Fibrinolytic changes in a patient with toxic shock syndrome; release of active u-PA

• Published in: Intensive care medicine Vol. 24; no. 3; pp. 258 - 261
• Main Authors: HAJ, M. A, ROBBIE, L. A, CROLL, A, ADEY, G. D, BENNETT, B
• Format: Journal Article
• Language: English
• Published: Heidelberg Springer 01-03-1998; Berlin Springer Nature B.V
• Subjects: Ablation; Adult; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Antigens; Bacteremia - complications; Biological and medical sciences; Blood platelets; Catheter Ablation - adverse effects; Cross Infection - complications; Diarrhea; Emergency and intensive care: infection, septic shock; Female; Fibrinogen - metabolism; Fibrinolysin - metabolism; Fibrinolysis; Humans; Intensive care; Intensive care medicine; Medical sciences; Multiple Organ Failure - microbiology; Plasma; Plasminogen - metabolism; Plasminogen Activator Inhibitor 1 - blood; Postoperative Complications - metabolism; Postoperative Complications - microbiology; Respiratory distress syndrome; Sepsis; Shock, Septic - metabolism; Shock, Septic - microbiology; Staphylococcal Infections - complications; Tissue Plasminogen Activator - blood; Urokinase-Type Plasminogen Activator - blood; United Kingdom > UK; u-Plasminogen activator; Cardiovascular disease; Plasmin; t-Plasminogen activator; Toxic shock syndrome; Bacteria; Micrococcales; Adult; Respiratory distress; Female; Micrococcaceae; Exotoxin; Staphylococcus aureus; Quantitative analysis; Human; Kidney disease; Urinary system disease; Serine endopeptidases; Pathophysiology; Respiratory disease; Enzyme; Septicemia; Acute; Exploration; Infection; Case study; Peptidases; Follow up study; Renal failure; Bacteriosis; Hydrolases; Staphylococcal infection
• ISSN: 0342-4642; 1432-1238
• DOI: 10.1007/s001340050561

Definition of the changes in the activators of plasminogen, u-PA and t-PA, and examination of the possible generation of plasmin in the circulation in overwhelming sepsis.
Serial blood analysis starting 4 h after development of symptoms of toxic shock syndrome.
Intensive care unit.
A previously healthy woman underwent endometrial ablation and rapidly thereafter developed staphylococcal toxic shock syndrome with organ failure. MEASUREMENT AND RESULT: t-PA, PAI-1, t-PA-PAI-1 complexes, plasminogen, fibrinogen and plasmin-alpha 2-antiplasmin complexes were measured serially by ELISA and free u-PA by SDS-PAGE with zymography. The onset of symptoms was accompanied by a rise of t-PA antigen-followed rapidly by PAI-1 antigen. Plasmin-alpha 2-antiplasmin complex was generated in large amounts but disappeared within hours. From day 3, free u-PA was detectable in the circulation without plasmin generation.
Despite the sustained presence of active u-PA in the circulation and of t-PA antigen at the onset of symptoms, plasmin-alpha 2-antiplasmin generation was largely suppressed by high levels of PAI-1. The suppression of plasmin generation by u-PA and t-PA may ensure the persistence of fibrin in the microcirculation and so contribute to organ failure.