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Global fibrinolytic capacity in early respiratory distress syndrome: a pilot study
Murat Yurdakök1, Ayse Korkmaz, Serafeddin Kirazli
1Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey. myur@gen.hun.edu.tr
Insights
Preterm infants who develop severe respiratory distress syndrome (RDS) exhibit a reduced fibrinolytic state. This study measured global fibrinolytic capacity (GFC) in plasma, finding significantly lower levels in infants who later developed RDS.
Area of Science:
- Neonatal Medicine
- Hematology
- Pulmonary Medicine
Background:
- Fibrin deposits in pulmonary microcirculation of preterm infants with severe respiratory distress syndrome (RDS) suggest coagulation system activation or insufficient fibrinolysis.
- Disseminated intravascular coagulation is not prominent in early RDS; reduced fibrinolytic activity is observed.
- In vitro evaluation of fibrinolytic potential is challenging due to its activation post-coagulation.
Purpose of the Study:
- To develop and utilize a standardized assay for measuring global fibrinolytic capacity (GFC) in plasma.
- To investigate GFC in preterm infants within the first 6 hours after birth who subsequently developed RDS.
- To validate the hypothesis of a reduced fibrinolytic state in early-stage RDS.
Main Methods:
- Development of a standardized in vitro assay to measure global fibrinolytic capacity (GFC) in plasma.
- Measurement of GFC, expressed as generated D-dimer concentrations, in preterm infants.
- Comparison of GFC between infants who later developed RDS and a control group.
Main Results:
- A standardized assay for global fibrinolytic capacity (GFC) was successfully developed for plasma evaluation.
- Significantly lower GFC, indicated by reduced D-dimer concentrations, was observed in preterm infants who later developed RDS.
- These findings confirm a reduced fibrinolytic state in the early stages of RDS.
Conclusions:
- The developed GFC assay provides a sensitive and reliable parameter for assessing in vitro plasma fibrinolytic potency.
- Reduced global fibrinolytic capacity in the first 6 hours of life is a significant finding in preterm infants who subsequently develop RDS.
- The study supports the "reduced fibrinolytic state in early RDS" hypothesis, offering insights into neonatal respiratory distress pathophysiology.
Abstract:
Fibrin deposits found in the pulmonary microcirculation and in the small airways of preterm infants with severe respiratory distress syndrome (RDS) has been explained by the activation of the coagulation system and/or insufficient fibrinolysis. Previous studies suggest that disseminated intravascular coagulation is not prominent in the early stages of RDS, and there is a reduced fibrinolytic activity in these patients. The in vitro evaluation of body's fibrinolytic potential is difficult in contrast to blood clotting because fibrinolysis is only activated after coagulation. To solve this problem a standardized assay was developed to measure the global fibrinolytic capacity (GFC) in plasma. This assay allows us a sensitive and reliable parameter to evaluate the fibrinolytic potency of plasma in vitro. We therefore studied GFC in the first 6 hr after birth in preterm infants who later developed RDS. Global fibrinolytic capacity which is expressed as generated D-dimer concentrations was significantly lower in preterm infants who later developed RDS compared to the control group in this study. These findings support our previous hypothesis of "reduced fibrinolytic state in early RDS".