fibrinopeptide-b and Pre-Eclampsia

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

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