COMBINED PLASMA FILTRATION, SELECTIVE ADSORPTION OF CYTOKINES WITH HEMOFILTRATION AND PLASMA EXCHANGE IN THE CORRECTION OF PLATELET AND COAGULATION HEMOSTASIS IN PATIENTS WITH THE SYNDROME OF DISSEMINATED INTRAVASCULAR COAGULATION

Abstract

Aim.To improve the efficiency of treatment of the patients with pancreatic necrosis through correcting the platelet-coagulation potential by methods of combined plasma filtration, selective sorption of cytokines with hemofiltration and plasmapheresis.Methods.The effects of selective sorption of cytokines with hemofiltration and plasmapheresis upon coagulation potential were studied in 70 patients with acute pancreatitis. Plasmapheresis was performed on PCS 2 (Haemonetics, USA); selective sorption of cytokines with hemofiltration – on Lynda® machine (Bellco, Italy). The method of computer laser phasemeter was used for vital assessing of platelet morphofunctional status.Results.In patients with pancreatic necrosis in the fermentation phase the percentage of resting platelets was 51.3%, which is 12% below the control numbers. The number of activated platelets increased: 25.1% of the cells were represented by platelets with low activation; 15.5% – highly activated cells. The number of degenerative-modified platelets increased by two times – up to 8.1%. In the phase of sequestration and suppurative complications the percentage of resting platelets was only 42.3%, which is 1.5 times lower than the control numbers. 34.2% of the cells were presented by platelets with low activation; 11.0% – highly activated cells. The number of degenerative-modified platelets exceeded 12.5%. The analysis of the morphological structure of the platelets population revealed that due to plasmapheresis inclusion into therapeutic complex in the phase of intoxication of pancreatic necrosis the normalization of platelet activation status of hemostasis was observed. In 5 (20%) patients the normalization of average platelets morphometric parameters was shown after selective sorption of cytokines with hemofiltration and plasmapheresis. These patients demonstrated positive clinical dynamics. In 15 patients morphometric values of platelets either remained at the same value or continued to increase progressively. In this subgroup of the patients purulent complications progressed in 9 patients, mortality was 35%.Conclusion.Thus, the level of thrombocyte hemostasis in different phases of pancreatic necrosis can be quantified using indicators of morphofunctional status of circulating platelets. When dealing with coagulation version of disseminated intravascular coagulation syndrome the number of activated cells is on the rise up to 40% or more. The development of consumption coagulopathy is characterized with progressive increase of degenerative platelets up to 10% or more. Combined plasma filtration, selective adsorption of cytokines with hemofiltration and exchange plasmapheresis are effective methods for adjusting of platelet and coagulation hemostasis in patients with necrotizing pancreatitis.