fibrin and Craniocerebral-Trauma

To determine the degree of regional and systemic coagulation activation soon after isolated severe head injury.. Prospective, controlled clinical study.. The emergency room and intensive care unit (ICU) of a trauma center in a university hospital serving a population of 5 million people.. Twenty-four trauma victims: 20 patients with isolated severe head injury (head trauma group, Glasgow Coma Score of < or =8) and four patients with isolated bone fracture (control group).. Insertion of central venous, i.e. superior caval vein, jugular bulb, and arterial catheters for blood sampling.. Central venous (i.e., superior caval vein) global coagulation variables (i.e., prothrombin time, activated partial thromboplastin time, fibrinogen concentration, antithrombin III activity, and platelet count) and central venous and jugular bulb activation coagulation and fibrinolysis variables (i.e., prothrombin fragment F1+2, thrombin-antithrombin III complex, soluble fibrin, and D-dimer concentration) were measured soon after trauma (<6 hrs) and 3 hrs later. When compared with the control group patients, upon ICU admission, fibrinogen concentration (p < .005) and platelet count (p < .025) were significantly decreased in the head trauma group. Thrombin-antithrombin III complex (p < .025), prothrombin fragment F1+2 (p < .025), and D-dimer (p < .005) concentrations measured at the time of ICU admission were significantly higher in the head trauma group than in the control group. Only in the head trauma group were soluble fibrin concentrations increased above the normal range; thrombin-antithrombin III complex and the prothrombin fragment F1+2 were found to be significantly higher in cerebrovenous blood than in central venous blood (p < .025). There was no cerebrocentral venous difference in the concentrations of soluble fibrin or D-dimer in either group.. Within 6 hrs after severe isolated head trauma, systemic procoagulant overflow from the traumatized cerebral microvasculature proceeds to the thrombin level and is then inhibited by antithrombin III. Regional and systemic hypercoagulability and increased D-dimer concentrations appear to be common among head trauma patients. Increased procoagulant and consecutive fibrinolytic turnover may, therefore, spark disseminated intravascular coagulation in this patient group.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Biomarkers; Blood Coagulation Factors; Blood Coagulation Tests; Craniocerebral Trauma; Disseminated Intravascular Coagulation; Female; Fibrin; Fibrinolysis; Glasgow Coma Scale; Humans; Intensive Care Units; Male; Middle Aged; Platelet Count; Prospective Studies

Limited data are available on whether donor kidneys with diffuse glomerular fibrin thrombi (GFT) are safe to use. In this study, the clinicopathologic characteristics of allografts with diffuse donor-derived GFT were examined.. All deceased donor kidney transplant implantation biopsies from our institution between July 2011 and February 2018 with diffuse GFT were included. A control group for comparison consisted of all cases with implantation biopsies obtained during the study period without diffuse GFT. Clinical data were extracted from electronic medical records for all study patients, including donor information.. Twenty-four recipients received kidneys with diffuse GFT from 16 deceased donors. All donors died from severe head trauma. On average, 79% of glomeruli contained fibrin thrombi. Nineteen cases had subsequent biopsy; all revealed resolution of GFT. Compared with the control group, kidneys with diffuse GFT had longer cold ischemia time (34 versus 27 h), were more frequently pumped using machine perfusion (100% versus 81%), and recipients experienced a higher frequency of delayed graft function (58% versus 27%). Only 2 grafts with diffuse GFT failed within the first year. Overall graft survival was similar between the diffuse GFT group and control group.. Deceased donor kidneys with diffuse GFT appear to be safe to use given that nearly 92% of recipients in this cohort who received such allografts experienced good clinical outcomes. Histologically, GFT demonstrated rapid resolution following transplantation. Interestingly, diffuse GFT only occurred in donors who suffered severe head trauma in this cohort, which may be a predisposing factor.

Topics: Adolescent; Adult; Craniocerebral Trauma; Donor Selection; Female; Fibrin; Graft Survival; Humans; Kidney Glomerulus; Kidney Transplantation; Male; Middle Aged; Retrospective Studies; Risk Factors; Thrombosis; Time Factors; Treatment Outcome; Young Adult

Topics: Blood Platelets; Craniocerebral Trauma; Fibrin; Humans; Tympanic Membrane; Tympanic Membrane Perforation; Wound Healing

Blood coagulation tests were performed on admission to the hospital and on consecutive days after severe and moderate head injury in 34 patients. Platelet counts and fibrinogen were normal at admission and raised thereafter. The partial thromboplastin time was shortened at admission and lengthened in the following days. Fibrinolytic activity was enhanced at admission. The ethanol gelation test was negative in all patients during the post-traumatic time course. It was concluded that, in the first 24 hours after injury, activated coagulation was present after head injury. In contrast with data of other authors, disseminated intravascular coagulation did not occur in these series.

Topics: Blood Cell Count; Blood Coagulation Tests; Blood Platelets; Craniocerebral Trauma; Disseminated Intravascular Coagulation; Factor V; Fibrin; Fibrinogen; Fibrinolysis; Humans; Prothrombin Time; Thrombin; Thromboplastin

Topics: Blood Coagulation Tests; Craniocerebral Trauma; Disseminated Intravascular Coagulation; Fibrin; Fibrinogen; Hemorrhage; Humans; Thrombocytopenia

Topics: Blood Coagulation; Blood Platelets; Craniocerebral Trauma; Diabetic Coma; Diagnosis, Differential; Fibrin; Humans; Nervous System Diseases; Thrombosis

Topics: Adult; Brain; Craniocerebral Trauma; Fibrin; Humans; Lung; Male; Pulmonary Artery; Pulmonary Embolism; Wounds, Gunshot