fibrinopeptide-a and Pre-Eclampsia

1. The lack of a general agreement on the definition of PE makes the interpretation of laboratory findings in different series of these patients difficult. 2. Thrombocytopenia is the most common hemostatic abnormality in patients with PE and is caused by platelet consumption. 3. There is little concrete evidence that thrombin mediates the thrombocytopenia in most of these patients. 4. Immune mechanisms or severe vasospasm with resultant endothelial damage may contribute to the thrombocytopenia in some patients.

Topics: Anemia, Hemolytic; Disseminated Intravascular Coagulation; Eclampsia; Epoprostenol; Factor VIII; Female; Fibrin; Fibrin Fibrinogen Degradation Products; Fibrinogen; Fibrinopeptide A; Humans; Hypertension; Platelet Count; Pre-Eclampsia; Pregnancy; Pregnancy Complications, Hematologic; Thrombin; Thrombocytopenia; Thromboxane A2

To assess coagulation activation and endothelial cell injury in normotensive and pre-eclamptic pregnant women, a comparison was made of plasma levels of tissue factor, fibronectin, fibrinopeptide A and D-dimer. Samples were taken from 50 nonpregnant women, 40 normotensive pregnant women in the third trimester and 27 women with pre-eclampsia after diagnosis and before treatment. High levels of fibrinopeptide A and D-dimer were found in pre-eclamptic women. Moreover, the ratio fibrinopeptide A:D-dimer was much greater in the pre-eclampsia group than in normotensive pregnant women. The levels of fibronectin and tissue factor were also higher in the pre-eclampsia group. The increase of tissue factor levels suggests an alteration of the extrinsic coagulation pathway in pre-eclampsia. The increase of fibrinopeptide A:D-dimer ratio shows that the activation of coagulation is associated with a relative hypofibrinolysis in pre-eclampsia.

Topics: Adult; Antifibrinolytic Agents; Blood Coagulation Disorders; Female; Fibrin Fibrinogen Degradation Products; Fibrinopeptide A; Gestational Age; Humans; Pre-Eclampsia; Pregnancy; Thromboplastin

To investigate the changes of urinary fibrinopeptide A (FPA) level in pregnancy induced hypertension (PIH) and its clinical significance.. High performance liquid chromatography (HPLC) was employed in determination. Urinary FPA was measured in 96 cases of normal pregnancy and 49 cases with PIH.. The urinary FPA levels in mild and moderate PIH groups were significantly higher than that in normal pregnancy (71.65 +/- 18.53 micrograms/L vs 40.17 +/- 20.26 micrograms/L, P < 0.01). The levels of urinary FPA in patients with preeclampsia increased significantly (146.65 +/- 32.53 micrograms/L) when compared with the mild and moderate PIH groups (P < 0.001). The levels of urinary FPA in patients with eclampsia (422.93 +/- 81.46 micrograms/L) were much higher than that in group of preeclampsia (P < 0.001).. It showed that the assay of urinary FPA might be helpful for earlier diagnosis, classification, treatment and judgement of prognosis in PIH.

Topics: Adult; Female; Fibrinopeptide A; Humans; Pre-Eclampsia; Pregnancy

The etiology of disseminated intravascular coagulation (DIC) in preeclampsia is not well understood. We measured plasma levels of fibronectin (FN), which may reflect endothelial cell injury, fibrinopeptide A (FPA), a specific marker of clotting, platelet counts (PLC) and mean platelet volumes (MPV), as well as beta-thromboglobulin (beta TG) and platelet factor 4 (Pf4), products of irreversible platelet activation in 24 preeclamptic patients and 24 controls matched for age, gestational age, labor status, and parity. In preeclampsia, FN and FPA were significantly elevated while PLC were significantly decreased (P less than 0.0001, less than 0.05 and less than 0.01, respectively). beta TG, Pf4, and MPV values did not show significant differences. These findings support the hypothesis that endothelial injury, clotting activation and platelet consumption are increased in preeclampsia. However, the much closer association of preeclampsia with FN levels as compared to FPA, beta TG, Pf4, suggests that endothelial injury is a more basic mechanism of preeclampsia than clotting or platelet activation.

Topics: Adolescent; Adult; Biomarkers; Female; Fibrinopeptide A; Fibronectins; Humans; Platelet Count; Pre-Eclampsia; Pregnancy; Pregnancy Complications, Hematologic

Various attempts have been made in recent years to identify the cause and pathophysiology of toxemia of pregnancy from the standpoint of changes in blood coagulation and fibrinolysis. It is believed that in toxemia of pregnancy, the fibrinolytic process changes as coagulation is augmented. However, definite conclusions about this sequence of events have not yet been reached. This study was designed to analyze the severity of toxemia of pregnancy and to examine the possibility of anticipating its onset from the standpoint of coagulation-fibrinolysis kinetics. The patient population comprised 116 women divided into 4 groups: I) A control group of 10 normal, nonpregnant women; II) Fifty-four normal pregnant women who were followed up from early pregnancy until delivery; III) Twenty-four women who were followed up from early pregnancy until delivery and developed toxemia of pregnancy; and IV) Twenty-eight women with severe toxemia of pregnancy of the pure type who were referred to our institution at the onset of the disease and were treated as inpatients. Intergroup comparison yielded the following results. 1. In group II (normal pregnancy), a significant increase was observed, first in fibrinopeptide B beta and then in fibrinopeptide A, as the pregnancy progressed. This suggested the acceleration of coagulation and fibrinolysis due to pregnancy. 2. In group III (6 of 24 cases developed severe toxemia of pregnancy), AT-III increased, while protein C and hematocrit levels increased relative to those on the normal pregnancy group during the 2nd trimester. Thus, changes in coagulation functions occurred before the onset of toxemia of pregnancy.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Antithrombin III; Blood Coagulation; Female; Fibrinolysis; Fibrinopeptide A; Fibrinopeptide B; Hematocrit; Humans; Kinetics; Pre-Eclampsia; Predictive Value of Tests; Pregnancy; Protein C

The cause(s) of the low plasma antithrombin III activity in women with preeclampsia is unknown. The purpose of this study was to evaluate the relationship between plasma antithrombin III activity and both clotting parameters (platelet count and fibrinopeptide A) and renal parameters (serum creatinine and uric acid concentration). Forty-seven preeclamptic women were studied within the 2-day interval before delivery. Creatinine did not correlate significantly with any of the other study parameters. However, there were significant correlations between antithrombin III activity and platelet count (r = 0.53, P less than .005) and between antithrombin III and fibrinopeptide A (r = -0.29, P less than .05). The correlation between platelet count and fibrinopeptide A was not significant. These findings support the hypothesis that antithrombin III consumption by fibrin generation is initiated by platelet activation, and is at least one cause of the low activity level known to occur in women with preeclampsia.

Topics: Antithrombin III; Creatinine; Female; Fibrinopeptide A; Humans; Platelet Count; Pre-Eclampsia; Pregnancy; Uric Acid

Hemostatic and platelet function studies were performed prospectively on 61 preeclamptic patients and 24 healthy pregnant control patients to delineate possible causes of thrombocytopenia in preeclampsia. Thrombocytopenia occurred in 50% of the preeclamptic patients, and was accompanied by qualitative platelet defects as shown by an increased bleeding time and decreased biosynthesis of thromboxane A2. All patients had normal routine coagulation and protamine sulphate paracoagulation assays. All nulliparous patients had normal levels of fibrinopeptide A, but approximately 60% of parous patients had slight elevations of fibrinopeptide A. Elevated levels of platelet-associated immunoglobulin G (IgG) were demonstrated in 35% of all preeclamptic patients and were inversely correlated (r = -0.524) with the severity of the thrombocytopenia. This study indicates that, at least in nulliparous patients, thrombin action is not a major contributor to the development of thrombocytopenia in preeclampsia. The observation of elevated levels of platelet-associated IgG suggests that immune mechanisms could contribute to the thrombocytopenia in some patients.

Topics: Adult; Blood Coagulation Tests; Female; Fibrinopeptide A; Hemostasis; Humans; Immunoglobulin G; Platelet Count; Platelet Function Tests; Pre-Eclampsia; Pregnancy; Prospective Studies; Thrombocytopenia

Paired maternal and umbilical vein blood samples were obtained from 15 women and the plasma antithrombin III activity and fibrinopeptide A concentration measured. Women with preeclampsia had significantly lower antithrombin III activities and higher fibrinopeptide A concentrations (P less than .05) than normals. However, there were no significant differences between the two groups of fetuses. Thus, thrombin generation was not increased in the fetuses delivered from preeclamptic women.

Topics: Antithrombin III; Blood Coagulation; Female; Fetal Blood; Fibrinogen; Fibrinopeptide A; Humans; Labor, Obstetric; Pre-Eclampsia; Pregnancy

Topics: Blood Coagulation; Female; Fibrinolysis; Fibrinopeptide A; Fibrinopeptide B; Humans; Pre-Eclampsia; Pregnancy

Serial measurements of the plasma concentration of fibrinopeptide A, thrombin-increasable fibrinopeptide B (reflecting B beta 1-42), desarginyl fibrinopeptide B, beta thromboglobulin, and platelet factor 4 were made before, during, and after delivery in patients with preeclampsia/eclampsia. The data were correlated with routine coagulation studies, hematologic and renal status, as well as with the clinical manifestations. In 11 patients with mild preeclampsia, there were small increases in the fibrinopeptides at the time of delivery, but no other hematologic changes. In 5 patients with severe preeclampsia/eclampsia, there were marked increases in plasma levels of fibrinopeptides and platelet alpha granule proteins, which correlated in time with the clinical manifestations. When the changes in these patients were compared with those occurring in patients undergoing intraamniotic hypertonic saline infusion, it was noted that: (1) patients with severe preeclampsia/eclampsia usually presented when plasmin action on fibrinogen exceeded that of thrombin; (2) in patients with preeclampsia/eclampsia the increase in fibrinopeptides lasted from 3 to 7 days, rather than for several hours as occurred after the infusion of hypertonic saline, indicating a more persistent stimulus to intravascular coagulation in preeclampsia/eclampsia; (3) severe thrombocytopenia and increased platelet protein levels were seen in these patients and were disproportionate to the degree of increase in the fibrinopeptide A level, suggesting that a mechanism other than thrombin must have contributed to the platelet changes; and (4) in two patients with severe preeclampsia/eclampsia, high desarginyl fibrinopeptide B levels preceded renal insufficiency, possibly reflecting fibrin II formation in renal vessels.

Topics: Adolescent; Adult; beta-Thromboglobulin; Blood Platelets; Cytoplasmic Granules; Eclampsia; Female; Fibrinogen; Fibrinolysis; Fibrinopeptide A; Fibrinopeptide B; Glycoproteins; Humans; Membrane Proteins; Platelet Factor 4; Platelet Membrane Glycoproteins; Pre-Eclampsia; Pregnancy

Increased plasma levels of beta-thromboglobulin (beta TG) and fibrinopeptide A (FPA), markers of platelet release and thrombin generation respectively, were measured in normal women, women taking oral contraceptives, normal pregnancy and pregnant women with hypertension or pre-eclampsia. No significant increases in beta TG or FPA were found in women taking oral contraceptives. Significantly increased concentrations of beta TG, but not FPA, were found in normal pregnant women in the second and third trimester of pregnancy when compared with non-pregnant age-matched controls. In eleven women with pregnancy hypertension and thirteen women with pre-eclampsia significantly elevated levels of both beta TG and FPA were found when compared with age, parity and gestation-matched pregnant controls. Although the mean value for both beta TG and FPA in the group with pre-eclampsia was higher than the group with pregnancy hypertension, the difference was not statistically significant. These findings provide additional evidence that pre-eclampsia and pregnancy hypertension are associated with activation of the coagulation system and the platelet release reaction.

Topics: Beta-Globulins; beta-Thromboglobulin; Contraceptives, Oral; Female; Fibrinogen; Fibrinopeptide A; Humans; Hypertension; Pre-Eclampsia; Pregnancy; Pregnancy Complications; Pregnancy Complications, Cardiovascular; Pregnancy Trimester, First; Pregnancy Trimester, Third