a potent procoagulant) in the coagulation process. .... excess or deficiency in procoagulant and anticoagulant .... blood coagulation in patients with cancer.
DECEPTIVE PROTHROMBIN AND ACTIVATED PARTIAL THROMBOPLASTIN TIMES IN ALCOHOLIC CIRRHOSIS Purnachander R. Sirikonda, MD, Charles R. Spillert, PhD, Baburao Koneru, MD, Rex Ponnudurai, MD, Dorian J. Wilson, MD, and Eric J. Lazaro, MS, MBBS Newark, New Jersey
It is believed that perioperative hemorrhage, in the hepatoportal area, results from a coagulopathy. This study determined if this could be quantitated by a modified recalcification time (MRT) test developed in our laboratory. Unlike prothrombin (PT) and activated partial thromboplastin times (APTT), the MRT is performed with whole blood to ensure the role of blood cells and chemicals (particularly tissue factor, a potent procoagulant) in the coagulation process. Candidates for liver transplantation (n=1 1) were studied. Samples (5 mL) of citrated venous blood were obtained from the patients. Aliquots (1 mL) from these samples were divided into groups of vials labeled C, S, and E. Groups C and S received 20 pL saline and group E, 20 pL of saline containing 10 pg of Escherichia coli endotoxin (055: B5W). Vial C was incubated for 10 minutes and vials S and E for 120 minutes, all at 370C. Then, the MRT was determined on 300 pL of blood from each vial after adding 40 pL of 0.1M calcium chloride. Mean MRT values (minutes±standard deviation) for C (MRTC), for S (MRTS), and for E (MRTE) were compared with like values from healthy controls (n=29). Despite prolonged PT and APTT values, MRT values were shortened From the Departments of Surgery, Anesthesiology, and Anatomy, UMDNJ-New Jersey Medical School, Newark, New Jersey. Requests for reprints should be addressed to Dr C.R. Spillert, Dept of Surgery, MSB/G505, UMDNJ-New Jersey Medical School, 185 S Orange Ave, Newark, NJ 07103-2714. 306
in patients with cirrhosis. This hypercoagulability detected by the MRT exonerates a hemorrhagic coagulopathy and possibly implicates widened and thinned gaps in the walls of the portal venous tributaries as the cause of pernoperative hemorrhage. (J Nat! Med Assoc. 1 996;88:306-309.) Key words * prothrombin time * activated partial thromboplastin time * cirrhosis The life-threatening consequences of hemorrhage from esophageal varices and from portal venous collaterals during surgical procedures performed in the hepatobiliary area are of great concern in the care of patients with hepatic cirrhosis., It is believed that this hemorrhage is largely due to a coagulopathy resulting from deficient coagulation factors produced by the diseased liver. Therefore, this study was conducted to determine if the hemorrhagic potential could be quantitated by a modified recalcification time (MRT) test developed in our laboratory. The rationale, methodology and interpretation of the MRT were summarized elsewhere.' Unlike the traditional prothrombin time (PT) and activated partial thromboplastin time (APTT), the MRT is performed with whole blood. This ensures assessment of the role of blood cells as well as chemical constituents (particularly tissue factor, a potent procoagulant) in the coagulation process. The hallmark of the MRT is based on the variability of latent tissue factor carried by the monocyte depending on prior priming of the monocyte in vivo.2 Release of latent tissue factor from the monocyte is accomplished by activation of the JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 88, NO. 5
DECEPTIVE PROTHROMBIN IN CIRRHOSIS
TABLE 1. MEAN MRTC, MRTS, AND MRTE VALUES IN CIRRHOTICS AND CONTROLS MRTS MRTC MRTE Group A: 5.6+1.5 C: 5.3+.0 E: 4.1 0.9 Cirrhotics (n=11) D: 6.8±1.2 B: 7.4±1.0 F: 5.7±0.9 Controls (n=29) P
