TY - JOUR
T1 - Deceptive prothrombin and activated partial thromboplastin times in alcoholic cirrhosis
AU - Sirikonda, Purnachander R.
AU - Spillert, Charles R.
AU - Koneru, Baburao
AU - Ponnudurai, Rex
AU - Wilson, Dorian J.
AU - Lazaro, Eric J.
PY - 1996/5
Y1 - 1996/5
N2 - It is believed that perioperative hemorrhage, in the hepatoportal area, results from a coagulopathy. This study determined if this could be quantitated by a modified recalcification time (MRT) test developed in our laboratory. Unlike prothrombin (PT) and activated partial thromboplastin times (APTT), the MRT is performed with whole blood to ensure the role of blood cells and chemicals (particularly tissue factor, a potent procoagulant) in the coagulation process. Candidates for liver transplantation (n=11) were studied. Samples (5 mL) of citrated venous blood were obtained from the patients. Aliquots (1 mL) from these samples were divided into groups of vials labeled C, S, and E. Groups C and S received 20 μL saline and group E, 20 μL of saline containing 10 μg of Escherichia coli endotoxin (055: B5W). Vial C was incubated for 10 minutes and vials S and E for 120 minutes, all at 37°C. Then, the MRT was determined on 300 μL of blood from each vial after adding 40 μL of 0.1M calcium chloride. Mean MRT values (minutes±standard deviation) for C (MRTC), for S (MRTS), and for E (MRTE) were compared with like values from healthy controls (n=29). Despite prolonged PT and APTT values, MRT values were shortened in patients with cirrhosis. This hypercoagulability detected by the MRT exonerates a hemorrhagic coagulopathy and possibly implicates widened and thinned gaps in the walls of the portal venous tributaries as the cause of perioperative hemorrhage.
AB - It is believed that perioperative hemorrhage, in the hepatoportal area, results from a coagulopathy. This study determined if this could be quantitated by a modified recalcification time (MRT) test developed in our laboratory. Unlike prothrombin (PT) and activated partial thromboplastin times (APTT), the MRT is performed with whole blood to ensure the role of blood cells and chemicals (particularly tissue factor, a potent procoagulant) in the coagulation process. Candidates for liver transplantation (n=11) were studied. Samples (5 mL) of citrated venous blood were obtained from the patients. Aliquots (1 mL) from these samples were divided into groups of vials labeled C, S, and E. Groups C and S received 20 μL saline and group E, 20 μL of saline containing 10 μg of Escherichia coli endotoxin (055: B5W). Vial C was incubated for 10 minutes and vials S and E for 120 minutes, all at 37°C. Then, the MRT was determined on 300 μL of blood from each vial after adding 40 μL of 0.1M calcium chloride. Mean MRT values (minutes±standard deviation) for C (MRTC), for S (MRTS), and for E (MRTE) were compared with like values from healthy controls (n=29). Despite prolonged PT and APTT values, MRT values were shortened in patients with cirrhosis. This hypercoagulability detected by the MRT exonerates a hemorrhagic coagulopathy and possibly implicates widened and thinned gaps in the walls of the portal venous tributaries as the cause of perioperative hemorrhage.
KW - Activated partial thromboplastin time
KW - Cirrhosis
KW - Prothrombin time
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M3 - Article
C2 - 8667440
AN - SCOPUS:0030137117
SN - 0027-9684
VL - 88
SP - 306
EP - 309
JO - Journal of the National Medical Association
JF - Journal of the National Medical Association
IS - 5
ER -