Disseminated intravascular coagulation in surgary

Abstract number: CD112

Kuznik B., Vitkovsky YU., Likhanov I., Sizonenko V., Abdulayev KH.

Chita Medical Academy, Russia

We established that blood coagulation had various characters in patients with lung destructive diseases, acute appendicitis, purulent peritonitis, chronic paraproctitis and thermal traumas. Prolonged time of recalcification combained with shortened time of blood coagulation and APTT. Thrombin time in some patients was shortened, in others it was slightly prolonged. Prothrombin time in patient was mostly shortened. Fibrinogen concentration was increased, but total euglobulin fibrinolysis, kaolin and streptokinase-activated fibrinolysis were decreased. Concentrations of antithrombin III and protein C were as a rule decreased. Positive ethanol and protamine sulfate tests, elevated content of soluble fibrin monomer complexes were observed. Operative intervention aggravated these changes of blood coagulation and fibrinolysis. Simultaneously patients'^™ numbers of CD4⁺ lymphocytes decreased, CD8⁺ cells increased, CD4⁺/CD8 ratio reduced and contents of the IgA, IgG, IgM disbalanced. Changes of hemostasis are strongly correlated with elevated concentration of pro-inflammatory cytokines IL 1 alpha, IL 1 beta, IL 8, TNF alpha, less with contra-inflammatory IL 4 and 10 and interferons alpha ant gamma. Particularly IL 1 and TNF alpha are strongly elevated in severe septic conditions, which was unfavourable prognostic sign. These data testify chronic DIC syndrome accompanied with secondary immunodeficiency in surgical patients. Treatment of these patients included heparin, plasma and immunomodulating drugs such as thymalin, thymogen, vilon, epithalamin. Administration of anticoagulants with immunomodulators led to rapid normalization of hemostasis and immunity. Thus, presented facts enable to recommend the immunomodulator administration in patients for treatment of diseases accompanied secondary immunodeficiency and DIC syndrome.