Fibrinogen proteolysis and platelet alpha-granule release in
preeclampsia/eclampsia
Z Borok, J Weitz, J Owen, M Auerbach and HL Nossel
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.
Volume 63,
Issue 3,
pp. 525-531,
03/01/1984
Copyright © 1984 by The American Society of Hematology
