Systemic activation of fibrinolysis may develop in certain clinical situations, either as a primary or secondary process.
Risk factor
Pathogenesis
acute promyelocytic leukemia (APML)
release of plasminogen activators (distinct from risk for DIC)
disseminated malignancy
release of plasminogen activators
urologic surgery, especially prostatectomy
shock, severe trauma, major surgery or heatstroke
release of plasminogen activator
cardiopulmonary bypass
infusion of thrombolytic agents
disseminated intravascular coagulation (DIC)
hereditary deficiency in plasmin inhibitors (familial fibrinolysis)
decreased levels of plasmin inhibitors
amyloidosis
decreased levels of plasmin inhibitors due to absorption onto amyloid fibrils
liver disease
decreased synthesis of plasmin inhibitors
liver disease, end-stage
decreased clearance of plasmin and plasminogen activators
where:
• Plasmin inhibitors include alpha-2 antiplasmin and plasmin activator inhibitor-1.
• Thrombolytic agents include urokinase, streptokinase, and t-PA.
• Localized release of plasminogen activator can result in menorrhagia.
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Specialty: Hematology Oncology, Clinical Laboratory
