Related Experiment Videos
Fibronectin and other DIC-related variables in patients with moderately severe infections receiving cryoprecipitate
Abstract:
Plasma fibronectin (Fn), a glucoprotein of suggested importance in host defence during infections also seems to be involved in blood coagulation and to be consumed during clot formation. Low Fn concentrations have been found in patients with DIC, but also in patients with infections without signs of overt DIC. In a randomized trial of Fn supplementation 28 patients with moderately severe infections, hospitalized in the Department for Infectious Diseases, were scheduled to receive either cryoprecipitate from 30 donors (n = 14) or 250-300 ml of stored plasma (n = 14). To elucidate the relationship between Fn plasma levels, Fn-rich cryoprecipitate infusion, and possible low-grade DIC in these patients, we measured platelet count, prothrombin complex (NT), fibrinogen, F V, F VIIIR:Ag, F VIII:C, F XII, plasminogen (Plg), antiplasmin (AP), antithrombin III (AT), kallikrein-inhibiting activity (KI) and spontaneous proteolytic activity (SPA). Compared to healthy controls, high initial values (p less than .001) were found for fibrinogen, F VIIIR:Ag, F VIII:C and SPA. Most values for platelets, F V, Plg, AP and KI were within the reference range. Low levels (p less than .001) were found for Fn, NT, F XII, AT and for the ratio F VIII:C/F CIIIR:Ag. A significant correlation was found between F XII, Plg and AT. Fn correlated poorly to the other variables. Cryoprecipitate infusion normalized the Fn concentration, but had no influence on other measured variables. Thus, although no patient had clinically overt DIC, and all survived, we observed a distinct pattern indicating activation of the coagulation system. Fn levels were low, but were not specifically related to this activation.
Insights
Plasma fibronectin (Fn) levels were low in patients with infections, indicating coagulation activation. Cryoprecipitate normalized Fn but did not affect other coagulation markers, suggesting Fn is not directly linked to this activation.
Area of Science:
- Biochemistry
- Hematology
- Infectious Diseases
Background:
- Plasma fibronectin (Fn) is a glycoprotein involved in host defense and blood coagulation.
- Low Fn concentrations are observed in patients with disseminated intravascular coagulation (DIC) and infections.
- The role of Fn in low-grade DIC during infections requires further elucidation.
Purpose of the Study:
- To investigate the relationship between plasma Fn levels, Fn-rich cryoprecipitate infusion, and potential low-grade DIC in patients with moderately severe infections.
- To assess the impact of cryoprecipitate supplementation on coagulation parameters in infected patients.
Main Methods:
- A randomized trial involving 28 patients with moderately severe infections receiving either cryoprecipitate or stored plasma.
- Measurement of various coagulation parameters including platelet count, fibrinogen, clotting factors (F V, F VIII, F XII), plasminogen, antiplasmin, antithrombin III, and proteolytic activity.
- Comparison of patient values to healthy controls and assessment of correlations between variables.
Main Results:
- Patients exhibited high initial levels of fibrinogen, F VIIIR:Ag, F VIII:C, and spontaneous proteolytic activity (SPA) compared to controls.
- Low initial levels of Fn, prothrombin complex (NT), F XII, and antithrombin III (AT) were observed.
- Cryoprecipitate infusion normalized Fn levels but did not significantly alter other measured coagulation variables.
- A distinct pattern of coagulation system activation was noted, though Fn levels showed poor correlation with other parameters.
Conclusions:
- Patients with moderately severe infections show evidence of coagulation system activation, characterized by low plasma fibronectin levels.
- While cryoprecipitate can normalize Fn levels, it does not impact other coagulation markers, suggesting Fn is not the primary driver of activation in this context.
- Further research is needed to fully understand the complex interplay between fibronectin, coagulation, and infection.