Vascular-platelet Hemostasis Research Articles

Influence of Peptide Bioregulators on Indicators of Hemostasis in Blood of Irradiated Experimental Animals at Low Altitude Conditions

In modern biology and medicine, much attention is paid to the study of the hemostasis regulation of some cell populations by substances of a peptide nature. They have the ability to regulate the functional and proliferative activity of cells and ensure communication in normal and pathological conditions. Research data showed that significant violations of the hemostatic system also occur with radiation damage to the body. One of the first radiation responses involves the coagulation cascade's activation, which leads to the breakdown of fibrinogen and the formation of fibrin clots. The potential threat of this is quite evident due to the existence of uranium mining tailings in several regions of the Kyrgyz Republic. Considering that significant disturbances of the hemostatic system occur during radiation damage to the body, and effective means are clearly not enough, the study of the effect of bioregulatory peptides in these conditions is of great importance. In the study, we carried out the total X-ray irradiation of laboratory animals on the X-ray therapeutic apparatus RUM-17. Peptide bioregulators peptide-1 and peptide-2 were administered intramuscularly to irradiated animals. Throughout the research, we used methods characterizing all links of hemostasis: vascular-platelet hemostasis, coagulation hemostasis, and fibrinolysis. The study has shown that the use of the peptide bioregulators in the background of acute radiation pathology leads to a decrease in the intensity of the chronic course of post-radiation thrombo hemorrhagic syndrome, contributing to an increase in the content of antithrombin III in the blood and modulating the versatile effects of endogenous heparin, which undoubtedly have a beneficial effect on the pathogenesis of radiation sickness.

VASCULAR-PLATELET HEMOSTASIS OF INJURED PATIENTS: PROSPECTIVE OBSERVATIONAL STUDY.

The aim: We study vascular-platelet hemostasis peculiarities in patients with severe trauma. Materials and methods: We included 50 patients, who were divided into control (n=15) and study (n=35) groups. The control group included patients without traumatic injuries, study group - patients with severe trauma. The study group was divided into the I subgroup (patients received 1 g tranexamic acid IV at the prehospital stage), and the II subgroup (1 g tranexamic acid IV after hospital admission). Results: The main changes in the I subgroup started on the 3rd day, while in the II subgroup - on the 1st day. Patients of both subgroups on the 1st and 3rd days had a normal number of platelets in venous blood, however, on the 3rd day, there was a decreasing level of discocytes whereas the level of discoechinocytes, spherocytes, spheroechinocytes, and the sum of active forms of platelets were increased in comparison with the control group (p<0.05). Conclusions: The changes in vascular-platelet hemostasis in patients appeared in the I subgroup on the 3rd day, while in the II subgroup - on the 1st day. For the I subgroup was the decreasing level of discocytes, whereas the level of discoechinocytes, spherocytes, spheroechinocytes, and the sum of active forms of platelets were increased. For the II subgroup on the 1st day, there was an increasing sum of active forms of platelets, on the 3rd day - the level of discocytes was decreased, and levels of discoechinocytes, spherocytes, spheroechinocytes, and the sum of active forms of platelets were increased.

Substantiation of marker indicators of diseases of the respiratory organs and the blood system in children with elevated blood levels of copper, nickel and chromium

Introduction. An urgent hygienic problem in regions with intensive industrial development is inadequate air quality, which causes unacceptable risks of developing somatic diseases among the population in their places of permanent residence. The purpose of the study is to substantiate the associative relationships of indicators of negative effects on the respiratory organs and the blood system with an elevated blood content of copper, nickel and chromium in children. Materials and methods. A hygienic assessment of the quality of ambient air in residential buildings was carried out, the risk was assessed, chemical-analytical, biochemical, general clinical, immunological and proteomic studies and statistical analysis were performed. Results. Established associative relationships of increased blood levels of copper, nickel and chromium with a change in the indicators of negative effects. Markers of the formation of chronic inflammation, accompanied by an imbalance of cellular and humoral immunity, are a decrease in the phagocytic index and number, overproduction of copper-specific IgG, total IgG; markers of a possible violation of the cascade of enzymatic reactions of the plasma system of blood coagulation and vascular-platelet hemostasis is a decine in the expression of prothrombin, vitronectin and hemoglobin beta subunit; development of induction of oxidative processes including an increase in MDA in blood plasma. Limitations. The conducted study does not make it possible to draw unambiguous conclusions about the effect of the studied chemicals on changes in biochemical and hematological parameters,and as well as morbidity rates, since the possibility of the impact of other factors (heredity, gender and age characteristics) not studied in this work is not excluded. Conclusion. It is expedient to use the obtained results for the implementation of targeted measures to prevent negative consequences on the part of the respiratory system, the immune system, and the blood system, etiopathogenetically associated with the aerogenic combined effect of nickel, chromium and copper oxides.

Endothelial dysfunction in patients with various forms of congenital epidermolysis bullosa

Introduction. The endothelial system is an important component of vascular-platelet hemostasis, capable of actively responding to mechanical and inflammatory agents. Patients with congenital epidermolysis bullosa are prone to mechanical damage to the skin and the development of a chronic inflammatory syndrome with a high probability of endothelial dysfunction.The study objective was to assess the state of the endothelial system and to reveal the dependence of endothelial dysfunction on the form of epidermolysis bullosa.Methods and materials. The study used venous blood of 57 patients (27 men and 30 women) with congenital epidermolysis bullosa. In patients with simple and dystrophic forms of epidermolysis bullosa, the platelet count, P-selectin, fibrinogen, albumin, C-reactive protein, von Willebrand factor antigen concentration, and factor VIII activity were determined.Results. Comparative results of endothelial dysfunction depending on the form of epidermolysis bullosa were represented and endothelial dysfunction’s dependence on the concentration of albumin, C-reactive protein, and platelet count was determined.Conclusions. In patients with a dystrophic form of epidermolysis bullosa, endothelial dysfunction is accompanied by an increase in the expression of P-selectin, factor VIII activity, and the concentration of von Willebrand factor antigen. Chronic inflammation and impaired nutritional status with a decrease in albumin contribute to the development of endothelial dysfunction.

The Role of Vascular-Platelet Hemostasis Disturbances in the Genesis of Respiratory Failure in Patients with COVID-19

The objective: to study the relationship between markers of imbalance in the platelet-vascular hemostasis system and lung damage and disease outcome in patients with COVID-19.Subjects and Methods: the study included 225 patients with the confirmed diagnosis of moderate, severe and extremely severe COVID-19. In all patients, lung damage was confirmed using computed and X-ray diagnostic methods. We studied the concentration of von Willebrand factor (vWF), activity of metalloproteinase ADAMTS-13, concentration of homocysteine, endothelin-1, thrombomodulin and the number of platelets and changes in these parameters on the 1st, 3–5th and 7–10th days from the admission to the intensive care unit (ICU). In deceased patients (n = 106), lung specimens were collected to assess the nature of morphological changes.Results. It was determined that by the 7–10th days with a lethal outcome of the disease, there was a statistically significant increase in the concentration of vWF by 22.2% (p = 0.0225), the vWF/ADAMTS-13 ratio by 2 times (p = 0.0408) and decrease in the platelet count by 52% (p = 0.0008) versus the initial stage of the study. In all the deceased, the morphological picture of lung tissue damage was characterized by destruction of alveolocytes, proliferation of connective tissue, cellular infiltration, plethora of capillaries, parietal erythrocyte thrombi in the lumen of capillaries, arterioles and venules, and obstructive erythrocyte thrombi in the lumen of vessels of lung microcirculation.Conclusion. The study showed that a possible cause of thrombosis in the lumen of vessels of lung microcirculation in the case of a lethal outcome of COVID-19 might be a primary imbalance in the vascular-platelet hemostasis characterized by a significant increase in the concentration of the vWF factor, the vWF/ADAMTS-13 ratio and a decrease in the number (consumption) of platelets by the 7–10th day of the disease versus the initial stage of the study.

Pathophysiology of Blood Vein Thrombotitis Hemostasis Disorders

Annotation: Primary or vascular platelet hemostasis disorders include thrombocytopenia, thrombocytopathy, and vasopathy. Hemorrhages are characteristic of the clinic of these diseases, with the appearance of hemorrhagic rashes on the skin as a result of increased permeability of the capillary wall, bleeding from the nose, metro and menorrhagia, resulting in the development of severe posthemorrhagic anemia. Hemorrhagic diathesis in this group and includes many nosologies acquired over a lifetime. Almost all disorders lead to life-threatening hemorrhages

КЛИНИЧЕСКИЕ И ГЕМОСТАЗИОЛОГИЧЕСКИЕ ОСОБЕННОСТИ ЦИРРОЗА ПЕЧЕНИ АУТОИММУННОЙ ЭТИОЛОГИИ У ДЕТЕЙ

Objective of the study: to determine clinical, hemostasiological features and evaluate the relationship of autoantibodies with hemostasiological disorders in children with liver cirrhosis (LC) class A according to Child–Pugh score in the outcome of autoimmune hepatitis (AIH). Materials and methods of research: a single-center, retrospective, controlled, non-randomized study. From 2017 to 2021, 31 children aged 13 (10; 15.5) years old [15 girls (48%) and 16 boys (52%)] with LC class A according to Child–Pugh classification in the outcome of AIH and 15 children aged 13 (10; 15.5) years [8 girls (53%) and 7 boys (47%)], belonging to health groups I–II. All participants were examined according to the medical standard for specialized medical care for children with LC in accordance with the «Autoimmune hepatitis in children” of the Federal clinical guidelines (Moscow, 2016) and the medical standard for specialized medical care for children with AIH. The parameters of the hemostatic system were determined on the ACL-TOP 500 hemocoagulation analyzer (Instrumentation Laboratory Company, USA) using standard kits: activated partial thromboplastin time (aPTT), Prothrombin time (PT) calculated as % of prothrombin activity according to Quick, thrombin time, fibrinogen content, activity of antithrombin III (ATIII), protein C, plasminogen, alpha2-antiplasmin (α2-AP). To determine the factor XII-dependent fibrinolysis activity (XIIa-DF) and the content of Soluble fibrin monomer complexes (SFMCs), reagent kits from the Tekhnologiya-Standard company (Russia) were used. The platelet count was determined using a Cell-Dyn 610 hematology analyzer (Abbott Diagnostics, USA). The study of platelet aggregation activity was carried out on a platelet aggregation analyzer using adenosine diphosphate (ADP) at a concentration of 1.25 mg/ml and collagen at a concentration of 2.0 microns/ml as an aggregation inducer. Measurement of plasma endothelin-1 was carried out by using Endothelin 1-21 ELISA Assay kit. Homocysteine concentration and VWF activity were determined on an ACL-TOP 500 hemocoagulation analyzer (Instrumentation Laboratory Company, USA) using standard kits. Results: the clinical picture was characterized by asthenoneurotic (100%), abdominal pain (45%), hemorrhagic [ecchymosis (55%), epistaxis (30%), bleeding gums (16%)] syndromes, hepatomegaly (90%), splenomegaly ( 65%). Hemostasiological disorders were characterized by a decrease in the content of platelets (p=0.001), an increase in the degree (ADP inducer, p=0.001; collagen inducer, p=0.023) and speed (ADP inducer, p=0.003; collagen inducer, p=0.032) of their aggregation, inhibition coagulation (p=0.001) and anticoagulant (p=0.002) components of hemostasis in comparison with a group of healthy children. Positive autoantibodies were diagnosed in 97% of patients, in 49% of cases, which is typical for Type 2 AIH. Indicators of vascular-platelet hemostasis can be used to assess autoimmune activity in children with Child–Pugh class A cirrhosis: VWF activity 200.0% is associated with an increase in antinuclear antibodies (ANA) in the blood (sensitivity – 83%, specificity – 69% ). Conclusion: indicators of vascular-platelet hemostasis can be used to assess autoimmune activity in children with class A cirrhosis according to Child–Pugh in the outcome of AIH.

Features of blood clotting system in girls with abnormal uterine bleeding of the puberty period

Objective: to evaluate the blood clotting system based on laboratory data in adolescent girls with uterine bleeding of the puberty period (MCPP). The study included 151 girls from 9 to 17 years old, of which 101 patients with MСPP and 50 patients with somatic pathology who do not suffer from MСPP. All patients underwent laboratory tests of blood coagulation parameters. The results of the study revealed lower values of the prothrombin index (PTI) and a tendency of compensatory increase in fibrinogen levels with a decrease in Duke bleeding time in the period of acute uterine bleeding in patients of the main group. In patients with MСPP, the threshold values of the blood clotting system parameters for the occurrence of uterine bleeding were determined, these are the level of PTI≤71.25%, fibrinogen ≤4.45 g/l, bleeding time according to Duque &lt;2.38 min (p&lt;0,05 according to the criterion χ2). The analysis of the obtained results indicates the presence of signs of insufficiency of the vascular-platelet hemostasis link in girls with MCPP.

Hemostasis and blood properties of cows during the dry season

The results of the research show that the properties of blood and coagulation abilities of blood change significantly in cows during the dry period. Most significantly, we found these differences in cows during the dry season. Platelet hemostasis of cows during pregnancy acquires significant changes. They indicate that during the period of fetal development, the state of vascular-platelet hemostasis of the animal acquires appropriate patterns in the dynamics and activity of individual components as the gestation period of animals increases. The number of platelets in the blood of cows from the first trimester of pregnancy to the end of the third trimester decreases. Significantly reduced thrombin and prothrombin clotting time, increases its clotting potential.

Features of vascular-platelet and coagulation hemostasis in relation to parameters of macular blood fl ow in women with preeclampsia

Background. Recently, more and more attention has been paid to the development of vascular retinal disorders after suffering preeclampsia. It is noted that the key role in this process is assigned to the systemic endothelial dysfunction that persists for a long time after delivery.Aim: to elucidate the features of vascular-platelet and coagulation hemostasis in relation to the indicators of blood flow in the macular region in women with preeclampsia.Materials and methods. The main group included 45 women with preeclampsia in the third trimester of pregnancy (35–36 weeks). Their age ranged from 19 to 40 years (27 ± 5.2 years). The comparison group was represented by 20 women with physiological pregnancy in the third trimester (35–36 weeks). Their age averaged 26 ± 5.1 years (18–38 years). Somatically healthy non-pregnant women (20 people) were included in the control group. Their age ranged from 19 to 38 years (26 ± 5.4 years). A comparative analysis of the studied parameters of macular blood fl ow, vascular-platelet and coagulation hemostasis between the groups was carried out.Results. When studying the number of platelets in pregnant women, it turned out that in patients with preeclampsia, this indicator was statistically signifi cantly lower compared to the comparison and control groups (p &lt; 0.05). The level of fi brinogen in women with complicated pregnancies was statistically significantly higher than in women with physiological pregnancy and in somatically healthy nonpregnant women (p &lt; 0.05). In addition, retinal microcirculation disorders were observed in women of the main group.Conclusions. The revealed disorders of vascular-platelet and coagulation hemostasis in women during the period of complicated pregnancy were accompanied by disorders of macular blood fl ow in the form of a decrease in the total average density of vessels in the superfi cial vascular plexus, subfoveolar thickness of the choroid and an increase in the area of the avascular zone relative to the group of women with physiological pregnancy and somatically healthy nonpregnant women.

Гемостаз та запалення у пацієнтів із політравмою

Актуальність. Причинами смерті при тяжких травмах є як ушкодження, несумісні з життям, так і тяжкі кровотечі. Коагулопатію, асоційовану з травмою, виявляють у 46 % пацієнтів уже на місці події та у 60 % пацієнтів — при надходженні на лікування. Мета: встановити наявність зв’язку між показниками загальної відповіді організму на запалення та показниками судинно-тромбоцитарного і коагуляційного гемостазу у пацієнтів з політравмою. Матеріали та методи. Проведено проспективне обсерваційне дослідження 20 пацієнтів віком від 19 до 55 років з політравмою, які перебували на лікуванні у відділенні анестезіології з ліжками інтенсивної терапії в Комунальному некомерційному підприємстві «8-ма міська клінічна лікарня м. Львова». Пацієнтів оцінювали за Injury Severity Score (ISS) та шкалою APACHE II (Acute Physiology And Chronic Health Evaluation II) з урахуванням тривалості синдрому загальної відповіді організму на запалення і лікування у відділенні інтенсивної терапії (ВІТ) та госпіталізації. Етапи дослідження: надходження на лікування у ВІТ (d1), третя доба (d3), п’ята доба (d5). Основними оцінюваними клінічними маркерами були показники: загальної відповіді організму на запалення, судинно-тромбоцитарного гемостазу (внутрішньосудинна активація тромбоцитів, агрегація тромбоцитів, індукована адреналіном і аденозиндифосфатом), коагуляційного гемостазу (міжнародне нормалізоване відношення, активований частковий тромбопластиновий час, рівень загального фібриногену та D-димерів). Результати. Встановлено наявність вірогідного (p &lt; 0,05) позитивного кореляційного зв’язку між співвідношенням рівнів дискоехіноцитів до сфероехіноцитів та рівнем загального фібриногену на етапі d1, а також тенденцію (p = 0,09) до наявності позитивного кореляційного зв’язку між цим співвідношенням та температурою тіла пацієнта. Виявлено вірогідний (p &lt; 0,05) зворотний кореляційний зв’язок між цим співвідношенням і рівнем тяжкості стану пацієнтів за шкалою APACHE II та прямий вірогідний (p &lt; 0,05) кореляційний зв’язок із тривалістю госпіталізації у ВІТ, а також тенденції до зворотного кореляційного зв’язку з тяжкістю ушкоджень за шкалою ISS (p = 0,07) та до прямого кореляційного внаслідок Systemic Inflammatory Response Syndrome (SIRS) (p = 0,12). Висновки. У пацієнтів із політравмою встановлено: наявність вірогідного (p &lt; 0,05) позитивного кореляційного зв’язку між співвідношенням дискоехіноцити/сфероехіноцити та рівнем загального фібриногену; тенденцію (p = 0,09) до позитивного кореляційного зв’язку між цим співвідношенням та температурою тіла пацієнта; вірогідний (p &lt; 0,05) зворотний кореляційний зв’язок з рівнем тяжкості стану пацієнтів за шкалою APACHE II; прямий вірогідний (p &lt; 0,05) кореляційний зв’язок з тривалістю госпіталізації у ВІТ; тенденцію (p = 0,07) до зворотного кореляційного зв’язку з тяжкістю ушкоджень за шкалою ISS та тенденцію (p = 0,12) до прямого кореляційного зв’язку з тривалістю SIRS.

Pathogenetic therapy of vascular-platelet hemostasis disorders in canine acute spontaneous babesiosis

The article presents the results of a study of the vascular-platelet hemostasis disorders processes in complications of canine acute spontaneous babesiosis, as well as a clinical trial of plasma substitute infusion for the purpose of identified disorders pathogenetic therapy. It was found that acute spontaneous Babesiosis is accompanied by complications in the form of subcompensated shock and a thrombogenic link of disseminated intravascular coagulation syndrome (DIC). This determines the potential risk of complications with a cautious prognosis. The basis for the diagnosis of complications is the establishment of the following changes: a significant deficit in the volume of circulating blood (a decrease in the hematocrit value, the volume of circulating plasma, the volume of circulating red blood cells, the specific volume of circulating blood), as well as significant changes in the functioning of the vascular-platelet link of hemostasis – thrombocytopenia against the background of an increase in the spontaneous aggregation ability of platelets and red blood cells, an increase in the wetting index of the vascular wall, which determines the thrombogenic state, and pronounced thrombocytopenia indicates the consumption of these shaped elements in blood clots. The described changes indicate the development of subcompensated shock and the thrombogenic component of DIC syndrome. Given the prognostic danger of established complications, there is a need for pathogenetic therapy of severe conditions. Infusions of plasma substitute solutions have been proposed to eliminate shock phenomena and the thrombogenic state of disseminated intravascular coagulation syndrome. A clinical trial of intravenous administration of Rheosorbylact solution and a mixture of Rheosorbylact with Dipyridamole was conducted in a comparative aspect. It is shown that a mixture of Rheosorbylact 100 ml and Dipyridamole solution 0.5 % 4 ml in the form of infusions at a dose of 5 ml/kg of animal body weight per day for 3 days can bring hemodynamic parameters and parameters of vascular-platelet hemostasis to physiological ones within 48 hours compared to an infusion of Rheosorbylact solution in its pure form. The synergy of the crystalloid solution of Rheosorbylact and the disaggregating vasodilator Dipyridamole enhances the disaggregating effect of both drugs, and the crystalloid solution itself is able to restore the lost volume of circulating blood.

Analysis of the association of polymorphisms of genes markers functions of endothelium and vascular-plate hemostasis with development of diabetic foot syndrome

The aim. To study the prevalence of various combinations of polymorphic variants of genes markers of endothelial function and vascular-platelet hemostasis in the development of diabetic foot syndrome.Materials and methods. In 198 patients with uncomplicated diabetes mellitus and 199 patients with diabetic foot syndrome, the frequency of polymorphic variants of the NOS 786C&gt;T, END1 Lys198Asn, ITGB3 1565T&gt;C (Leu33Pro), F5 1691G&gt;A, F2 20210G&gt;A, MMP9 8202A&gt;G, MTHFR 1298A&gt;C, VEGFA-634C&gt;G genes was studied. Using binary logistic regression analysis, the relationship of various combinations of polymorphisms of the studied genes with the development of diabetic foot was assessed.Results. In diabetic foot syndrome, the most significant contribution is made by the combination of polymorphic variants of the ITGB3 1565T&gt;C (Leu33Pro) and MTHFR 1298A&gt;C genes. With the development of this complication of diabetes mellitus, a combination of the 1565 TC polymorphism of gene ITGB3 and the 1298AA polymorphism of gene MTHFR is 2.1 times more common. The association of the 1565TT polymorphism of gene ITGB3 and the 1298AC polymorphism of gene MTHFR is 2 times more common in diabetes mellitus without complications.Conclusion. The combination of the 1565TС polymorphism of gene ITGB3 and the 1298АА polymorphism of gene MTHFR is associated with the risk of developing a diabetic foot and increases the risk of developing this complication by 2.4 times. The presence of a combination of the 1565TT polymorphisms of gene ITGB3 and the 1298AC polymorphism of gene MTHFR is more common in uncomplicated diabetes mellitus, which suggests its protective effect against the development of diabetic foot syndrome.

Показатели гемостаза при неалкогольном стеатозе печени (экспериментально-клиническое исследование)

Aim. Assessment of the morphological changes of the liver on the model of non-alcoholic steatosis in laboratory animals and hemostasis parameters in animals and patients with steatosis. Materials and methods. The experimental part of the study was conducted on 18 white rats divided into 2 groups: control (intact animals) and “Steatosis” (animals with liver steatosis modeled in laboratory conditions). The clinical part was performed on 52 patients with non-alcoholic fatty liver disease (the clinical form is non-alcoholic liver steatosis), with an average age of 43.0 ± 11.1 years and a body mass index of 37.2 ± 2.6. The control group consisted of 20 practically healthy individuals. At the end of the experiment, on the 30th day, the animals were removed from the experiment, direct blood sampling was performed from the right atrium, the liver mass and mass coefficient were determined, and a histological examination of the liver was performed. Laboratory tests included the determination of the following indicators of hemostasis in blood plasma: activity of the von Willebrand factor, platelet aggregation with ADP, collagen and ristocetin; prothrombin time, Quick prothrombin, international normalized ratio, thrombin time, activated partial thromboplastin time (APTT), fibrinogen and Hageman-dependent fibrinolysis. Results. In the experiment, the mass coefficient of the liver was significantly higher in the “Steatosis” group compared to the control group (3.75 (3.38-3.99) and 3.5 (3.3-3.6), respectively) (p = 0.009). Structural reorganization of the liver confirms the development of steatosis in animals. In animals with steatosis, a change in indicators reflecting the activity of the plasma link according to the external mechanism of coagulation was found: an elongation of the prothrombin time (p = 0.034), a decrease in the prothrombin index according to Quick (p = 0.018), an increase in INR (p = 0.027). APTT and thrombin time in animals with steatosis are higher than in the control, but these changes are not statistically significant (p = 0.181 and p = 0.364, respectively). The concentration of fibrinogen, Hageman-dependent fibrinolysis, platelet aggregation with ADP and the activity of the von Willebrand factor did not have statistically significant differences when comparing the two groups. In patients with steatosis, the number of platelets did not significantly differ from the control (p = 0.082). However, there was a decrease in aggregation with collagen (p = 0.002) and with ADP (p = 0.02). Platelet aggregation with ristocetin and the activity of the von Willebrand factor was higher than in the control (p = 0.001 and p = 0.01, respectively). In patients with steatosis, there was an extension of the APTT and an increase in the concentration of fibrinogen in comparison with the control, but these indicators did not go beyond the reference values of the set. The thrombin time was significantly prolonged in patients with steatosis in comparison with practically healthy individuals (p &lt; 0.001). Conclusion. Non-alcoholic fatty liver disease is accompanied by a violation of the functioning of both vascular-platelet and coagulation hemostasis. There is a violation of the aggregation properties of platelets, signs of endothelial damage, hepatic coagulopathy.

The hemostatic parameters in pregnant women with different types of diabetes mellitus

BACKGROUND: The prevalence of diabetes mellitus (DM) in pregnancy is on the rise. Despite that gestational hypercoagulability is a physiological condition, diabetic pregnancy is associated with a high risk of venous thromboembolic complications (VTEC). There are many surveys related to the hemostatic parameters in non-pregnant women, but studies in pregnant women are not enough.AIMS: To assess the coagulation and vascular-platelet hemostasis parameters in pregnant women with various types of diabetes mellitus, taking into account its correction method. The data were compared with these indicators in women with preeclampsia and healthy pregnant women at the same gestational age.MATERIALS AND METHODS: An observational, single-center, retrospective cohort study was carried out at D.O. Ott ­Research Institute of Obstetrics, Gynecology, and Reproductive Medicine. The study included 1994 pregnant women who presented several groups taking into account the type of DM and its correction method, a group of women with preeclampsia (PE), and healthy women. The analysis of clinical data was carried out at 28–32 gestational weeks from 2012 to 2017. The study’s primary endpoint was taken as indicators of fibrinogen content, prothrombin index, thrombin time, activated partial thromboplastin time (APTT), and international normalized ratio (INR) antithrombin III, D-dimer, von Willebrand factor, and fibronectin. Additionally, the incidence of VTEC during pregnancy and within six weeks after delivery, gestational arterial hypertension, preeclampsia, fetal growth restriction, premature birth, and stillbirth cases was assessed.RESULTS: in pregnant women with various types of diabetes mellitus and preeclampsia, a state of pathological hypercoagulation was observed compared to the control group. These changes were characterized by an increase and activation of the following blood parameters: fibrinogen, the degree and rate of platelet aggregation, D-dimer, homocysteine, von Willebrand factor, and fibronectin. At the same time, the content of antithrombin III was significantly reduced in patients with DM. Correlation analysis established a direct relationship between the range of the studied factors with the degree of glycemic control and the frequency of obstetric complications.CONCLUSIONS: Diabetes mellitus in pregnancy is associated with a hypercoagulation condition and overexpression in the synthesis of endothelial dysfunction markers. Moreover, the severity of these processes depends on the type of DM and the severity of metabolic disorders. In diabetic pregnancy, exceptional attention to coagulation indicators, regular monitoring, and preventive treatment is required in order to improve the perinatal outcomes.

Risk factors for thromboembolic complications in patients with elevated body mass index during the perioperative period of laparoscopic myomectomy

Background. Uterine fibroid is one of the most common diseases in gynaecological practice accounting from 32 to 70 % according to various authors. In 80 % of cases, fibroids are observed in women of reproductive age. Laparoscopic myomectomy is one of the main methods of surgical treatment for uterine fibroids in women of reproductive age. A large number of advantages of this method of surgical treatment in many cases lead to underestimation of the existing risks such as the risk of thrombosis in women with elevated body mass index (BMI). The purpose of this study is to detect the risk of thrombosis in adequate comprehensive thromboprophylaxis of patients with elevated BMI in the perioperative period of laparoscopic myomectomy using an instrumental method of diagnosis such as low-frequency piezoelectric blood viscometer. Materials and methods. Patients aged 30–45 years undergoing laparoscopic myomectomy (n = 60) were examined. They were divided into 3 groups depending on the BMI and thromboprophylaxis method. Group 1 (n = 16) included women with the BMI &lt; 30 kg/m2, who did not receive thromboprophylaxis. Group 2 (n = 18) consisted of patients with the BMI &gt; 30 kg/m2, who were treated with enoxaparin thromboprophylaxis at a dose of 2,000 anti-Xa IU/0.2 ml subcutaneously (at the BMI of 30–40 kg/m2) and 4,000 anti-Xa IU/0.4 ml subcutaneously (at the BMI &gt; 40 kg/m2). Third group (n = 26) included individuals with the BMI &gt; 30 kg/m2 who received enoxaparin and pentoxifylline for thromboprophylaxis. Results. The low-frequency piezoelectric blood viscometry revealed statistically significant (p &lt; 0.05) deviations from the reference values of the coagulogram towards structural (increased maximum clot density) and chronometric hypercoagulation (acceleration of the time of formation of fibrin-platelet structure T5, shift of the blood clotting time T3 to the left, an increase in the intensity of coagulation drive), elevated thrombin activity (an increase in the constant of thrombin activity, a decrease in T2 time), activation of vascular-platelet hemostasis (reduced period of T1 reaction onset, increased intensity of contact coagulation), inhibition of the lytic activity (a decrease in the intensity of retraction and lysis of the clot) in groups 2 and 3. On the first day after surgery in groups 2 and 3, there was a significant increase (compared to preoperative indicators) in the chronometric indicators such as T1, T2 and T5; a decrease in the structural indicator of maximum clot density, as well as a significant decrease in the constant of thrombin activity, intensity of contact coagulation, which confirms the effectiveness of antithrombotic therapy. However, group 2 reported an increase in the activity of vascular-platelet hemostasis, higher intensity of contact coagulation compared to group 3, shorter T1 and T2 time, and the constant of thrombin activity was higher. On the 5th day after surgery, a normocoagulation trend of hemostatic potential was observed in all groups of patients. Conclusions. The use of low-frequency piezoelectric blood viscometry allows reliably and quickly assessing the kinetics of thrombosis formation.

Changes in the blood coagulation system that determine postoperative complications in patients with non-tumor mechanical jaundice

The OBJECTIVE was to study the features of changes in the blood coagulation system that contribute to the development of postoperative complications in patients depending on the stage of non-tumor mechanical jaundice at admission.METHODS AND MATERIALS. A total of 537 patients with mechanical jaundice were examined and changes in the blood coagulation system were analyzed. Vascular-platelet hemostasis was characterized by the following tests: capillary resistance, the number of desquamated endothelial cells, the number of blood platelets. Plasma hemostasis was analyzed using activated partial thromboplastin time, plasma soluble fibrin level, thrombin time, prothrombin ratio, prothrombin index, and fibrinogen blood level. Then, XIIa-dependent fibrinolysis in the blood and the level of the fibrin D-dimer in the blood plasma were determined.RESULTS. It was found that in the first stage of mechanical jaundice, with cholestasis, there were no changes in blood coagulation system that go beyond the normal limits. In the second stage, during cytolysis of hepatocytes, hyperbilirubinemia and hypertransaminasemia contribute to the activation of platelet first, and then plasma hemostasis. In the third stage (cholangitis), the death of endotheliocytes increases and there is a deficiency of blood coagulation factors due to their consumption and increased fibrinolysis.CONCLUSION. In the stage of cholestasis in patients with non-tumors mechanical jaundice, the parameters of the coagulation system remain within the reference values. In the stage of cytolysis, as endotheliotoxicosis increases, platelet and plasma hemostasis begins to activate, which can lead to thrombosis and thromboembolism in vital organs. In the stage of cholangitis, further activation of plasma hemostasis causes hemorrhagic syndrome. The occurrence of the described disorders in blood coagulation system with the progression of MJ dictates the need to monitor the changes in the blood coagulation system and their correction for the prevention of intra-and postoperative complications.

Some features of the hemostasis system in pregnant women at risk of developing preeclampsia

The objective: a study of the hemostasis system in pregnant women with a risk of preeclampsia development.Materials and methods. 100 pregnant women with the risk for preeclampsia (main group) were examined. The risk factors were determined according to the Guideline “Hypertensive Disorders During Pregnancy”, Order No. 676 of the Ministry of Health of Ukraine. The control group contained of 50 healthy women with physiological pregnancy. The groups were representative in age and reproductive history.The following indicators of hemostasis were studied: the platelet system (the number of platelets, their aggregation ability and the total platelet aggregation index (TPAI), the coagulation system (autocoagulation test, thrombin time, prothrombin index, fibrinogen concentration) and the state of the fibrinolysis system which was determined by such indicators: plasma level of free heparin, activity of antithrombin III, indicators of ethanol and protamine sulfate tests, concentration of soluble fibrin in blood plasma.Results. In pregnant women with a risk of preeclampsia, there are changes in platelet hemostasis indicators: a significant decrease in the number of platelets and a significant (p&lt;0.05) increase in platelet aggregation ability, there is a tendency to an increase in TPAI indicators. In the main group a significant increase in the fibrinogen concentration, plasma lysis indicators and a tendency to an increase of the free heparin concentration, a decrease of antithrombin III and, in comparison with the indicators in healthy women, a 3-fold increase in the content of soluble fibrin (p&lt;0.05) were found.Conclusions. In pregnant women with a risk of preeclampsia development, there are disorders in the vascular-platelet hemostasis, coagulation and fibrinolytic blood systems, namely, a significant tension in the platelet link of the system, an increase in thrombogenic potential, and a sharp inhibition of the fibrinolytic link of hemostasis.

Trauma-induced coagulopathy: prospective observation study

Coagulopathy remains the leading cause of illness and death in people with severe trauma.&#x0D; The aim was to study the indicators of vascular-platelet hemostasis in severe trauma and to establish changes in the main pathophysiological mechanisms of primary hemostasis that occur in patients with trauma-induced coagulopathy, compared with almost healthy individuals of the same age.&#x0D; Materials and methods. The study included 44 patients aged 19 to 55 years (36.1 [28.7; 43.2] years). The control group included 20 patients of the therapeutic department without preconditions for changes in the hemostasis system, and the main group - 24 patients with diagnosis of “severe trauma” who were treated in the anesthesiology and intensive care department.&#x0D; Results and discussion. We studied indicators of intravascular platelet activation. Patients had a normal number of platelets in the venous blood, but the level of spherocytes and spheroechinocytes increased. On the 3rd day after the injury, number of platelets in the venous blood was normal, however the level of discocytes decreased, and the level of discochinocytes, spheroechinocytes and the sum of active forms of platelets increased. On the fifth day, the level of discochinocytes and active forms of platelets, significantly higher (p&lt;0.05) among patients of the main group, and spherocytes, spheroechinocytes and platelets involved in the aggregates, were significantly lower than in the control group of patients (p&lt;0.05).&#x0D; Conclusions. Indicators of vascular-platelet hemostasis in patients with polytrauma had significant differences from those of the control group. This may be evidence of activation of the vascular-platelet system of the hemostasis system and may be a prerequisite for late thrombotic complications in patients with polytrauma

ROLE AND PROBLEMATICS OF THE EPIDURAL ANESTHESIA DURING EXTENSIVE LIVER RESECTIONS

Abstract. In the following article it was evaluated the coagulopathy and/or hypotension incidence rate in patients with the liver extensive resection, who were treated with the thoracal epidural anesthesia and pain management (TEA). Materials and methods. There were enrolled 55 subjects whom the liver extensive resection with TEA both in the intraoperative, and post-operative period was performed at the following site: National Institute of Surgery and Transplantology of the NAMS of Ukraine named after A.A. Shalimov. Influence on the haemodynamics was evaluated on the basis of the mean blood pressure (MBP) decrease lower than 65 mm Hg and appearance of the necessity of vasoactive substances’ administration. We determined the coagulation system’s alteration on the basis of changes of the indicators related to the prothrombotic time (PTT), prothrombotic index (PTI) and international normalization ratio (INR). Vascular platelet hemostasis was evaluated on the basis of the platelets level dynamics. Result. 80% of the 55 subjects required administration of noradrenaline with the aim of the objective MBP control. Execution of the liver extensive resection was characterized by the verifiable decrease of the platelets in the early post-operative period, but this decrease was not clinically significant. It was observed the verifiable increase of the PTT starting from the intraoperative period at the 16,5% (р=0,0001) in comparison with the baseline values, which correlated with the change of PTI and INR.Execution of the liver extensive resection was characterized by the decrease of the blood coagulation properties in early post-operative period, and which led to the verifiable increase of the prothrombotic time, INR and decrease of PTI. Conclusion. Now therefore, the influence of the TEA on the systemic hemodynamics and coagulation system requires of the alternative safe pain management methods’ search for this subjects’ group.