Plasmatic and cell components of hemostasis in patients with serious burned wounds: studying at early period of disease

Abstract

We studied coagulation parameters of severely burned patients at early period of disease (1–10 days). All patients had II–III degree burned wound, varied from 22 to 75 % total body surface area (median 40 % [35; 60]). Patients were divided into two groups: survival (35 patients, 1th group) and lethal (19 patients, 2nd group) outcomes. During burned shock (1st‑2nd day) 1th group had normal activated partial thromboplastin time, fibrinogen concentration, protein C activity, whereas in 2nd group these parameters were reliably abnormal. In both groups we noticed significant decay of antitrombin III activity and increase of D-dimer, followed by very low integrity of platelets. We found correlation between morphofunctional platelet rate and blood clotting activity. At 3rd day all patients showed significant increase of fibrinogen concentration without change of other parameters. At 10th day patients with survival outcome normalized antitrombin III activity and had particular recover of platelet integrity, patients with lethal outcomes did not have such effects. Values of D-dimer, antitrombin III and protein C activity reliably differed between the groups throughout the observation period. The decrease of antitrombin III and protein C activity in the first day after the burn is critical. Reducing the activity of antitrombin III less than 75 % is a predictor of adverse outcome.