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Studies on components of the plasma kallikrein system as a risk factor in diabetics undergoing cardiopulmonary bypass
W Heller1, M J Gallimore, H E Hoffmeister
1Department of Thoracic, Heart and Cardiovascular Surgery, University of Tuebingen, Germany.
Insights
Diabetics undergoing cardiopulmonary bypass show enhanced activation of the FX11-plasma kallikrein system, indicated by lower FX11 and prekallikrein levels. This may contribute to increased blood loss in diabetic patients during surgery.
Area of Science:
- Biochemistry
- Hematology
- Cardiovascular Surgery
Background:
- The FX11-kallikrein system plays a crucial role in hemostasis and inflammation.
- Cardiopulmonary bypass (CPB) can activate coagulation and inflammatory pathways.
- Diabetes mellitus is associated with altered hemostatic function and increased surgical risk.
Purpose of the Study:
- To investigate the FX11-kallikrein system activation in diabetic patients during CPB.
- To compare FX11-kallikrein system component levels between diabetic and non-diabetic patients undergoing CPB.
- To explore the relationship between FX11-kallikrein system activation and blood loss during CPB in diabetics.
Main Methods:
- Blood samples were collected from non-diabetic and diabetic patients before and during CPB.
- Levels of FX11, prekallikrein, kallikrein inhibition, alpha-2-macroglobulin, and kallikrein-like activities were measured.
- Beta FX11a inhibition was also assessed.
Main Results:
- FX11 and prekallikrein levels decreased in both groups, with significantly larger reductions in diabetics.
- Diabetic patients exhibited lower kallikrein inhibition and alpha-2-macroglobulin levels, both pre-operatively and during CPB.
- Higher beta FX11a inhibition was observed in diabetics, suggesting enhanced FX11-plasma kallikrein system activation, correlating with increased blood loss.
Conclusions:
- Diabetic patients undergoing CPB demonstrate significantly enhanced activation of the FX11-plasma kallikrein system.
- Lower levels of key FX11-kallikrein system components and inhibitors in diabetics during CPB indicate a hyperactivated state.
- This enhanced system activation in diabetics may contribute to increased intraoperative blood loss.
Abstract:
Components of the FX11-kallikrein systems were determined in blood samples from non diabetics and diabetics undergoing cardiopulmonary bypass (CPB). FX11 and prekallikrein levels fell in both groups with the largest falls in the diabetic group. Kallikrein inhibition was also lower in the diabetic group. Alpha-2-macroglobulin levels were lower in the diabetic group before operation and were markedly lower throughout CPB. Kallikrein like activities were also lower in the diabetic group. Beta FX11a inhibition values were higher in the diabetic group and fell in both groups during CPB. From the results obtained we concluded that the lower levels of FX11, prekallikrein, kallikrein inhibition and alpha-2-macroglobulin in the diabetic patients during CPB reflect enhanced activation of the FX11-plasma kallikrein systems. Blood loss in the diabetic group was higher than the for non diabetic group.