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Excessive fibrinolysis in suspected amyloidosis: Demonstration of plasmin‐α2‐plasmin inhibitor complex and von Willebrand factor fragment in plasma
Author(s) -
Takahashi Hoyu,
Koike Tadashi,
Yoshida Nobuhiko,
Kitahara Osamu,
Hanano Masaharu,
Shibata Akira,
Aoki Nobuo
Publication year - 1986
Publication title -
american journal of hematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.456
H-Index - 105
eISSN - 1096-8652
pISSN - 0361-8609
DOI - 10.1002/ajh.2830230210
Subject(s) - plasmin , fibrinolysis , tranexamic acid , von willebrand factor , antifibrinolytic , fibrinogen , fibrin , medicine , plasminogen activator , endocrinology , immunology , gastroenterology , chemistry , platelet , biochemistry , surgery , blood loss , enzyme
We performed a hemostatic evaluation in detail in a patient with suspected amyloidosis who was suffering from several bleeding episodes. He had a shortened euglobulin clot lysis time, decreased alpha 2‐plasmin inhibitor (α2‐PI), decreased plasminogen, elevated tissue‐type plasminogen activator (t‐PA), elevated plasmin‐α2‐PI complex, and decreased ratio of ristocetin cofactor to von Willebrand factor (vWF) antigen. Fibrinogen and fibrin/fibrinogen degradation products levels fluctuated, with abnormal values on several occasions. On crossed immunoelectrophoresis, plasmin‐α2‐PI complex and vWF fragment were demonstrated in the patient plasma. These abnormal findings and bleeding symptoms improved following the administration of tranexamic acid. Discontinuation of tranexamic acid resulted in deterioration of these parameters. These observations indicate that pathologic fibrinolysis (continuous intravascular plasmin generation) characterized by the consumption of α2‐PI and plasminogen, formation of plasmin‐α2‐PI complex, and fragmentation of vWF contributed to the bleeding in this patient. It is important to recognize excessive fibrinolysis as the underlying cause of bleeding in these patients, since specific treatment with antifibrinolytic agents is effective in controlling the bleeding.