August 1981

Accelerated Fibrinogen and Platelet Destruction After Peritoneovenous Shunting

Author Affiliations

From the Departments of Medicine (Dr Stein and Mss McLemore and Schwotzer) and Surgery (Drs Fulenwider, Ansley, and Nordlinger), Emory University School of Medicine, Atlanta, and the Division of Hematology, Centers for Disease Control, Atlanta (Dr Evatt and Ms Wideman).

Arch Intern Med. 1981;141(9):1149-1151. doi:10.1001/archinte.1981.00340090045011

• Peritoneovenous shunting with the LeVeen valve is generally recognized as an effective procedure for the treatment of intractable ascites and renal failure associated with severe liver disease. We recently observed a generalized hemorrhagic diathesis in patients receiving these valves. To investigate the mechanism of this hemorrhagic complication, we prospectively performed kinetic studies with 51Cr-labelled platelets and 125I-labelled fibrinogen in ten patients. When results of studies before and after valve insertion were compared, the following reductions were noted: fibrinogen concentration, 55%; the fibrinogen survival, 49%; the platelet count, 55%; and the platelet survival, 35%. No endotoxin was detectable in ascitic fluid preoperatively, and there was no apparent relationship between ascitic fluid cell counts and changes in fibrinogen and platelet survival. Until the component or components of ascitic fluid responsible for accelerated consumption can be identified and steps are taken to modify the rates of platelet and fibrinogen consumption, it would seem prudent to select patients for surgery conservatively.

(Arch Intern Med 1981;141:1149-1151)