kaolinite and Blood-Coagulation-Disorders

Topics: Biomarkers; Blood Coagulation Disorders; Blood Coagulation Tests; Humans; Kaolin; Lupus Coagulation Inhibitor; Partial Thromboplastin Time; Reference Values; Specimen Handling; Whole Blood Coagulation Time

Topics: Adrenal Cortex Hormones; Autoantibodies; Azathioprine; Blood Coagulation Disorders; Blood Coagulation Factors; Blood Coagulation Tests; DNA; Factor VIII; Female; Fetal Death; Humans; Immunoglobulin G; Immunoglobulin M; Kaolin; Lupus Coagulation Inhibitor; Lupus Erythematosus, Systemic; Partial Thromboplastin Time; Phospholipids; Pregnancy; Pregnancy Complications, Hematologic; Prothrombin Time; Thrombosis; von Willebrand Factor

Venous thromboembolism (VTE) remains a frequent postinjury complication with well established but nonmodifiable risk factors. We hypothesized that fibrinolysis shutdown (SD) as measured by thromboelastography (TEG) would be an independent risk factor for VTE in trauma patients.. A subgroup of patients enrolled in the CLOTT-2 (Consortium of Leaders in the Study of Traumatic Thromboembolism 2), multicenter prospective cohort study had kaolin TEG and tissue plasminogen activator (tPA)-TEG data at 12 and 24 hours postadmission. Patients underwent a screening duplex venous ultrasound examination during the first week unless clot was already detected on computed tomography. Injury factors associated with early fibrinolysis SD (defined as kaolin TEG Ly30 ≤0.3%) and/or tPA resistance (tPA-R) (defined as kaolin TEG with tPA 75 ng Ly30 <2.1%) were investigated as was the association of the TEG measurements with the development of VTE.. A total of 141 patients had both TEG measurements at 24 hours, and 135 had both TEG measurements at 12 hours. Shutdown was evident at 12 hours in 71 of 135 (52.6%) patients and in 62 of 141 (44%) at 24 hours. Tissue plasminogen activator resistance was found in 61 of 135 (45.2%) at 12 hours and in 49 of 141 (34.3%) at 24 hours. Factors significantly associated with SD included receiving >4 U of FFP in the first 24 hours, the presence of a major brain injury or pelvic fracture, and the need for major surgery. In contrast, factors significantly associated with early tPA-R included >4 U of red blood cells transfused in the first 24 hours and the presence of a major chest injury or long bone fracture. Deep vein thrombosis was detected in 15 patients and pulmonary clots in 5 (overall VTE rate, 14.2%). Tissue plasminogen activator resistance at 12 hours was found to be an independent risk factor for VTE (hazard ratio, 5.57; 95% confidence interval, 1.39-22.39).. Early development of a hypercoagulable state as defined by tPA-R at 12 hours after admission represents a potentially modifiable risk factor for postinjury VTE.. Therapeutic/Care Management; Level II.

Topics: Blood Coagulation Disorders; Humans; Kaolin; Prospective Studies; Thrombelastography; Tissue Plasminogen Activator; Venous Thromboembolism

Most data in the literature report reduced coagulation activities in the first few days of life with respect to adults and the effects of these differences must be considered when diagnosing and treating hemostatic disorders. The management of pediatric population is further complicated by the lack of age-related reference values and by the unreliability of currently-used hemostatic tests, while an accurate interpretation of results is required to reduce the cases of inappropriate investigation. Thromboelastography (TEG®) is a point-of-care test that provides an efficient analysis of the dynamic viscoelastic properties of whole blood that may provide superior evaluation and management of coagulopathies in newborn. This study was designed to determine reference values for kaolin-activated TEG in full-term healthy newborn by taking small blood samples from the umbilical cord and facilitate accurate interpretation of neonatal TEG results.. Kaolin-activated TEG was performed in 85 full-term healthy newborn and 40 healthy adults. TEG data analyzed were: reaction time, clot formation time, α-angle, maximum amplitude, clot lysis at 30 minutes, Functional Fibrinogen and coagulation index.. Reference values for kaolin-activated TEG in healthy full-term newborn are presented, despite a large variability in reaction time, clot formation time and in coagulation index, not significant impact on range values was evident and no significant differences between neonates and adults were observed.. Neonatal coagulation tests are closer to adult standards and although significant age-related differences in kaolin-activated TEG variables do not appear to be present, the usefulness of TEG for pediatric population is an open field that needs to be further evaluated, the results of this study can be used to interpret the data for newborn.

Topics: Adult; Blood Circulation Time; Blood Coagulation; Blood Coagulation Disorders; Blood Coagulation Tests; Female; Fetal Blood; Fibrinogen; Humans; Infant, Newborn; Kaolin; Male; Point-of-Care Systems; Reference Values; Thrombelastography

Rotational thromboelastometry (ROTEM) and thromboelastography (TEG) have been increasingly used to diagnose acute coagulopathy and guide blood transfusion. The tests are routinely performed using different triggering activators such as tissue factor and kaolin, which activate different pathways yielding different results. To optimize the global blood coagulation assays using ROTEM and TEG, we conducted a comparative study on the activation methods employing tissue factor and kaolin at different concentrations as well as standard reagents as recommended by the manufacturer of each device. Key parameter values were obtained at various assay conditions to evaluate and compare coagulation and fibrinolysis profiles of citrated whole blood collected from healthy volunteers. It was found that tissue factor reduced ROTEM clotting time and TEG R, and increased ROTEM clot formation time and TEG K in a concentration-dependent manner. In addition, tissue factor affected ROTEM alpha angle, and maximum clot firmness, especially in the absence of kaolin activation, whereas both ROTEM and TEG clot lysis (LI30, CL30, and LY30) remained unaffected. Moreover, kaolin reduced ROTEM clotting time and TEG R and K, but to a lesser extent than tissue factor, in-tem and ex-tem. Correlations in all corresponding parameters between ROTEM and TEG were observed, when the same activators were used in the assays compared with lesser correlations between standard kaolin TEG and ROTEM (INTEM/EXTEM). The two types of viscoelastic point-of-care devices provide different results, depending on the triggering reagent used to perform the assay. Optimal assay condition was obtained to reduce assay time and improve assay accuracy.

Topics: Blood Coagulation Disorders; Blood Coagulation Tests; Female; Humans; Kaolin; Male; Thrombelastography; Thromboplastin

Topics: Animals; Bandages; Blood Coagulation Disorders; Female; Hemorrhage; Hemostatic Techniques; Hypothermia, Induced; Kaolin; Liver; Male

Severe hepatic injuries may be highly lethal, and perihepatic packing remains the mainstay of treatment. This is not always successful, particularly in the setting of hypothermia and coagulopathy. Kaolin-impregnated Combat Gauze (CG) is an effective hemostatic dressing used primarily to treat external wounds. The objective of this study was to determine the ability of CG to control severe hemorrhage in hypothermic, coagulopathic swine with a high-grade hepatic injury.. Anesthetized animals underwent splenectomy and were cooled to 32°C while undergoing a 60% exchange transfusion with Hextend. A grade V liver injury was created in the left middle hepatic lobe. Animals were allowed to freely bleed for 30 s and then randomized to treatment with CG or plain gauze laparotomy pads (PG) applied to the injury site. Animals were then resuscitated with warmed Hextend.. There was no difference between groups in preinjury hemodynamic or laboratory values. Animals packed with CG had less blood loss when compared with standard packing (CG = 25 mL/kg versus PG = 58 mL/kg, P = 0.05). There was a trend towards lower hetastarch resuscitation requirements in the CG group (CG = 7 mL/kg versus PG = 44 mL/kg, P = 0.06) but no statistically significant difference in mortality (CG = 13% versus PG = 50%, P = 0.11). Histology of the injury sites revealed more adherent clot in the CG group, but no inflammation, tissue necrosis, or residual material.. In pigs with severe hepatic injury, Combat Gauze reduced blood loss and resuscitation requirements when compared with plain laparotomy pads. Combat Gauze may be safe and effective for use on severe liver injuries.

Topics: Animals; Bandages; Blood Coagulation Disorders; Disease Models, Animal; Female; Hemorrhage; Hemostatic Techniques; Hemostatics; Hypothermia, Induced; Incidence; Inflammation; Kaolin; Liver; Male; Necrosis; Pilot Projects; Swine; Treatment Outcome

Topics: Blood Coagulation Disorders; Female; Humans; Kaolin; Male; Thrombelastography

Thromboelastography/metry (TEG®; Haemoscope, Niles, IL/ROTEM®; Tem International GmbH, Munich, Germany) is increasingly used to guide transfusion therapy. This study investigated the diagnostic performance and therapeutic consequence of using kaolin-activated whole blood compared with a panel of specific TEM®-reagents to distinguish: dilutional coagulopathy, thrombocytopenia, hyperfibrinolysis, and heparinization.. Blood was drawn from 11 healthy volunteers. Dilutional coagulopathy was generated by 50% dilution with hydroxyethyl starch 130/0.4 whereas thrombocytopenia (mean platelet count 20 ×10⁹/l) was induced using a validated model. Hyperfibrinolysis and heparin contamination were generated by tissue plasminogen activator 2 nM and unfractionated heparin 0.1U/ml, respectively. Coagulation tests were run on ROTEM® delta.. Kaolin-activated whole blood showed no differences between dilutional coagulopathy and thrombocytopenia (mean clotting time 450 s vs. 516 s, α-angle 47.1° vs. 41.5°, maximum clot firmness 35.0 mm vs. 34.2 mm, all P values ≥0.14). Hyperfibrinolysis specifically disclosed an increased maximum lysis (median: 100%, all P values less than 0.001), and heparin induced a distinctly prolonged clotting time (2283 s, all P values less than 0.02). The coagulopathies were readily distinguishable using a panel of TEM-reagents. In particular, dilutional coagulopathy was separated from thrombocytopenia using FIBTEM (maximum clot firmness 1.9 mm vs. 11.2 mm, P < 0.001). The run time of analysis to achieve diagnostic data was shorter applying a panel of TEM-reagents. A transfusion algorithm based on kaolin suggested platelets in case of dilutional coagulopathy, whereas an algorithm applying TEM-reagents suggested fibrinogen.. Monoanalysis with kaolin was unable to distinguish coagulopathies caused by dilution from that of thrombocytopenia. Algorithms based on the use of kaolin may lead to unnecessary transfusion with platelets, whereas the application of TEM-reagents may result in goal-directed fibrinogen substitution.

Topics: Adult; Algorithms; Blood Coagulation Disorders; Female; Fibrinolysis; Hemostasis; Humans; Indicators and Reagents; Kaolin; Male; Middle Aged; Thrombelastography; Thrombocytopenia; Time Factors

Early recognition of coagulopathy may improve the care of patients with multiple injuries. Rapid thrombelastography (RapidTEG) is a new variant of thrombelastography (TEG), in which coagulation is initiated by the addition of protein tissue factor. The kinetics of coagulation and the times of measurement were compared for two variants of TEG--RapidTEG and conventional TEG, in which coagulation was initiated with kaolin. The measurements were performed on blood samples from 20 patients with multiple injuries. The RapidTEG results were also compared with conventional measurements of blood coagulation. The mean time for the RapidTEG test was 19.2 +/- 3.1 minutes (mean +/- SD), in comparison with 29.9 +/- 4.3 minutes for kaolin TEG and 34.1 +/- 14.5 minutes for conventional coagulation tests. The mean time for the RapidTEG test was 30.8 +/- 5.72 minutes, in comparison with 41.5 +/- 5.66 minutes for kaolin TEG and 64.9 +/- 18.8 for conventional coagulation tests---measured from admission of the patients to the resuscitation bay until the results were available. There were significant correlations between the RapidTEG results and those from kaolin TEG and conventional coagulation tests. RapidTEG is the most rapid available test for providing reliable information on coagulopathy in patients with multiple injuries. This has implications for improving patient care.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Blood Coagulation; Blood Coagulation Disorders; Emergency Service, Hospital; Female; Humans; Kaolin; Male; Middle Aged; Multiple Trauma; Point-of-Care Systems; Thrombelastography; Thromboplastin; Young Adult

We have developed a Silica Clotting Time (SCT) test suitable to screen patients with lupus anticoagulants (LA) and compatible with photo-optical instruments. The SCT results were considered to be positive for LA whenever the clotting times were longer than the upper normal limit at low phospholipid concentration and to be confirmed when the prolonged clotting times were corrected to normal by high phospholipid concentration. We studied plasmas from healthy subjects, patients with known diagnoses of LA, patients with acquired deficiencies of blood coagulation and hemophiliacs with anti-factor VIII antibodies. The test was positive for all LA patients, and negative for all non-LA patients except 7 hemophiliacs with anti-factor VIII antibodies. Our data indicate that the SCT is a sensitive test, suitable for screening patients suspected of having LA. Its compatibility with photo-optical instruments makes it a suitable candidate to replace the kaolin clotting time. The contemporaneous performance of SCT at low and high phospholipid concentrations provides screening and confirmation in a single procedure.

Topics: Anticoagulants; Autoantibodies; Blood Coagulation Disorders; Blood Coagulation Tests; Factor VIII; Hemophilia A; Humans; Kaolin; Liver Cirrhosis; Lupus Coagulation Inhibitor; Mass Screening; Phospholipids; Sensitivity and Specificity; Silicon Dioxide

Acquired inhibitors of plasma thromboplastin antecedent (PTA) have been described in several recent studies, which collectively emphasize the heterogeneity of PTA functions that are impaired by this class of circulating anticoagulants. To clarify whether acquired inhibitors of PTA exhibit inhibitory properties that vary widely from one patient to the next, IgG inhibitors from four patients were isolated. The effect of these inhibitors on the binding of PTA to glass, the activation of kaolin-bound PTA, the coagulant activity of both kaolin-bound and fluid phase activated PTA (aPTA), and the enzymatic activity of aPTA against a low molecular weight substrate was quantified. The relative inhibition of these individual components of PTA activation and function by the four anticoagulants was quite similar. The results indicate that the principal binding sites for acquired inhibitors of PTA are PTA domains involved with surface binding and conversion of PTA to aPTA, with less effective steric impairment of aPTA enzymatic activity.

Topics: Adult; Aged; Antibodies, Anti-Idiotypic; Anticoagulants; Binding Sites; Blood Coagulation Disorders; Dipeptides; Factor XI; Factor XIa; Glass; Humans; Immunoglobulin G; Kaolin; Male; Molecular Weight; Prostatic Neoplasms

This study was undertaken to evaluate the precision and sensitivity of three different commercial APTT reagents containing the activators kaolin, micronized silica, or ellagic acid. These reagents varied greatly in their ability to detect mild coagulopathies. The ellagic acid reagent was able to detect the mildest deficiencies for the most common coagulopathies. This reagent was sensitive to 50% levels of Factor VIIIC, whereas the APTT with the kaolin reagent was not prolonged until levels of 35% or less were attained. The micronized silica reagent was the least sensitive to Factor IX deficiency, detecting levels of 12% or less. Precision was similar for all reagents when tested with normal and slightly abnormal plasmas. Since methods and instrumentation vary, each laboratory should evaluate their APTT reagent to determine its precision and sensitivity.

Topics: Blood Coagulation Disorders; Blood Coagulation Tests; Evaluation Studies as Topic; Female; Humans; Indicators and Reagents; Kaolin; Male; Partial Thromboplastin Time; Reference Values

The presence of the lupus anticoagulant was diagnosed in six pregnant women because they had prolonged activated partial thromboplastin and kaolin clotting times which could not be corrected by dilution of test samples with normal plasma. All previous pregnancies (14) had ended in intrauterine death in the five multigravidas. Three women had had thrombotic episodes during pregnancy. The diagnosis of SLE was established in four. Antinuclear antibody was identifiable in all 6. All were treated with prednisone 40-60 mg/day and aspirin 75 mg/day. Suppression of the lupus anticoagulant activity was achieved in five patients, all of whom gave birth to live infants. In the sixth patient suppression of the anticoagulant activity was demonstrated between pregnancies; a further pregnancy in this patient was lost before she had received sufficient prednisone to suppress the anticoagulant. Since treatment with prednisone and aspirin can lead to successful pregnancies, it is important to screen all women with SLE, thrombotic episodes, recurrent intrauterine deaths, or a biologically false-positive VDRL for the presence of the lupus anticoagulant.

Topics: Adult; Antibodies, Antinuclear; Aspirin; Blood Coagulation Disorders; Blood Coagulation Factors; Female; Fetal Death; Humans; Immunoglobulins; Kaolin; Lupus Coagulation Inhibitor; Lupus Erythematosus, Systemic; Partial Thromboplastin Time; Platelet Count; Prednisone; Pregnancy; Pregnancy Complications, Hematologic; Pregnancy, Multiple; Thrombophlebitis

Low amount of sulfatides initiated intrinsic coagulation and the appearance of kallikrein activity in normal human plasma. The initiation of procoagulant and kallikrein amidolytic activity was dependent on the presence of Factorr XII, high molecular weight kininogen and prekallikrein. Because the activated partial thromboplastin clotting times in prekallikrein deficient plasma approach normal values upon prolonged incubation with kaolin, this phenomenon was studied and found to be even more pronounced in the presence of sulfatides. Shortening of the clotting time was essentially completed in 5 min in the presence of sulfatides whereas a pre-incubation of 15 to 20 min was required in the presence of kaolin. The limited proteolysis of 125I-Factor XII in plasma during incubation was more rapid and more extensive in the presence of sulfatides than in the presence of kaolin. Factor XII cleavage in prekallikrein deficient plasma was completed in less than 5 min in the presence of sulfatides and in less than 15 min in the presence of kaolin. Thus, the appearance of Factor XII-dependent coagulant activity correlates with the limited proteolysis of Facto XII when normal or prekallikrein deficient plasma is activated by sulfatides or by kaolin. These observations are consistent with the hypothesis that Factor XII is cleaved in plasma to generate maximal Factor XIIa activity.

Topics: Animals; Blood Coagulation; Blood Coagulation Disorders; Cattle; Factor XII; Factor XIIa; Humans; Kaolin; Partial Thromboplastin Time; Peptide Fragments; Prekallikrein; Sulfoglycosphingolipids

Topics: Adolescent; Adult; Blood Coagulation Disorders; Blood Coagulation Tests; Citrates; Female; Humans; Kaolin; Male; Middle Aged; Partial Thromboplastin Time

Topics: Afibrinogenemia; Blood Coagulation Disorders; Blood Coagulation Tests; Factor V Deficiency; Factor VII Deficiency; Factor X Deficiency; Factor XI Deficiency; Factor XII Deficiency; Factor XIII Deficiency; Hemophilia A; Hemophilia B; Humans; Hypoprothrombinemias; Kaolin; Phosphatidylethanolamines; Prekallikrein; Prothrombin Time; Thrombin; Thromboplastin; von Willebrand Diseases

Proteolytic cleavage and activation of isolated, single chain, zymogen Hageman factor was observed in the presence of kaolin alone. The rate of cleavage of kaolin-bound Hageman factor was enhanced 50-fold by the presence of prekallikrein and high molecular weight kininogen. The two-chain 82,000 dalton form of activated Hageman factor (alpha-HF(a)) also cleaved kaolin- bound single-chain Hageman factor in a dose-dependent manner, yielding fragments of 28,000 and, 50,000 dahons under reducing conditions. Cleavage of kaolin-bound single-chain Hageman factor was not inhibited by preincubation with diisopropylfluorophosphate (12 mM) for 10 min, but long-term incubation of Hageman factor with diisopropylfluorophosphate (up to 48 h) resulted in inhibition of cleavage of kaolin-bound Hageman factor to an extent proportional to the inhibition of procoagulant Hageman factor activity. Hageman factor cleavage was maximal when the kaolin concentration was {approximately} 10-fold greater than the Hageman factor concentration (wt:wt), and was partially inhibited by high molecular weight kininogen. Kaolin-bound Hageman factor cleaved clotting factor XI in an amount which correlated with the extent of cleavage of the Hageman factor. These findings are compatible with the concept that single-chain Hageman factor and alpha- HF(a), are both capable of cleaving and activating kaolin-bound Hageman factor and that a close molecular association of kaolin-bound Hageman factor molecules is required for this reaction.

Topics: Animals; Blood Coagulation Disorders; Electrophoresis, Polyacrylamide Gel; Factor XII; Isoflurophate; Kallikreins; Kaolin; Kininogens; Prekallikrein; Rabbits; Tritium

Topics: Adult; Age Factors; Blood Coagulation Disorders; Blood Coagulation Tests; Child; Factor XI Deficiency; Factor XII Deficiency; Female; Hemostasis; Humans; Infant; Kaolin; Male; Phosphatidylethanolamines

Topics: Administration, Oral; Animals; Anticoagulants; Biomarkers; Blood Coagulation Disorders; Blood Proteins; Cattle; Cold Temperature; Factor VII; Factor VII Deficiency; Factor X; Factor X Deficiency; Humans; Hypoprothrombinemias; Kaolin; Protein Precursors; Prothrombin; Prothrombin Time; Rabbits; Thromboplastin; Vitamin K

Amphoteric polyelectrolytes with alkaline isoelectric points (for example Ampholine 9-11) intended for use in isoelectric focussing were found to shorten the prolonged partial thrombosplastin clotting time with kaolin (PTTK) of plasma deficient in factor VIII. The response of this PTTK to Ampholine 9-11 was linear when plotted on double log paper with a slope slightly greater than that of factor VIII itself. Ampholine 9-11 at 2% concentration had factor VIII and factor IX activity equal to that of normal plasma as well as somewhat less activity as factor XI. It had no significant correcting effect on the clotting of plasmas deficient in factors V, VII, X, II OR XII. Ampholine 9-11 inhibited low concentrations of contact activators and its effect in correcting factor VIII deficient plasma was found to be related to the degree of contact activation.

Topics: Amino Acids; Blood Coagulation; Blood Coagulation Disorders; Dose-Response Relationship, Drug; Hemophilia A; Humans; In Vitro Techniques; Isoelectric Point; Kaolin

The AA. have standardized a method for determining the kaolin activated plasma recalcification time (TRA) and have fixed its normal range between 33 and 60 seconds (average +/- 3 DS) testing 2000 normal subjects. By this method they have been able to demonstrate that TRA is more sensitive than PTT during the haemorrhagic manifestations in thrombocytopenic patients and in monitoring heparin therapy, while it shows a behaviour similar to PTT in detecting coagulation defects. It has also been found that TRA had remarkably increased its values in thrombocytopatic non thrombocytopenic patients, when PTT was normal. TRA does not seem to be useful in coumarin or indanedione therapy, since its values are constantly but not proportionally increased only when prothromsitive than PTT during the haemorrhagic manifestations in thrombocytopenic pabin time is very prolonged. Finally TRA can advantageusly substitute the whole blood clotting time and the non activated recalcification time for its easy performance, remarkable precision and low cost.

Topics: Anticoagulants; Blood Coagulation Disorders; Blood Coagulation Tests; Blood Platelet Disorders; Female; Humans; Kaolin; Male

Reagents may be prepared from normal plasma and used with the prothrombin time and partial thromboplastin time tests to distinguish isolated defects of factors I, II, VII, VIII, IX, X, XI, or XII.

Topics: Adolescent; Adult; Aluminum Hydroxide; Blood Coagulation Disorders; Blood Coagulation Tests; Child; Child, Preschool; Factor XI Deficiency; Female; Hemophilia A; Hemophilia B; Humans; In Vitro Techniques; Kaolin; Male; Middle Aged; Phospholipids; Plasma; Prothrombin Time; Thromboplastin; Tromethamine; von Willebrand Diseases

Twelve Indian patients with pre-eclampsia, 15 with eclampsia and 15 with normal pregnancy in the third trimester were investigated. A systemic bleeding diathesis was encountered in two patients with eclampsia and in none with pre-eclampsia; two patients with pre-eclampsia, however, had excessive uterine haemorrhage. Coagulation studies showed statistically significant prolongation of thrombin time, elevation of serum fibrinogen degradation products (FDP) and hypofibrinogenaemia in patients with pre-eclampsia as well as eclampsia. In patients with eclampsia, significant thrombocytopenia also occurred. Euglobulin lysis time showed no significant change in patients with pre-eclampsia and eclampsia. There was no significant difference in the coagulation profile between patients with eclampsia and pre-eclampsia, except for more hypofibrinogenaemia in the former. The laboratory findings suggest the occurrence of intravascular coagulation in patients with pre-eclampsia and eclampsia.

Topics: Adult; Albuminuria; Blood Coagulation; Blood Coagulation Disorders; Blood Platelets; Eclampsia; Edema; Female; Fibrinogen; Hemorrhagic Disorders; Humans; Hypertension; India; Kaolin; Middle Aged; Phosphatidylethanolamines; Pre-Eclampsia; Pregnancy; Pregnancy Trimester, Third; Prothrombin Time; Serum Globulins; Thrombocytopenia; Uterine Hemorrhage

This paper reports an asymptomatic coagulation defect responsible for an abnormality at the contact phase of blood coagulation in vitro, distinct from Hageman factor and Fletcher factor deficiencies. Coagulation studies in a 50-yr-old French woman without bleeding tendency revealed the following results: whole-blood clotting time in glass tubes and activated partial thromboplastin time with kaolin and ellagic acid were greatly prolonged; one-stage prothrombin was normal; no circulating anticoagulant was detected, and the infusion of normal plasma corrected the coagulation defect with an estimated half-life of 6.5 days; the levels of factor VIII, IX, XI, and XII were normal; mutual correction was obtained with a Fletcher factor-deficient plasma; the level of whole complement was normal. Studies of the contact phase of blood coagulation and contact-induced fibrinolysis showed the same abnormalities as in Hageman factor- and Fletcher-deficient plasmas. These results indicate that the patient's plasma is deficient in a previously undescribed coagulation factor, which participates in the initial stage of the blood coagulation process in vitro. Family studies revealed consanguinity in the propositus' parents. The assay of this newly described factor in the propositus' children revealed a partial defect, compatible with a heterozygous state, in three of the four tested children. This indicates a recessive inheritance of this new blood coagulation defect.

Topics: Blood Coagulation; Blood Coagulation Disorders; Blood Coagulation Factors; Blood Coagulation Tests; Consanguinity; Female; Humans; Kaolin; Middle Aged; Pedigree

Topics: Blood Cell Count; Blood Coagulation Disorders; Blood Coagulation Factors; Blood Coagulation Tests; Blood Platelets; Cardiovascular Diseases; Humans; Kaolin; Male; Platelet Adhesiveness; Prothrombin Time; Purpura; Radiation Injuries; Risk; Thromboplastin; Thrombosis; Thyroid Diseases

Topics: Aprotinin; Arginine; Blood Coagulation; Blood Coagulation Disorders; Blood Coagulation Tests; Bradykinin; Citrates; Esterases; Factor XI; Factor XII; Humans; In Vitro Techniques; Kallikreins; Kaolin; Kininogens; Kinins; Trypsin

Topics: Biological Assay; Blood Coagulation; Blood Coagulation Disorders; Blood Coagulation Tests; Buffers; Capillary Permeability; Citrates; Esterases; Factor IX; Factor VIII; Factor XI; Factor XII; Fibrinolysis; Humans; In Vitro Techniques; Kaolin; Kinins; Thromboplastin

Topics: Aged; Animals; Azathioprine; Blood Coagulation Disorders; Blood Transfusion; Cattle; Cryoglobulins; Cyclophosphamide; Factor VIII; Female; Hemoglobins; Humans; Kaolin; Phosphatidylethanolamines; Prednisolone; Swine; Time Factors

Topics: Adolescent; Blood Coagulation Disorders; Blood Coagulation Tests; Child; Child, Preschool; Humans; Infant; Kaolin; Male; Surgical Procedures, Operative; Thromboplastin

Topics: Adenosine Diphosphate; Animals; Blood Coagulation; Blood Coagulation Disorders; Calcium; Kaolin; Snakes; Swine; Swine Diseases; Thromboplastin; Time Factors; Venoms

Topics: Blood Coagulation Disorders; Blood Coagulation Tests; Blood Platelet Disorders; Erythroblastosis, Fetal; Exchange Transfusion, Whole Blood; Female; Humans; Infant, Newborn; Kaolin; Microscopy, Phase-Contrast; Phosphatidylethanolamines; Plasminogen; Pregnancy; Time Factors

Topics: Blood Coagulation Disorders; Blood Coagulation Tests; Hemophilia A; Hemophilia B; Humans; Kaolin; Thromboplastin

Topics: Blood Coagulation; Blood Coagulation Disorders; Blood Platelets; Collagen; Factor IX; Factor VIII; Factor XI; Factor XII; Hemostasis; Humans; Kaolin; Platelet Adhesiveness

Topics: Adenosine Diphosphate; Aspirin; Blood Coagulation Disorders; Collagen; Epinephrine; Factor XI; Factor XII; Humans; Kaolin; Platelet Adhesiveness; Time Factors

Topics: Blood Coagulation Disorders; Brain Diseases; Disseminated Intravascular Coagulation; Female; Humans; Injections, Intravenous; Kaolin; Substance-Related Disorders

Topics: Adenine Nucleotides; Aged; Blood Coagulation Disorders; Blood Coagulation Tests; Blood Platelet Disorders; Blood Platelets; Connective Tissue; Epinephrine; Epistaxis; Female; Hemarthrosis; Humans; Kaolin; Melena; Platelet Adhesiveness; Thrombin; Tissue Extracts

Topics: Animals; Blood Coagulation Disorders; Blood Coagulation Tests; Epinephrine; Factor V; Factor VII; Factor VIII; Hypersplenism; Kaolin; Rats; Splenectomy; Thromboplastin

Heparin therapy in 114 patients was controlled by daily blood tests-the whole blood coagulation time, kaolin-activated partial thromboplastin time of plasma, and plasma heparin assay. Bleeding episodes occurred in 7 out of 92 patients (7.6%) who had normal haemostatic mechanisms before therapy and in 11 out of 22 patients (50%) with defective haemostasis, mostly due to intravascular coagulation or renal failure. The dose of heparin ranged from 20,000 to 60,000 units in each 24-hour period. In some patients bleeding was related to overdosage, but in others the laboratory tests indicated satisfactory or suboptimal dosage at the time of bleeding. Though there were positive correlations between the results of the three tests, these were not close, and no one test was preferable. Hence laboratory control of heparin therapy is unsatisfactory and patients may bleed despite careful control of the dose by all three methods.

Topics: Acute Kidney Injury; Adult; Aged; Blood Coagulation Disorders; Blood Coagulation Tests; Female; Hemorrhage; Heparin; Humans; Kaolin; Male; Middle Aged; Thromboplastin

Purified acid-soluble and insoluble human collagen accelerated the clotting of plateletpoor plasma in silicone-treated tubes. The clot-promoting effect did not appear to be due to thromboplastic activity since the collagen preparations did not activate factor X in the presence of factor VII and calcium. Instead, collagen appeared to accelerate clotting by activating Hageman factor (factor XII) on the basis of the following findings: collagen increased the clot-promoting activity of partially purified Hageman factor but exerted no further effect in the presence of kaolin, a known activator of Hageman factor; clot-promoting eluates were obtained from collagen exposed to normal, hemophilic, or PTC-deficient plasma but not from collagen exposed to Hageman or PTA-deficient plasma. The collagen molecule itself appeared to be required for the clot-promoting activity since digestion with collagenase or thermal denaturation at pH 2.5 (about 35 degrees C) resulted in very marked reduction in clot-promoting activity. Since thermal denaturation is associated with transformation of collagen structure from triple helical to random coil form, it is suggested that the native form of collagen is essential for the ability to activate Hageman factor. Blockage of the free amino groups by treatment with nitrous acid or dinitrofluorobenzene only slightly reduced the clot-promoting activity of collagen. In contrast, since addition of cationic proteins to collagen markedly reduced pro-coagulant activity it is suggested that negatively charged sites on the collagen molecule are critical for Hageman factor activation. This suggestion is supported by the finding that pepsin treatment of collagen, which removes the predominantly negatively charged telopeptides, results in significant decrease in coagulant activity. Esterification of collagen, which neutralizes 80-90% of the free carboxyl groups, reduced coagulant activity by over 90% and it is suggested that the free carboxyl groups of glutamic and aspartic acids provide the negatively charged sites critical for Hageman factor activation.

Topics: Adult; Aspartic Acid; Blood Coagulation; Blood Coagulation Disorders; Blood Coagulation Tests; Blood Viscosity; Calcium; Child; Collagen; Factor XII; Glutamates; Hot Temperature; Humans; Kaolin; Microbial Collagenase; Nitrobenzenes; Pepsin A; Skin; Sodium Chloride; Thromboplastin

Topics: Blood Cell Count; Blood Coagulation; Blood Coagulation Disorders; Blood Platelet Disorders; Blood Platelets; Factor IX; Factor V; Factor VII; Factor VIII; Factor X; Factor XI; Factor XII; Humans; Kaolin; Phospholipids; Surface Properties; Venoms; von Willebrand Diseases

Topics: Blood Coagulation Disorders; Blood Coagulation Factors; Blood Coagulation Tests; Factor VIII; Hemophilia B; Humans; Hypoprothrombinemias; Kaolin; Methods; Prothrombin Time; Thromboplastin; Time Factors

Topics: Adolescent; Adult; Blood Coagulation Disorders; Blood Coagulation Factors; Child; Child, Preschool; Factor VII; Factor VIII; Factor XIII; Female; Humans; Infant; Kaolin; Lymphoma, Non-Hodgkin; Male; Prothrombin Time; Pulmonary Embolism; Thrombocytopenia; Thrombophlebitis; Thromboplastin; Wiskott-Aldrich Syndrome

Topics: Adenosine Triphosphatases; Blood Coagulation Disorders; Enzymes; Fibrinolysis; Fibrinolytic Agents; Humans; In Vitro Techniques; Kaolin; Luciferases; Phosphotransferases

Topics: Animals; Blood Coagulation; Blood Coagulation Disorders; Collagen; Elastin; Factor XII; Hemophilia B; Humans; Kaolin; Rabbits; Thrombosis

Topics: Adenine Nucleotides; Blood Coagulation Disorders; Blood Coagulation Factors; Blood Coagulation Tests; Blood Platelet Disorders; Blood Platelets; Edetic Acid; Erythrocytes; Factor XII; Hemophilia A; Hemophilia B; Kaolin; Lipoproteins; Microscopy; Microscopy, Phase-Contrast; Pharmacology; Platelet Factor 3; Platelet-Rich Plasma; Research; von Willebrand Diseases

Topics: Blood Coagulation Disorders; Blood Platelet Disorders; Blood Platelets; Factor XII; Humans; In Vitro Techniques; Kaolin

Topics: Adenine Nucleotides; Adenosine Triphosphate; Adolescent; Blood Coagulation Disorders; Blood Coagulation Tests; Blood Platelet Disorders; Blood Platelets; Child; Factor IX; Factor VIII; Humans; Kaolin; Serotonin; Thrombasthenia; Thromboplastin

Topics: Blood Coagulation Disorders; Blood Coagulation Tests; Child; Diagnosis; Hemorrhagic Disorders; Humans; Infant; Infant, Newborn; Kaolin; Liver Function Tests; Mass Screening

Topics: Blood Coagulation Disorders; Humans; Kaolin; Partial Thromboplastin Time; Plasma; Thromboplastin

Topics: Blood Coagulation; Blood Coagulation Disorders; Blood Coagulation Tests; Hemorrhagic Disorders; Humans; Kaolin