Endotoxin And Blood Coagulation In Patients With Traumatic- Haemorrhagic And Bacteriotoxic Shock

Blood coagulation and fibrinolysis was carefully monitored in patients suffering from traumatic-haemorrhagic shock. Parameters like antithrombin III (AT III),factor X (IIa), plasminogen,fibrin degradation products, antiplasmin and fibronectin were measured. It could be demonstrated that a severe haemorrhagic shock correlated with an activated blood coagulation and stabilisation of circulation was followed by normalisation of blood coagulation.

However in patients developping septic complications new disorders in blood coagulation were observed. The appearance of endotoxins was measured by a recently developped limulus amoebocyte lysate (LAL). Best results were obtained by diluting heat treated heparinized plasma samples followed by an incubation step with the X a substrate S-2222. Detection of less than 0.2 ng endotoxin/ml plasma could be achieved. The available data of 30 patients with traumatic-haemorrhagic and bacteriotoxic shock showed that the appearance of endotoxin mostly correlated with a decrease of AT III and fibronectin.

In conclusion, AT III, fibronectin and endotoxin may serve as sensitive markers in the early diagnosis of sepsis.