Identification of soluble fibrinogen fibrin monomer complexes by non-enzymatic polymerisation in the tissue

Abstract

In states of plasmic hypercoagulability and consumption coagulopathy ethanol favours the non-enzymatic polymerization of circulating soluble fibrinogen fibrin monomer complexes (FFMC) in vitro. The ethanol-gelation test of Godal and Abildgaard makes use of this phenomenon, called paracoagulation. The present studies show that it is also possible to visualize soluble FFMC by means of ethanol-gelation. In the electron microscope, FFMC, polymerized non-enzymatically by ethanol in the spleen, are characterized by plump or slender mycelioid fibrillar precipitates that show a uniform rhythmic transverse striation, a period-coincidental filamentary arrangement and an average periodicity of 23 nm. The ultrastructure demonstrates these ethanol-induced filaments to be in vitro-polymerized fibrin monomer derivatives. Paracoagulation with ethanol allows the identification of soluble FFMC in the tissue prior to the formation of highly polymerized fibrin-rich microthrombi, the established equivalents of the DIC-syndrome. The electron microscope studies also show the existence of a second type of fibrillary structure in the tissue polymerized by ethanol. This second type lacks the characteristic periodicity of fibrin and the period-coincidental arrangement of the filamentary structures, but is characterized by closely packed or chain-like aligned, irregularly sized spherical bodies. There is some evidence that these spherical bodies in vitro represent non-enzymatically polymerized complexes of fibrin monomers and fibrin degradation products (FDP), the equivalent of a limited local or generalized fibrinolysis in vivo.

Morphologic Diagnosis of Disseminated Intravascular Coagulation: Histologic, Histochemical and Electronmicroscopic Studies

“…Systematic investigations on the ultrastructure demonstrated, however, that the fibrinogen derivatives adsorbed on the surface of the RES cells are only partly characterized by myceloid fibrillar precipitates with the axial periodicity of 23 nm. Furthermore, fibrillar bundles became visible, consisting of filaments with irregularly sized spheric bodies, arranged in chains [15]. Residues of filamentary structures with a transverse striation and a rhythmic axial periodicity, characteristic of fibrin, were only occasionally seen between the spheric precipitates.…”

“…Using fluorescein-labeled antifibrinogen antiserum, these fibrillar precipitates showed intensive secondary fluorescence. Electron microscopic studies of the ethanol-fixed paraffin sections [15] revealed fibrillar structures with a uniform transverse striation and an axial periodicity of 23 nm. This could not be demonstrated by fixation of the material with formalin.…”

“…Several findings suggest that these rudimentary chains of spheric structures on the surface of splenic RES cells represent fibrinolytic degradation products, the equivalents of a limited local or generalized fibrinolysis which, like fibrinogen, form soluble aggregates with fibrin monomers [15]. The electron microscopic findings of Stewart [80,81] have shown that fragment X, which forms during the early phases of fibrinolysis, may form aggregates after ethanol gelation.…”

“…Sometimes remnants of filamentary structures with trans verse striation became visible between the spheric bodies in the electron microscope. In view of these electron microscopic findings of Stewart [81] it becomes evident that the rudimentary chains of spheric structures on the surface of splenic RES cells may represent fibrinolytic degradation products which had already in vivo formed soluble aggregates with fibrin monomers [15]. The paracoagulation phenomenon thus can help to visualize not only soluble fibrinogen-fibrin monomer complexes but also soluble fibrin monomer-fibrin degradation product complexes, the equivalents of intravascular fibrinolysis during the early phase of DIC.…”

Perfusionsstörungen

“…Hyaline Membranen als Korrelate der Hyperkoagulabilität (BLEYL et al 1978). Als Folge der Zellnekrosen in der Alveolarwand treten Fibrinmonomere respiratorischen Insuffizienz im Schock der Mikrothrombosierung und nachfolgender Perfusionsstörung die größte Bedeutung zugemessen werden muß.…”