 groups were analyzed by repeated measurement analysis of variance. Results The APTT(t=2.239, P 0.05)showed no statistically significant difference between 2 groups after hypothermia therapy.The differences in INR(F=12.470, P 0.05) between 2 groups.The differences in PLT(F=32.420, P 0.05). But the degree of brain injury and time had interactive effects in PT(F=3.374, P 0.05). Conclusion The coagulopathy function is worse in neonates with severe HIE in hypothermia therapy which may aggravate the hemorrhage risk.And the effect of hypothermia on neonates with moderate HIE is less evident.So hierarchical intervention on coagulopathy in neonates with HIE during hypothermia should be adopted to relieve the hemorrhage risk. Key words: Hypothermia; Hypoxic-ischemic encephalopathy; Coagulopathy; Amplitude integrated electroencephalogram

The cascade mechanism for the coagulation pathway has prevailed since its original proposal, and subsequent observations have supported the role of thrombin on coagulation reactions other than in Fibrinogen - Fibrin conversion. In very small quantities, thrombin has been reported as increasing the activity of Factor VIII: C. We report here, observations which support a reverse proposal, namely that Factor VIII: C increases activity of thrombin in Fibrinogen - Fibrin conversion.Thrombin clotting times were performed employing human Fibrinogen solutions, fresh citrated normal platelet - poor human plasma and fresh citrated platelet - poor plasma from severely affected Hemophilia A patients, in whom Factor VIII : C assays were less than 1% in a one stage, activated partial thromboplastin time assay. A platelet aggregometer was used to assess the thrombin time, and the rate of clot formation (fibrin polymerization) was indicated by optical density change in the form of a curve, the tangent of the maximal slope of curve being equated with this clot formation rate.Results indicate that with very small concentrations of thrombin, Factor VIII: C enhances the rate of fibrin clot formation and that Factor VIII: C restores the abnormal rate of clot formation observed in severe Hemophilia A; the test system was known to be calcium-free, which ensured that activation of Factor X did not ensue. The concentration of Fibrinogen remained constant in all experiments. The observed phenomena are confirmed when employing purified fibrinogen solutions, using decreasing amounts of Factor VIII: C.

Objective To assess the effects of hydroxyethyl starch (HES) 130/0.4 on blood coagulation function and platelet function in the elderly.Methods Thirty elderly patients undergoing gastric and intestinal tumor resection under general anesthesia were randomly assigned to one of 2 groups ( n = 15 each):HES group and normal saline group (group NS).The patients were premedicated with im phenobarbital 0.1 g and scopolamine 0.3 mg.Anesthesia was induced with midazolam 0.02-0.05 mg/kg,fentunyl 3-5 μg/kg,prepofol 1-2 mg/kg,vecuronium 2 mg and succinylcholine 1-1.5 mg/kg and maintained with isoflurune (end-tidal concentration 0.5 %-1.5% ) and intermittent iv boluses of fentanyl and vecurunium after tracheal intubation.HES or NS 25 ml/kg was infused after tracheal intubation at a rate of 10-15 ml·kg-1·h-1 through central venous line. Venous blood samples were taken before (T1,baseline) and at 30 min (T2) and 4 h (T3) after HES or NS infusion for determination of hemoglobin (Hb),platelet count (Plt),prothrombin time (PT),activated partial thromboplastin time (APTT) and fibrinogen level (FIB),plasma factor Ⅷ,yon Willebrand factor (vWF).Glass bead activated whole blood clotting time (gbACT),clot rate and platelet function were also measured at the 3 time points using Sonoclot analyzer.Results The 2 groups were comparable with respect to M/F sex ratio,age,body weight and duration of operation.Hb and Pit were significantly decreased at T2and T3 after HES or NS infusion as compared with the baseline values at T1 before infusion.There was no significant change in PT,APTT,FIB,Ⅷ ,vWF,gbACT,clot rate and PIT function after infusion in both groups.Conclusion Infusion of HES 130/0.4 25 ml/kg during operation does not have significant effects on blood coagulation function and platelet function in the elderly. Key words: Hetastarch; Aged; Blood coagulation tests; Platelet function tests

Purification and characterization of a novel thermostable anticoagulant protein from medicinal leech Whitmania pigra Whitman

To compare the blood-cooling and hemostasis effects of Rehmanniae Radix before and after carbonizing on rats with blood heat and hemorrhage syndrome. The blood heat and hemorrhage syndrome rat model was established. Indexes including rectal temperature,whole blood viscosity,plasma viscosity,thrombin time(TT),activated partial thromboplastin time(APTT),prothrombin time(PT),fibrinogen content(FIB),red blood cell(RBC),hemoglobin(Hb),hematocrit(HCT),blood platelet count(PLT),mean platelet volume(MPV),serum IL-1,serum IL-6 and lung histopathology were detected to investigate the blood-cooling and hemostasis effects of Rehmanniae Radix and its carbonized products. Compared with the blank control group,the rectal temperature was significantly increased with rise of the high,middle and low whole blood viscosities and plasma viscosity(P<0.05); both the high and low whole blood restore viscosity and the high and low whole blood relative viscosity were increased significantly(P< 0.05); TT,APTT and PT were notably prolonged with the increase in FIB content(P<0.05); RBC,Hb and HCT increased significantly(P< 0.05); concentrations of serum IL-1 and IL-6 were also increased(P< 0.05) in model group. Additionally,obvious hemorrhages in lung and stomach were observed in rats of the model group. Rehmanniae Radix and its carbonized products can significantly reduce rectal temperature,high middle and low whole blood viscosities and plasma viscosity(P<0.05). TT and APTT were shortened,with lower expression of FIB in group of Rehmannia Radix and its carbonized products. Hemorrhages of lung and stomach were improved by Rehmannia Radix and its carbonized products. The results indicated that Rehmannia Radix before and after carbonizing had the hemostasis and blood-cooling effects by promoting coagulation,improving blood rheology and inhibiting expressions of IL-1 and IL-6.