Year 2020 Vol. 28 No 6

PEDIATRIC SURGERY

.P. RAZIN 1, S.V. IGNATYEV 2, .S. SEMAKIN 3

COAGULATION DISORDERS IN CHILDREN WITH DESTRUCTIVE FORMS OF APPENDICITIS

Kirov State Medical University 1,
Kirov Research Institute of Hematology and Blood Transfusion of the Federal Medical-biological agency 2,
Kirov Regional Pediatric Hospital 3, Kirov,
The Russian Federation

Objective. To assess the hypercoagulable state of hemostasis in children with the destructive forms of appendicitis in the early postoperative period.
Methods. The study included children (n=30) with the destructive forms of acute appendicitis at the age of 7-14 years. The control group (n=50) consisted of healthy children. The severity of the intoxication-inflammatory syndrome was assessed according to the hemogram and biochemical blood analysis, the state of the coagulation link of hemostasis on the basis of screening, local tests and the integral test Thrombodynamics.
Results. There was a significant increase in the number of leukocytes, stab and segmented neutrophils, ESR in patients with the destructive forms of appendicitis in the early postoperative period. Leukocyte index of intoxication corresponded to moderate and severe patients 5.73; 3.6-7.4 (Me; Q1-Q3), C-reactive protein in the study group exceeded the norm 32 folds 163.8; 132.8-224.9 mg/l (Me; Q1-Q3). We established a statistically significant increase in the concentration of fibrinogen (5.91.0 g/l), soluble fibrin monomer complexes (204.059.1 μg/ml), factor VIII (301.396.6%), von Willebrand factor (226.062.5%) and its activity (161.536.2%), a significant increase in the indices of the integral test Thrombodynamics initial clot growth rate Vi (60.53.9 μm/min), stationary clot growth rate Vst (41.13.9 μm/min), CS clot size (1444.2192.9 μm) and clot density D (31157.62599.3 c.u.). The results of all patients in the study group showed inhibition of plasma fibrinolytic activity.
Conclusion. Destructive forms of appendicitis are accompanied by a pronounced intoxication-inflammatory syndrome in combination with hypercoagulation disorders of the hemostatic system, which causes a state of increased thrombotic readiness, which, in the presence of additional factors, can result in thrombosis. This is the basis for additional studies and a more scrupulous diagnostic search for thromboembolic complications in children.

Keywords: appendicitis, peritonitis, surgical treatment, coagulation disorders, hypercoagulation, prothrombotic condition, thrombosis
p. 664-670 of the original issue
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Address for correspondence:
610027, Russian Federation,
Kirov, Karl Marx Str., 112,
Kirov State Medical University
of the Ministry of Health
of the Russian Federation
tel. +7 912 828-15-27,
e-mail:mprazin@yandex.ru,
Razin Maxim Petrovich
Information about the authors:
Razin Maxim P., MD, Professor, Head of the Pediatric Surgery Departmentr, Kirov State Medical University, Kirov, Russian Federation.
https://orcid.org/0000-0003-3561-3256
Ignatyev Sergey V., PhD, Senior Researcher of the Scientific and Clinical Department of Hematology, Chemotherapy and Bone Marrow Transplantation, Kirov Research Institute of Hematology and Blood Transfusion of the Federal Medical-biological Agency, Kirov, Russian Federation.
http://orcid.org/0000-0002-8457-2967
Semakin Alexander S., Pediatric Surgeon, Kirov Regional Pediatric Hospital, Kirov, Russian Federation.
http://orcid.org/0000-0002-6889-0543
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