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 |
release of plasminogen activators |
|
shock, severe trauma, major surgery or heatstroke |
release of plasminogen activator |
|
cardiopulmonary bypass |
release of plasminogen activator |
|
infusion of thrombolytic agents |
release of plasminogen activator |
|
disseminated intravascular coagulation (DIC) |
release of plasminogen activator |
|
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.
Specialty: Hematology Oncology, Clinical Laboratory
