Biography
Biography: Dr. Elena Fokina
Abstract
Purpose of the work.
To study the hemostatic system changes in the dynamics of infection in patients with erysipelas to clarify the pathogenesis of hidden hemolysis and correction of drug therapy
Methods.
The degree of disfibrinogenemia (fibrinogen and D-dimer level), the functional activity of the platelets (aggregation with ADP) and the erythrocytes (aggregation with lanthanoid (LaCl3) and protamine sulfate (PS)) were studied in 60 patients with erysipelas. Also, we have studied endothelial dysfunction manifested in the decrease of athrombogenicity of vascular wall endothelium (antithrombin III and protein C) and in the increase of adhesive properties of the endothelium (von Willebrand factor (vWf).The comparison groups comprised patients with focus of inflammation localized on the face (n=24), and the legs (n=36) at various stages of the disease (day 1-3; 4-6; 7-10; and 11-15 from the onset of the disease), undergoing in hospital treatment in Moscow 2nd Clinical Hospital for the Infectious Diseases.
Results and discussion.
The thesis, according to which the rate of hemorrhagic complications in leg erysipelas is by 3,9 times higher than in facial erysipelas, was confirmed by laboratory findings. A significant decrease of protein C was noted in patients with leg erysipelas and concomitant chronic venous insufficiency. We have found increased D-dimer and decreased α2-macroglobulin levels. The signs of intravascular (latent) hemolysis (the decrease of haptoglobin concentration and the increase of indirect bilirubin and LDH blood level) with the increase of erythrocytes deformability (aggregation with LaCl3 by 37%) and the decrease of elasticity (aggregation with PS by 2 times) - have been identified as one of the main factors for DIC-like syndrome in erysipelas.
Conclusions and recommendations.
The risk of developing severe (hemorrhagic, bullous-hemorrhagic) erysipelas form in lower-limb is higher, than in facial, OR = 9,88 [2,81; 34,7]. Signs of intravascular hemolysis are the indication for drugs that improve the rheological properties of blood.