The bood coagulation and fibrinolytic study in obstructive jaundice

Abstract

In order to know the causative factors of abnormal bleeding tendency following surgery on the patients with obstructive jaundice, fibrin/fibrinogen degradation products (FDP) including fibriolytic activity, platelet counts, platelet retention and aggregation, and the blood coagulation systems were investigated.Total 20 patients with obstructive jaundice were studied. 16 of them had malignant tumor and the rest four had choledocholithiasis.The serum FDP level was elevated significantly in most of these patients and showed a some correlationship with the increase of the serum total bilirubin and alkalinephosphatase values. However, the elevation of FDP could not be explained only by the degree of obstructive jaundice.The serum FDP level did not show any intimate correlation with the serum γ-globulin and BUN values. This might suggest that the serum FDP level is under the influence of some other agents rather than the liver or kidney disfunction.The serum FDP elevation is often appreciated as one of the reliable diagnostic indicator for the syndrome of DIC. In general, the syndrome of DIC usually accompanies abnormal decrease of plasma fibrinogen level, platelet counts and prolongation of the prothrombin time. On the contrary, in these 20 cases these lab. results were within normal limits.In studying the relationship between the elevation of serum FDP or serum bilirubin and platelet retention or platelet aggregation, platelet aggregation was suppressed in these patients with either the marked increase of FDP level or the elevation of serum total bilirubin value.But or on the other hand, fibrinolytic activity, which was measured by the fibrin plate method and euglobulin clot lysis time was found not to be increased.In spite of the presence of high serum FDP, the syndrome of DIC was not apparent. It is not clear that the elevation of serum FDP was due to malignant tumor, chronic DIC or obstructive jaundice. However, these data suggest that the elevation of serum FDP have some influence on the postoperative bleeding tendency in the patients with obstrutive jaundice.