The regional lymph in Disseminated intravascular coagulation syndrome development in experimental peritonitis.

Federal Government-Funded Educational Institution of Higher Professional Training under the Ministry of Health of the Russian Federation Volgograd state medical University

Author: Fastova I.A.

Сo-authors: Yakovleva D.A.

Introduction. In the light of current knowledge, peritonitis is viewed as a systemic inflammatory response of the body to a developing purulonecrotic process in the abdominal organs. Clinical presentations of peritonitis include endotoxicosis and multiple organ dysfunction where the lethal outcome rates range between 30 % to 86 % [3, 4]. In about 60 % of patients who died of peritonitis, hemocoagulation disturbance in the form of disseminated intravascular coagulation (DIC) was revealed [1, 2, 5]. In this case, small disseminated clots of fibrin, erythrocytes, leucocytes and of mixed composition are revealed. The body’s internal environment is invaded by aggressive factors, secondary endogenous toxic substances, and thromboplastic active substances formed in the intestine. They arrive by two routes: via the portal system, and via mesenteric lymph which enters the thoracic duct and further the systemic circulation; thus the development of DIC syndrome is triggered.

Background. The aim of the research was to determinate the role of mesenteric lymph in DIC syndrome development in experimental peritonitis.

Methods. In experiments conducted on 12 mature nonpedigree dogs we modeled peritonitis with nembutal anesthesia by introducing the animal’s fecal masses into the abdominal cavity. Blood was taken from the femoral vein, and lymph—from the intestinal tract at baseline, and 3 and 6 hours after peritonitis inducement. 6 dogs which received sham surgery composed the control group. Coagulation and fibrinolysis factors were determined with Technology Standard test systems on CGL-2110 turbidimetric hemocoagulometer (Minsk, Belarus). To estimate the general coagulating power of the blood and lymph, we determined the activated partial thromboplastin time (aPTT), prothrombin time (PTT), thrombin time (TT), antithrombin III (AT III), and fibrinolysis. Hematocrit and the amount of leucocytes were counted as well. In the course of experiments 3 animals died. All experimental animals and those who died underwent a postmortem examination. The findings we obtained went through statistical processing using Student’s t distribution.

Results. Throughout the experiment of modeled peritonitis, the hematocrit value in the blood showed a considerable increase from 45.74 4.7 at baseline to 52.34 4.7 within 6 hours (p<0.01). The number of thrombocytes elevated within 3 hours of the experiment and dropped significantly by the 6^th hour of induced peritonitis (p<0.01). The lymph flow velocity at baseline amounted to 0.34±0.02 ml/min. In 3 hours it increased to 0.54±0.03 ml/min (p<0.05); and by the 6^th hour of induced peritonitis it dropped to 0.26±0.02 ml/min. Analyzing the obtained data one can state that a reliable reduction of aPTT, TT, PTT, as well as an increase in AT III and fibrinogen concentration and fibrinolysis time can be observed. By the 6^th hour of the experiment the coagulating power of the blood decreased significantly (p<0.001). As early as within the first three hours of the experiment, coagulation depletion was noted in mesenteric lymph: aPTT, TT, and PTT grew longer while the concentration of fibrinogen and AT III decreased. These trends intensified by the 6^th hour of induced peritonitis. Throughout the experiment, we noted enhanced fibrinolysis in the lymph.

Indicators	Blood plasma (v.femoralis)			Lymph (tr.intestinalis)
	Initial	3h.	6h.	Initial	3h.	6h.
	n=9	n=9	n=9	n=9	n=9	n=9
Prothrombin time, sec.	16,03±0,07	13,74±0,2***	18,33±0,32***	36,7±2,2	48,75±3,2***	53,6±5,3***
Thrombin time, sec.	27,88±0,45	17,7±0,2***	31,49±0,36***	25,1±3,45	32,8±4.24***	48,82±4,7***
aPTT, sec.	23,02±0,53	20,21±0,22**	26,8±0,39**	38,92±5,7	46,89±2.8***	65,7±6,7***
Fibrinogen, g/l.	2,722±0,06	3,478±0,18**	1,5±0,07***	0,35±0,08	0,26±0,03***	0,18±0,02***
Antitrombin-III, %	98,28±0,23	146,5±1,5***	65,58±1,3***	21,7±0,62	17,4±1,2***	13,73±2,13***
Fibrinolysis, min.	190,7±1,23	203,2±1,03***	189,8±0,88	256±35	167,8±8,2***	96±13***

Note: * - p<0,05; ** - p<0,01; *** - p<0,001 compared with the initial.

Conclusions. Development of experimental peritonitis produces changes in blood coagulation and regional lymph. The blood (femoral vein) primarily responds to peritonitis development by activating the coagulation system while regional lymph (intestinal tract) responds by suppressing the coagulation system, as a result of a sudden discharge of the coagulating factor into the systemic circulation. Throughout the experiment, the fibrinolytic activity of mesenteric lymph was considerably higher than in the blood.

Literature.

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