SummaryWe characterized a symptomatic CRMred factor X (FX) deficiency produced by the Glu19Ala mutation in the γ-carboxyglutamic-rich domain. FX activity levels in plasma were markedly reduced in prothrombin time assays (< 1-5%), whereas in activated partial thromboplastin assays (16%) and in RVV assays (17%) the reduction in activity mirrored that in antigen levels (17%). Activation of recombinant 19Ala-FX by factor IXa/factor VIIIa or RVV, and the activity in thrombin generation assays, were comparable to those of wild-type FX. Differently, complete activation of recombinant 19AlaFX required a factor VIIa/TF concentration 30-fold higher than that of wild-type FX. The recombinant FVIIa significantly reduced PT values in 19Ala-FX reconstituted plasma, thus suggesting an alternative approach for treatment of FX deficiencies characterized by defective FX activation.The study of this FX deficiency provides an “in vivo” and “in vitro” model for the investigation of Gla domain interactions.

Intradialytic hypoxemia, leukopenia and coagulation system activation were monitored in 9 uremic patients during hemodialysis with cuprophane (Cu) and polysulfone (Psf) membranes, using the following parameters: polymorphonuclear count (PMN), elastase alpha-1 proteinase inhibitor (EI-alpha 1PI) complex, platelet count, beta-thromboglobulin (BTG), fibronectin (FN) and arterial oxygen tension (PaO2). Our results indicate that 1) intradialytic hypoxemia observed with both membranes does not seem to be exclusively related to the well-known membrane-dependent leukopenia; 2) platelet activation, as demonstrated by the plasma BTG increase, appears to be an exclusive cellulosic membrane-related phenomenon; 3) at the same time platelet activation seems to be the major factor responsible for high FN levels, the highest FN levels occurring concurrently with the lowest platelet count.

Summary: Twenty-eight consecutive patients with mitral valve prolapse (MVP), seven of whom had previous cerebrovascular disorders (CVD), were studied for platelet function and coagulation tests. While platelet function tests were found to be normal with the exception of platelet aggregation rate (PAR), there was a significant rise of factors VIII vWF:Ag (Von Willebrand) and (FPA) fibrinopeptide A. Six cases had high levels of both these factors, suggesting the existence of a particular subset of patients with MVP, with a higher risk of thromboembolic episodes, although only three out of seven patients with previous CVD had either FPA or VIII vWF:Ag levels. The broad spectrum of subjects with MVP probably explains the different results obtained when studying platelet function and coagulation factors. Therefore, larger population studies and prolonged follow-up of cases with either coagulation abnormalities similar to the ones found in the present report and/or altered platelet function tests are suggested to discover if it is possible to detect patients with a potential for thromboembolism.

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All arteries leading to the liver were ligated and an end-to-side portacaval shunt was performed in twelve pigs. Before and 1,3,6 and 9 hrs after the laparatomy a blood sample was drawn by femoral artherial catheter. APTT, Prothrombin, Factor VIII AHF(one-stage method), platelet and red cells counts, fast-acting Antiplasmin by S-2251, AT III by S-2238 were performed on each sample. Prothrombin slowly but progressively decreased while APTT reduced. VIII AHF showed a little increase at first but the higher level, about the 160% of initial value, was recorded at the 9th hr.AT III increased during the 1st hr but, as Antiplasmin, slowly decreased to the 70% in the following, hours. The AT III and the first VIII AHF increase occurred during portal, vi na clumping, simultaneously to a very deep fall of blood pressure. The cases of portal system and an adrenergic stress may explain this finding. The survival of the pigs was quite costant, more than 24 hrs: this model of hepatitis failure has been chosen for application of articial devices to support liver function.