The role of hemorheological disorders in the pathogenesis of hemorrhagic pancreatic necrosis: 616.13-008.64

Abstract

Summary. Background. The pathogenesis of acute pancreatitis and pancreonecrosis is still the focus of researchers and clinicians. The role of hemorheological disorders in these diseases remain uncertain until now. Objectives: to define the role of hemorhe- ological disorders in the pathogenesis of hemorrhagic pancreonecrosis and to study the specifics of the mechanism of these disorders. Patients/Methods. This study included 29 patients (12 women and 17 men, age of 23 to 60 years old) with hemorrhagic pancreatic necrosis. We examined blood viscosity, hematocrit and some erythrocyte properties as count, diameter, aggregation, electrophoretic mobility, deformability and mechanical resistance; other investigated parameters were plasma protein composition, plasma and erythrocytes sialic acid concentrations, lipids, total calcium and fibrinogen concentrations, blood fibrinolytic activity, platelets aggregation activity; total hemocoagulation activity was studied with thromboelastography. Control group contained 15 practically healthy individuals (7 women and 8 men). Results. Expressed disturbances of blood rheological properties, mostly in erythrocytes were detected in patients with pancreonecrosis. Red blood cells (RBC) showed 2-times decreasing of mechanical resistance, of their volume by 18.7%, of deformability by 43.8%, of count by 8.75%. Hematocrit remained normal level due to RBC increased volume (sphericity). RBC aggregation had been increased by 1.8 times. Blood viscosity at the shear rate of 1 s–1 was increased by 3.3 times and at the shear rate of 150 s–1 by 1.58 times. Raised erythrocyte aggregation was caused by a decrease of RBC electrophoretic mobility of 35.9%. Sialic acid concentration in RBC membranes was lower of 20.8% whereas conjugated sialic acid in plasma showed increasing by 2.25 times. Conclusions. RBC morphofunctional and physicochemical disturbances cause the increase in blood viscosity in patients with pancreonecrosis. It is distinguishing feature of hemorheological disorders in hemor- rhagic pancreonecrosis developing, seems, due to high activity of proteolytic enzymes and biologically active amines. Of particular importance in hemorrhagic pancreonecrosis belong to platelet involving into intravascular coagulation.

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