Fibrinogen/Fibrin Degradation Products in Serum of Patients with Idiopathic Thrombocytopenic Purpura: Elevated Levels during Severe Thrombocytopenic Phase of the Disease

Summary

Sera from 23 patients with idiopathic thrombocytopenic purpura (ITP), 14 patients with aplastic anemia with severe thrombocytopenia and healthy control subj ects were tested for the presence of fibrinogen/fibrin degradation products (FDP), using the tanned red cell hemagglutination inhibition immunoassay. The concentrations of circulating FDP of ITP patients (mean 12.01 μg/ml) were significantly higher than those of the patients with aplastic anemia (mean 4.01 μg/ml, p <0.05) or normal controls (mean 3.10 μg/ml, p <0.001). The patients with untreated ITP with very low platelet counts had higher levels of FDP than those of the treated group (p < 0.01). Serum FDP and a battery of other coagulation-fibrinolysis tests were serially carried out over a period of 10 weeks in two patients with ITP. The initially high FDP promptly decreased as circulating platelets increased in response to steroid in both patients, while plasma fibrinogen, euglobulin lysis time, prothrombin time and partial thromboplastin time remained essentially normal during the course of observation. The exact source of the increased serum FDP in ITP was not extablished, but a few possible mechanisms responsible for this abnormality were discussed.

• References

• 1 Alkjaersig N. 1961. The antifibrinolytic activity of platelets. In: Johnson S. A, Monto J. W, Rebuck J. W, Horn Jr. R. C. (eds.) Henry Ford Hospital Symposium: Blood Platelets . Little, Brown; Boston: p. 329.
• 2 Aster R. H, Keene W. R. 1969; Sites of platelet destruction in idiopathic thrombocytopenic purpura. British Journal of Haematology 16: 61.
• 3 Baldini M. 1966; Idiopathic thrombocytopenic purpura. New England Journal of Medicine 274: 1245.
• 4 Brecher G, Schneiderman M, Cronkhe E. P. 1953; The reproducibility and constancy of the platelet count. American Journal of Clinical Pathology 23: 15.
• 5 Buckell M. 1958; The effect of citrate on euglobulin methods of estimating fibrinolytic activity. Journal of Clinical Pathology 11: 403.
• 6 Cohen P, Gardner F. H, Barnett G. O. 1961; Reclassification of the thrombocytopenias by the Cr⁵¹-labeling method by measuring platelet life span. New England Journal of Medicine 264: 1294.
• 7 Das P. C, Allan A. G. E, Woodfield D. G, Cash J. D. 1967; Fibrin degradation products in sera of normal subjects. British Medical Journal 4: 718.
• 8 Doan C. A, Bouroncle B. A, Wiseman B. K. 1960; Idiopathic and secondary thrombocytopenic purpura: clinical study and evaluation of 381 cases over a period of 28 years. Annals of Internal Medicine 53: 861.
• 9 Fearnley G. R, Chakrabarti R. 1964; Pharmacological enhancement of fibrinolytic activity of blood. Journal of Clinical Pathology 17: 328.
• 10 Fletcher A. P, Alkjaersig N, Sherry S. 1962; Pathogenesis of the coagulation defect developing during pathological plasma proteolytic (“fibrinolytic”) states. I. The significance of fibrinogen proteolysis and circulating fibrinogen breakdown products. Journal of Clinical Investigation 41: 896.
• 11 Kashiwagi H, Riddle J. M, Abraham J. P, Frame B. 1965; Functional and ultrastructural abnormalities of platelets in Ehlers-Danlos syndrome. Annals of Internal Medicine 63: 249.
• 12 Marder V. J, Matchett M. O, Sherry S. 1971; Detection of serum fibrinogen and fibrin degradation products: Comparison of six technics using purified products and application in clinical studies. American Journal of Medicine 51: 71.
• 13 Merskey C, Lalezari P, Johnson A. J. 1969; A rapid, simple, sensitive method for measuring fibrinogen split products in human serum. Proceedings of the Society for Experimental Biology and Medicine 131: 871.
• 14 Siegel A. 1956. Nonparametric Statistics for the Behavioral Sciences, International Student edn. (Kogakusha Co., Tokyo) McGraw-Hill Book Co.; New York: p. 116.
• 15 Stefanini M, Murphy I. 1956; Studies of platelets. XIV. Human platelets as source of anti-fibrinolysin. Journal of Clinical Investigation 35: 355.
• 16 Wintrobe M. M. 1967. Clinical Hematology.. Lea and Febiger; Philadelphia: 893.