The Fibrinolytic Enzyme System in Normal, Hemorrhagic and Disease States1

Abstract

A set of determinations including fibrinogen, active fibrinolysin, free and total profibrinolysin, and inhibitors is described which gives evidence of changes taking place intravascularly during hemorrhage from afibrinogenemia. Levels of these factors in normal pregnant and non-pregnant subjects are presented as a basis for comparison with cases involving surgical and obstetrical hemorrhage. The low levels of profibrinolysin and inhibitors in afibrinogenemia following abruptio placentae and surgery for cirrhosis of the liver indicate that fibrinolysis is probably the principle cause of this phenomenon. It is suggested that the profibrinolysin is activated in these cases, thus reducing the quantity of precursor, while the active enzyme which is formed destroys fibrinogen by intravascular hydrolysis. Many disease states, such as cirrhosis of the liver, prostatic carcinoma, and severe infection, appear to present their own pattern of variation in the factors described.