Early stage hemostasis differences in survivor and lethal cases with acute necrotizing pancreatitis

Objective. To analyze the differences in the hemostais at patients with acute pancreatitis
Materials and methods. In 25 patients (mean age: 46,2 ± 6,74 years); partial thromboplastin time (APTT), prothrombin time (results expressed as INR), thrombin time, fibrinogen concentration, the concentration of D-dimer, protein C, protein S, plasmin inhibitor, plasminogen and von Willebrand factor (vWF), the activity of antithrombin III, hemoglobin concentration (Hb), hematocrit (Ht), number of erythrocytes (RBC), mean corpuscular volume (MCV), mean corpuscular hemoglobin content (MCH), mean corpuscular hemoglobin concentration (MCHC), the width of the distribution by volume of erythrocytes (RDW), platelet count (PLT) value trombocrit (PCT), mean platelet volume (MPV), platelet distribution width by volume (PDW) were evaluated. Statistical processing. The data were treated with the use of the exact one-sided Mann–Whitney test, sign test and Wilcoxon rank sign test.
Results. In patients with acute pancreatitis there were identified significant changes in platelet, coagulation, fibrinolytic and anticoagulant mechanisms.
Conclusion. The reduction in the activity of antithrombin, protein C and plasminogen was noted in the group of died patients.

1. Vlasov A.P., Kormishkin A.E., Rubtsov O.Yu., Polozova E.I., Bolotskikh V.A., Muratova T.A. The state of the humoral component of the hemostatic system in the initial stages of acute pancreatitis. Modern problems of science and education. Russian scientifc journal (Sovremennye problemy nauki i obrazovaniya). 2015; 5: 51. Available at: http://www.science-education.ru/ru/article/view?id=21651/ (Accessed 15 September 2015). (in Russian)

2. Pandol S.J., Saluja A.K., Imrie C.W., Banks P.A. Acute pancreatitis: bench to the bedside. Gastroenterology. 2007; 132(3): 1127–51. http://dx.doi.org/10.1053/j.gastro.2007.01.055

3. Kovaleva O.V., Shitova M.S., Zborovskaya I.B. Autophagy: cell death or a way to survive? Сlinical oncohematology (Klinicheskaya onkogematologiya). 2014; 7(2): 103–13. (in Russian)

4. Pelts V.A. Morden condition of diagnostics and surgical treatment of acute pancreatitis. Siberian Medical Journal (Tomsk). Russian journal (Sibirskiy meditsinskiy zhurnal). 2010; 25(4-1): 27–32. (in Russian)

5. Andersson E. Crosstalk between inflammation and coagulation in acute pancreatitis. Dis. Lund. Dis. Bulletin No.138. Sweden: Lund University; 2010: 79. Available at: https://lup.lub.lu.se/search/publication/1645799

6. Kuznik B.I. Levin Yu.M. Coagulation and fbrinolytic activity of lymph. Hematology and Transfusiology. Russian journal (Gematologiya i transfusiologiya). 2012; 57(5): 42–7. (in Russian)

7. Panteleev M.A., Sveshnikova A.N. Platelets and hemostasis. Oncohematology. Russian journal (Onkogematologiya). 2014; 9(2): 65–73. doi:10.17650/1818-8346-2014-9-2-65-73. (in Russian)

8. Manuylov A.M., Sinkova O.A. Nature of hemostasis disorders in various forms of acute pancreatitis. Journal of Intensive Care. Russian journal (Vestnik intensivnoy terapii). 2007; 5: 167–8. (in Russian)

9. Gonzelez H.J., Sahay S.J., Samadi B., Davidson B.R., Rahman S.H. Splanchnic vein thrombosis in severe acute pancreatitis: a 2-year, singleinstitution experience. HPB(Oxford). 2011; 13(12): 860–4. doi:10.1111/j.1477-2574.2011.00392.x.

10. Kuznetsov N.A., Rodoman G.V., Shalaeva T.I., Nalivayskiy A.A. Ways to improve the results of treatment of patients with pancreatic necrosis. Surgery. Journal named after N.I. Pirogov. Russian journal (Khirurgiya. Zhurnal im. N.I. Pirogova). 2008; 5: 40–5. (in Russian)

11. Bokeriya L.A., Klimovich L.G., Potekhina A.V., Putyato N.A., Samsonova N.N. Mechanisms of involving coagulation inhibitors in the development of inflammatory reactions and perspective directions of anticoagulant therapy. Clinical Physiology of Circulation. Russian journal (Klinicheskaya fziologiya krovoobrashcheniya). 2004; 1: 46–55. (in Russian)

12. Ermolaev A.A., Plavunov N.F., Spiridonova E.A., Stazhadze L.L., Baratashvili V.L. Acute pulmonary embolism: problems of diagnosis in prehospital setting. Sklifosovsky Journal of Emergency Medical Care. Russian journal (Zhurnal im. N.V. Sklifosovskogo. Neotlozhnaya meditsinskaya pomoshch). 2012; 1: 13–9. (in Russian)

13. Roytman E.V., Andrianova M.Yu., Kolesnikova I.M., Spiridonova E.A., Rumyantsev S.A. Pharmacoprophylaxis VTE today: do laboratory testing? Clinical pathophysiology. Russian journal (Klinicheskaya patofziologiya). 2013; 4: 28–33. (in Russian)

14. Besselink M.G. Splanchnic vein thrombosis complicating severe acute pancreatitis. HPB(Oxford). 2011; 13(12): 831–2. doi:10.1111/j.1477-2574.2011.00411.x.

15. Zhang Q., Zhang Q.X., Tan X.P., Wang W.Z., He C.H., Xu L., Huang X.X. Pulmonary embolism with acute pancreatitis: A case report and literature review. World J. Gastroenterol. 2012; 18(6): 583–6. doi: 10.3748/wjg.v18.i6.583.

16. Bagnenko S.F., Goltsov V.R., Andreev M.I., Lapshin V.N., Afonchikov V., Paley D.A., Reutskaya I.A. Multiorgan failure in acute destructive pancreatitis: pathogenesis, clinical manifestations, diagnosis, prevention and treatment. Manual for physicians. St.Peterburg: St. Petersburg Research Institute of Emergency Care prof. I. Dzhanelidze; 2010. (in Russian)

17. Zhou M.T., Chen C.S., Chen B.C., Zhang Q.Y., Andersson R. Acute lung injury and ARDS in acute pancreatitis: Mechanisms and potential intervention. World J. Gastroenterol. 2010; 16(17): 2094–9. doi:10.3748/wjg.v16.i17.2094.

18. Pezzilli R., Bellacosa L., Felicani C. Lung injury in acute pancreatitis. J. Pancreas. 2009; 10(5): 481–4.

19. Zagaria M.E. Acute pancreatitis: risks, causes, and mortality in older adults. U.S. Pharmacist. 2011; 36(1): 20–4.

20. Saveliev V.S., Filimonov M.I., Gelfand B.R., Burnevich S.Z. The destructive pancreatitis. Standards for the diagnosis and treatment. Annals of Surgical Hepatology. Russian journal (Annaly hirurgicheskoy gepatologii). 2001; 6(2): 115–22. (in Russian)

21. Melkumyan A.L., Berkovsky A.L., Kishinets R.S., Kozlov A.A. Monitoring of the effciency of direct anticoagulants. Hematology and Transfusiology. Russian journal (Gematologiya i transfusiologiya). 2013; 58(1): 32–8. (in Russian)

22. Kylänpää M.L., Repo H., Puolakkainen P.A. Inflammation and immunosuppression in severe acute pancreatitis. World J. Gastroenterol. 2010; 16(23): 2867–72. doi: 10.3748/wjg.v16.i23.2867.

23. Shankar-Hari M., Wyncoll D. Activated protein C in severe acute pancreatitis without sepsis? Not just yet... Crit. Care. 2010; 14(4): 188. doi:10.1186/cc9190.

24. Chapin J.C., Hajjar K.A. Fibrinolysis and the control of blood coagulation. Blood Rev. 2015; 29(1): 17–24. doi:10.1016/j.blre.2014.09.003.

25. Vasiliev S.A., Vinogradov V.L., Berkovsky A.L., Markova M.L. D-dimer – a diagnostic and prognostic marker of the thrombotic disorders. Hemorrhagic diathesis, thrombosis, thrombophilia. Russian journal (Gemorragicheskie diatezy, trombozy, tromboflii). 2014; 1: 15–27. (in Russian)

26. Carpenter S.L., Mathew P. Alpha2-antiplasmin and its defciency: fbrinolysis out of balance. Haemophilia. 2008; 14(6): 1250–4. doi: 10.1111/j.1365-2516.2008.01766.x.

27. Badhal S.S., Sharma S., Saraya A., Mukhopadhyay A.K. Prognostic signifcance of D-dimer, natural anticoagulants and routine coagulation parameters in acute pancreatitis. Trop. Gastroenterol. 2012; 33(3): 193–9. http://dx.doi.org/10.7869/tg.2012.48.

28. Kishkun A.A. Guidance on the laboratory methods of the diagnosis. Moscow: GEOTAR-Media; 2007. (in Russian)