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Title: Studies of coagulation and fibrinolysis in normal and pregnant subjects
Author: Woodfield, D. G.
Awarding Body: University of Edinburgh
Current Institution: University of Edinburgh
Date of Award: 1968
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In this thesis, the development, refinement and standardisation of a wide range of coagulation and fibrinolytic assay techniques are described. Particular attention was directed towards the assay of Factor VIII, cryofibrinogen and fibrin/fibrinogen degradation products (F.D.P.). A new type of coagulation end point recorder was investigated and the use of the Atlas computer in the analysis of results is outlined. In addition, a study was made of various standard plasma preparations for the control of coagulation factor assays. Using these laboratory techniques, the effect of severe and moderate exercise, adrenalin infusions and beta- adrenergic receptor blockage on selected parameters of the coagulation and fibrinolytic systems, in normal volunteers, were studied. No correlations were observed between parameter changes in either system, and contrary to some reports, Factor XII was not increased post exercise. Some subjects exhibited a low fibrinolytic response to the exercise procedures, confirming previous work from this laboratory, but the coagulation response in these individuals did not appear to differ in any constant manner from the normal pattern. The adrenalin induced changes in Factor VIII were completely blocked by Propranolol, but this drug only partially lowered the response to adrenalin of plasminogen activator. The new beta -adrenergic blocker drug, ICI 50172, was fouhd to have only minimal effects on the two systems. These results are fully discussed in the light of presently available concepts of the haemostatic mechanism. In the studies on pregnant subjects, parameters of coagulation and fibrinolysis throughout the gestational period were measured. One new finding was that of a significant increase of serum F.D.P. in late pregnancy. It was also found, in another study, that the reactivity of the fibrinolytic system to an exercise stress in the third trimester was greatly impaired in some subjects. Further coagulation and fibrinolytic studies in pregnant and non -pregnant patients undergoing intra- abdominal surgical operations, demonstrated that significant changes occurred in euglobulin lysis activity, fibrinogen and F.D.P. levels. The application of specific coagulation and fibrinolytic tests to clinical haemostatic emergencies of pregnancy is described in the final section. All these studies have provided a basis for a fuller discussion in each section, of concepts such as the Shwartzman reaction, disseminated intravascular coagulation, and haemorrhage and thromboembolism. It is concluded that although some of the physio-pathologidal interrelationships of coagulation and fibrinolysis are now becoming clarified, many problems still remain, and these may only be resolved when improved methodology becomes available. The extension of work reported in this thesis may aid in the elucidation of important aspects of haemorrhage and thrombosis.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available