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Thromb Haemost 1974; 32(02/03): 292-305
DOI: 10.1055/s-0038-1647700
Original Article
Schattauer GmbH

Regulation of Fibrinogen Synthesis in Portal Hypertension[*]

M Grün
1   Department of Medicine, University of Würzburg, Germany (Dir.: Prof. Dr. H. A. Kühn)
,
H Liehr
1   Department of Medicine, University of Würzburg, Germany (Dir.: Prof. Dr. H. A. Kühn)
,
D Brunswig
1   Department of Medicine, University of Würzburg, Germany (Dir.: Prof. Dr. H. A. Kühn)
,
H Thiel
1   Department of Medicine, University of Würzburg, Germany (Dir.: Prof. Dr. H. A. Kühn)
› Author Affiliations
Further Information

Publication History

Received: 19 June 1973

Accepted: 04 June 1974

Publication Date:
24 July 2018 (online)

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Summary

The fibrinogen synthesis rate in patients with cirrhosis of the liver is enhanced. To confirm this, both experimental and clinical investigations were carried out. The fibrinogen synthesis rate was studied, using the incorporation rate of 14-C-Leucine into thrombin clottable plasma protein in the setting of experimental portal hypertension caused by gradual occlusion of the portal vein. Under these conditions the plasma distribution space increased to 148% of the control (day 6). This was dependent on the amount of the portocaval shunt volume. While plasma fibrinogen concentration remained unaltered, the plasma fibrinogen pool increased to 154% of the controls. At the same time, the fibrinogen synthesis rate increased to 159%. In relation to liver weight per 100 gm body weight the rate of synthesis was much more enhanced (211 % of control). During the decline to normal plasma volume, due to a decrease of portocaval shunt volume, the fibrinogen synthesis was inhibited (61% of control).

Under clinical conditions in patients with cirrhosis and portal hypertension, the pathophysiological state is in important aspects comparable to the experimental model. A group of 28 patients with cirrhosis was investigated from the same point of view. In these patients the plasma volume and the plasma fibrinogen pool was markedly increased, depending again on the portocaval shunt volume but not on the portal pressure. From these data it is concluded that in patients with cirrhosis fibrinogen synthesis is enhanced.

* Dedicated to Prof. Dr. H. A. Kuhn on the occasion of his 60th birthday.


 

  • References

  • 1 Ansari A, Silvis S. E. 1972; Plasma fibrinogen in health and disease. American Journal Gastroeneterology 57: 13.
    PubMedGoogle Scholar
  • 2 Bateman J. C, Shorr H. I, Elgvin T. 1949; Hypervolemic anemia in cirrhosis. Journal of Clinical Investigations 28: 539.
    CrossrefPubMedGoogle Scholar
  • 3 Bocci Y, Pacini A. 1973; Factors regulating plasma protein synthesis. II. Influence of fibrinolytic products on plasma fibrinogen concentration. Thrombosis et Diathesis Haemorrhagica 29: 63.
    PubMedGoogle Scholar
  • 4 Buchenau D, Liehr H. 1973; Die Bestimmung des Lebervolumens mittels Ultraschall. Zeitschrift für Gastroenterologie 11: 11.
    PubMedGoogle Scholar
  • 5 Feissly R, Lüdin H. 1949; Microscopie par contrastphasis : Application à l’hematologie. Revue d’hématologie 04: 481.
    PubMedGoogle Scholar
  • 6 Hiller G. I, Huffmann E. R, Levey S. t. 1949; Studies in cirrhosis of the liver. I. Relationship between plasma volume, plasma protein concentration and total circulating proteins. Journal of Clinical Investigations 28: 322.
    CrossrefPubMedGoogle Scholar
  • 7 Hörder M. H, Huth K, Leinweber B, Lasch H. G. 1968; Verbrauchskoagulopathie bei Leberzirrhose?. Verhandlungen der Deutschen Gesellschaft für innere Medizin 74: 150.
    PubMedGoogle Scholar
  • 8 Hörder M. H. 1969; Consumption coagulopathy in liver cirrhosis. Thrombosis et Diathesis Haemorrhagica Suppl 36: 319.
    PubMedGoogle Scholar
  • 9 Krauss H, Liehr H, Grün M, Thiel H. 1973; Histological investigations concerning consumption coagulopathy in rats with gradual occlusion of the portal vein. Beiträge zur pathologischen Anatomie und zur allgemeinen Pathologie 149: 84.
    PubMedGoogle Scholar
  • 10 Liehr H, Hörder M. H, Mersch-Baumert K. 1971; a Hämostasestörungen bei Leberzirrhose. Acta Hepato-splenologica 18: 166.
    PubMedGoogle Scholar
  • 11 Liehr H, Grün M, Hörder M. H, Binder H, Pöschmann A. 1971; b Portale Hypertension der Batte durch protrahierten Gefäßverschluß. Zeitschrift für die gesamte experimentelle Medizin 155: 267.
    PubMedGoogle Scholar
  • 12 Liehr H, Grün M, Hörder M. H, Mersch-Baumert K. 1972; a Umsatzstörungen im Gerinnungssystem bei experimenteller portaler Hypertension der Ratte. Acta-hepato-gastroenterologica 19: 98.
    PubMedGoogle Scholar
  • 13 Liehr H, Grün M, Thiel H, Krauss H, Rost R. 1972; b Hepatic blood flow in rats with galactosamine hepatitis. Acta hepato-gastroeneterologica 19: 259.
    PubMedGoogle Scholar
  • 14 Liehr H, Grün M, Thiel H, Rost R. 1973; a Hämodilution und Hyperzirkulation als Kompensationsmechanismus reduzierter portaler Leberdurchblutung bei portaler Hypertension. Zeitschrift für Gastroenterologie 11: 391.
    PubMedGoogle Scholar
  • 15 Liehr H, Zwirner R. 1973; b Pathophysiologische Überlegungen zur portocavalen Shunt operation. Deutsche medizinische Wochenschrift 98: 1140.
    PubMedGoogle Scholar
  • 16 McFarlane A. S, Todd D, Cromwell S. 1964; Fibrinogen catabolism in humans. Clinical Sciences 26: 415.
    PubMedGoogle Scholar
  • 17 Mammen E. F. 1970; Gerinnungsstörungen bei Lebererkrankungen. Deutsche medizinische Wochenschrift 95: 2241.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 18 Miller L. J, Titthasiri N, Hanvan H. R. (cited by : ADELSON, E . (1968): 1961. Proceedings of Fifth Internal Congress of Biochemistry Moscow. Fibrinogen Metabolism. In: Laki K. Fibrinogen; New York: 225.
    Google Scholar
  • 19 Milstone H. 1941; A factor in normal human blood which participates in streptococcal fibrinolysis. Journal of Immunology 42: 109.
    PubMedGoogle Scholar
  • 20 Murray J. F, Dawson A. M, Sherlock S. 1958; Circulatory changes in chronic liver disease. American Journal of Medicine 24: 338.
    PubMedGoogle Scholar
  • 21 Perera G. A. 1946; The plasma volume in Laennec’s cirrhosis of the liver. Annals of Internal Medicine 24: 643.
    CrossrefPubMedGoogle Scholar
  • 22 Ratnoff O. D, Menzie C. 1951; A new method for determination of fibrinogen in small samples of plasma. Journal of Laboratory and Clinical Medicine 37: 316.
    PubMedGoogle Scholar
  • 23 Schröder J, Börner W, Qualo R. 1958; Über die Abhängigkeit der zirkulierenden Blutmenge von der Körperzusammensetzung. Zeitschrift für Kreislaufforschung 47: 714.
    PubMedGoogle Scholar
  • 24 Thiel H, Grün M, Liehr H. 1973; Die Bestimmung des plasmatischen Verteilungsraumes bei der Ratte. Arzneimittelforschung (Drug Research) 23: 979.
    PubMedGoogle Scholar
  • 25 Tsakiris A, Bühlmann A. 1963; Hämodynamische Befunde bei Leberzirrhose. Schweizerische medizinische Wochenschrift 93: 325.
    PubMedGoogle Scholar
  • 26 Tytgat G. N, Collen D, Verstraete M. 1971; Metabolism of fibrinogen in cirrhosis of the liver. Journal of Clinical Investigation 50: 1690.
    CrossrefPubMedGoogle Scholar
  • 27 Young M. C, Kolmen S. N. 1970; Recovery of fibrinogen in fibrinolytic dogs. Influence of split products. Thrombosis et Diathesis Haemorrhagica 23: 50.
    PubMedGoogle Scholar