Fibrinolytic changes in a patient with toxic shock syndrome; release of active u-PA.

Abstract:

OBJECTIVE:Definition of the changes in the activators of plasminogen, u-PA and t-PA, and examination of the possible generation of plasmin in the circulation in overwhelming sepsis. DESIGN:Serial blood analysis starting 4 h after development of symptoms of toxic shock syndrome. SETTING:Intensive care unit. PATIENT:A previously healthy woman underwent endometrial ablation and rapidly thereafter developed staphylococcal toxic shock syndrome with organ failure. MEASUREMENT AND RESULT: t-PA, PAI-1, t-PA-PAI-1 complexes, plasminogen, fibrinogen and plasmin-alpha 2-antiplasmin complexes were measured serially by ELISA and free u-PA by SDS-PAGE with zymography. The onset of symptoms was accompanied by a rise of t-PA antigen-followed rapidly by PAI-1 antigen. Plasmin-alpha 2-antiplasmin complex was generated in large amounts but disappeared within hours. From day 3, free u-PA was detectable in the circulation without plasmin generation. CONCLUSION:Despite the sustained presence of active u-PA in the circulation and of t-PA antigen at the onset of symptoms, plasmin-alpha 2-antiplasmin generation was largely suppressed by high levels of PAI-1. The suppression of plasmin generation by u-PA and t-PA may ensure the persistence of fibrin in the microcirculation and so contribute to organ failure.

journal_name

Intensive Care Med

journal_title

Intensive care medicine

authors

Haj MA,Robbie LA,Croll A,Adey GD,Bennett B

doi

10.1007/s001340050561

subject

Has Abstract

pub_date

1998-03-01 00:00:00

pages

258-61

issue

3

eissn

0342-4642

issn

1432-1238

journal_volume

24

pub_type

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