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The peculiar features of changing the hemostasis in children with chronic constipation
I V Kirgizov1, A M Sukhorukov, V A Dudarev
1Department of Children Surgery of Krasnoyarsk State Medical Academy, The Municipal Clinical Hospital No 20, Russia. kirgizov@online.ru
Insights
Children with chronic constipation exhibit altered blood clotting, specifically hypocoagulation and impaired microcirculation due to vitamin K-dependent factor deficits. These hemostasis changes can lead to thromboses in intestinal vessels.
Area of Science:
- Pediatric Hematology
- Gastroenterology
- Vascular Biology
Background:
- Chronic constipation in children is a common condition with potential systemic implications.
- Hemostasis, the process of stopping bleeding, involves complex interactions between blood vessels, platelets, and clotting factors.
- Understanding hemostatic alterations in pediatric chronic constipation is crucial for managing complications.
Purpose of the Study:
- To investigate the specific changes in hemostasis associated with chronic constipation in children.
- To identify the underlying mechanisms contributing to these hemostatic alterations.
- To correlate hemostatic findings with clinical presentation and morphological changes.
Main Methods:
- Chronometric assessment of blood clotting mechanisms.
- Evaluation of platelet aggregation and fibrinolysis.
- Thrombocytovascular hemostasis analysis.
- Morphological examination of intestinal vascular channels.
Main Results:
- Identified chronometric hypocoagulation due to deficits in vitamin K-dependent factors (II, VII, IX, X) and impaired coagulation stages.
- Observed thrombocytopathy with increased adenosine-5-diphosphate aggregation and suppressed internal fibrinolysis.
- Detected endotheliosis and microcirculatory impairment, leading to thromboses in submucous and mucous membrane vessels.
- Correlated severity of hypocoagulation and factor deficits with compensated, subcompensated, and decompensated forms of the condition.
- Morphological findings confirmed organized thrombi and neutrophil infiltration in the large intestine wall.
Conclusions:
- Chronic constipation in children is linked to significant hemostatic abnormalities, including hypocoagulation and impaired microcirculation.
- Vitamin K-dependent factor deficiency and thrombocytopathy are key contributors to the observed hemostatic derangements.
- These hemostatic changes, particularly thrombosis, play a role in the pathophysiology of chronic constipation and its complications.
Abstract:
Our purpose was to study the peculiarities of changing the hemostasis in children with chronic constipation. In the course of our investigation of hemostasis in children with chronic constipation, we found chronometric hypocoagulation with impairment of internal (XII, XI, IX, VIII) and external (II, V, VII, X) mechanisms of blood clotting, at the base of which is a deficit of vitamin K-dependent factors (II, VII, IX, X) and a slight impairment of the final stage of coagulation. In thrombocytovascular hemostasis, thrombocytopathy demonstrated increased adenosine-5-diphosphate aggregation and suppression of the internal route of fibrinolysis and endotheliosis. We must point out that all these changes lead to impairment of microcirculation in the form of thromboses, particularly in the submucous and mucous membrane vessels, which is confirmed by the morphologic findings. In the compensated form, chronometric hypocoagulation with a deficit of II, IX, and X factors is noted. In the subcompensated form, hypocoagulation increases, and the deficit of V and VII factors is in part the cause. Endotheliosis and the increase of the thrombogenesis dynamics are noted in the thrombocytovascular section. In the decompensated form, there is marked hypocoagulation. Low activity of antithrombin III leads to high content of fibrinmonomeasured complexes in combination with reduction of the thrombocytes quantity and to hypercoagulation. The present changes are confirmed by the morphologic research methods of studying the vascular channel of the large intestine wall, where organized thrombi and a marked plethora of neutrophil tissue infiltration are often revealed.
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