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The recognition that hypofibrinogenemia may be an important factor in the hemorrhagic diathesis which occurs in a number of pathological states has given rise to an increased study of this phenomenon. In many of these conditions an accompanying fibrinolysin has been reported. However, evidence as to the presence of this enzyme varies from investigator to investigator and from method to method. Therefore, a study has been undertaken to investigate as quantitatively as possible the various factors of the fibrinolytic enzyme system. Early in the investigation it became evident that an active fibrinolysin could be detected only transiently in the blood and that a large part of the discrepancy found in the literature may have been a result of the particular time at which the sample was drawn. It has been frequently observed that lysis of plasma clots at all dilutions may occur at one stage, and yet a blood sample drawn an hour later, which has a lower fibrinogen level, may show no evidence of lysis. Indirect evidence obtained from a changing profibrinolysin or inhibitor level may, therefore, give more information as to what is occurring intravascularly than does the presence or absence of an active fibrinolysis. The following set of experimental tests has been set up as a routine for examining blood from patients with hemorrhagic tendencies which are suspected to be in the field of hypofibrinogenemia or fibrinolysin. These tests have also been applied to a number of normal subjects, pregnant women, obstetrical patients with abruptio placentae, patients undergoing portacaval shunt for cirrhosis of the liver, as well as patients with carcinoma and other disease states.

The Fibrinolytic Enzyme System in Normal, Hemorrhagic and Disease States1