Evaluación de la actividad fibrinolítica en pacientes que consultan por hemorragia mucocutánea
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Fecha
2011
Profesor/a Guía
Facultad/escuela
Idioma
es
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Editor
Universidad Andrés Bello
Nombre de Curso
Licencia CC
Licencia CC
Resumen
La principal manifestación clínica en los pacientes con Sangrado de Causa Desconocida (SCD) es la hemorragia mucocutánea, sin embargo los exámenes realizados para detectar las patologías más frecuentes asociadas a estos síntomas no muestran alteraciones. En estos pacientes el tratamiento más utilizado para disminuir el sangrado es el uso de un antifibrinolítico, no obstante se desconoce el estado de la actividad fibrinolítica en ellos, debido a que las técnicas disponibles para evaluarla son poco sensibles y muy laboriosas.
Nuestro estudio propuso demostrar que un aumento en la actividad fibrinolítica (hiperfibrinolisis) sería 1a causa del sangrado mucocutáneo de causa desconocida. Para evidenciar una hiperfibrinolisis, los pacientes SCD fueron evaluados con la técnica Tiempo de Lisis del Coágulo, utilizando plasma rico en plaquetas (TLC-PRP). También se evaluó la dependencia de la fibrinolisis con la cantidad de trombina generada durante la formación del coágulo, con la técnica de Generación de Trombina en PRP y la medición de proteínas antifibrinolíticas, como son los niveles de PAI-1 y T AFI plasmático e intraplaquetario. Se estudiaron 21 pacientes SCD derivados por médicos hematólogos y 23 controles
sanos pareados por sexo y edad.
El TLC mostró una diferencia significativa entre PLP, PRP-Ris y PRP-TRAP de
pacientes SCD con respecto a los controles, mientras que en PRP sin agonista no hubo
diferencias. El TLC-PRP activado con Ristocetina, fue el tiempo que mejor discriminó
entre estos dos grupos, destacándose que el promedio de éste resultó ser significativamente
menor en los pacientes.
Con respecto a los parámetros de medición de generación de trombina, los pacientes
SCD presentan un índice de velocidad de generación de trombina significativamente
menor. Los niveles de PAI-1 en el plasma de los pacientes SCD se encuentran
significativamente disminuidos, lo que podría ser eventualmente una de las causas del
sangrado que presentan estos pacientes.
En conjunto nuestros resultados indican que estos pacientes presentan una
hiperfibrinolisis, que se traduciría en una baja estabilidad del coágulo, explicando su
tendencia al sangrado. Un porcentaje de 42.8% de estos pacientes presentaron francamente
una hiperfibrinolisis, dando todos ellos razones normalizadas (TLC-PRP /TLC-Pool
Normal) bajo el rango de referencia para esta prueba.
The main clinical manifestation in patients with bleeding of unknown cause (BUC) is mucocutaneous bleeding, however, the tests performed to detect the most common diseases associated with these symptoms didn't show abnormalities. In these patients the management used to drop off bleeding is the use of antifibrinolytic drugs. However, the fibrinolytic system is not evaluated, because the assays available are of low sensitive and quite Iaborious. The aim of our study was to demonstrate an increase in fibrinolytic activity in these patients (hyperfibrinolysis) which would explain mucocutaneous bleeding. To demonstrate a hyperfibrinolysis in BUC patients we evaluated the fibrinolytic a system with Clot Lysis Time using platelet-rich plasm (TLC-PRP), this is a global assay for evaluated the fibrinolytic system and which incorporate platelets. We also evaluated the amount of thrombin generated during clot formation with assay Thrombinoscope with PRP and measuring specific antifibrinolytic proteins in plasma and platelets, such as PAI-1 and TAFI. We studíed 21 patients referred by hematologists and 23 healthy controls matched by sex and age. The TLC-PRP showed a significant difference between BUC patíents and controls. The TLC-PRP activated with Ristocetin, show the best díscriminated between these two groups, the average was significantly lower in patients than in controls. With regard to measuring parameters of thrombin generation, BUC patients show an index of thrombin generation rate sígnificantly lower. The Ievels of PAI-1 in plasma were significantly decreased in patients' BUC compared with controls, which could possibly be a cause of bleeding in these patients. Overall, our results indicate that the BUC patients have a hyperfibrinolysis, which means low stability of the clot with a bleeding tendency. A percentage of 42.8% of these patients had a marked hyperfibrinolysis given a normalized ratio (BUC-PRP CLT/PRP CL T-NC), below the reference range for this assay.
The main clinical manifestation in patients with bleeding of unknown cause (BUC) is mucocutaneous bleeding, however, the tests performed to detect the most common diseases associated with these symptoms didn't show abnormalities. In these patients the management used to drop off bleeding is the use of antifibrinolytic drugs. However, the fibrinolytic system is not evaluated, because the assays available are of low sensitive and quite Iaborious. The aim of our study was to demonstrate an increase in fibrinolytic activity in these patients (hyperfibrinolysis) which would explain mucocutaneous bleeding. To demonstrate a hyperfibrinolysis in BUC patients we evaluated the fibrinolytic a system with Clot Lysis Time using platelet-rich plasm (TLC-PRP), this is a global assay for evaluated the fibrinolytic system and which incorporate platelets. We also evaluated the amount of thrombin generated during clot formation with assay Thrombinoscope with PRP and measuring specific antifibrinolytic proteins in plasma and platelets, such as PAI-1 and TAFI. We studíed 21 patients referred by hematologists and 23 healthy controls matched by sex and age. The TLC-PRP showed a significant difference between BUC patíents and controls. The TLC-PRP activated with Ristocetin, show the best díscriminated between these two groups, the average was significantly lower in patients than in controls. With regard to measuring parameters of thrombin generation, BUC patients show an index of thrombin generation rate sígnificantly lower. The Ievels of PAI-1 in plasma were significantly decreased in patients' BUC compared with controls, which could possibly be a cause of bleeding in these patients. Overall, our results indicate that the BUC patients have a hyperfibrinolysis, which means low stability of the clot with a bleeding tendency. A percentage of 42.8% of these patients had a marked hyperfibrinolysis given a normalized ratio (BUC-PRP CLT/PRP CL T-NC), below the reference range for this assay.
Notas
Tesis (Tecnólogo Médico con especialidad en Bioanálisis Clínico, Inmunohematología y Banco de Sangre)
Palabras clave
Trastornos de Coagulación Sanguínea, Células Sanguíneas, Análisis de Sangre, Chile