Search

The changes in the level of glycated proteins and some factors of coagulation were studied in 30 patients with diabetes mellitus--15 with and 15 without diabetic retinopathy. The mean level of glycoalbumin was elevated (2.9 +/- 0.8 mg) HMF (mg protein) without an authentic difference in the two subgroups. Glycohemoglobin was also increased (means--13.6 +/- 1%) in all studied subjects The activity of antithrombin III was high (means--222 +/- 53%) and the concentration--reduced--means--22.1 +/- 2.2 mg%, without authentic difference in the two subgroups. The concentration of alpha-2-macroglobulin, as well as its activity showed no significant deviations. Factor VIII (von Willebrand) was within reference limits (means--97.04 +/- 15.06%) with a tendency to lower values in the group without diabetic retinopathy. Fibrinogen level (means--4.3 +/- 1.2 g) was within the reference range, and FDP--increased in the majority of the examined. A syndrome of intensified latent coagulability, equivalent to chronic decompensated DIC, determined by the basic dismetabolism and non-enzymatic glycating of proteins has been outlined. The changes are more marked in the cases with diabetic retinopathy.

The thrombocytic beta-thromboglobulin (beta-TG) level--a specific globulin secreted by the alpha-granules--is an important criterion in the contemporary diagnosis of acquired thrombocytopathies. The beta-TG was determined by the radioimmunologic test of the firm "Amersham" in thrombocytic lysates and thrombocyte-poor plasma of 54 persons: 24 patients with acute leukemia, 14 patients with chronic myeloid leukemia and 15 healthy controls. The leukemic patients were with a preliminary proved thrombocytopathy type "empty thrombocytic pool disease" which had been proved via aggregation measurement by the ATP and ADP levels in the thrombocytes and by the thrombocytic factor 4 level. While the intraplatelet beta-TG concentration in acute leukemia and chronic myeloid leukemia was found unchanged, in the patients with acute leukemia its secretion in the plasma was decreased (154.71 + 16.77 ng/10(5) platelets). The data interpretation shows that in these malignant hemopathies the alpha-granules do not take part in the "empty pool disease". In acute leukemia the pathogenesis of the thrombocytopathy is determined by the so-called "thrombocytic secretion paresis" which is confirmed by the thrombocytic factor 4 low level.

Factor VIII/von Willebrand antigen (VA), part of the molecule of plasma factor VIII, realizes the interaction between platelets and vascular endothelium and the triggering of primary hemostasis. The modern diagnostics and treatment of the complicated acquired thrombocytopathies are impossible without the investigation on the concentration of factor VIII/von Willebrand antigen. The immune coagulation method used allows the objective, exact and fast determination of VA--referent values have been developed in healthy subjects. The patients with blastic leukosis studied--28 and with chronic myeloleukemia--18, all with severe endogenous complicated thrombocytopathy, functionally and biochemically confirmed, showed normal values of VA/von Willebrand antigen. On the contrary, a slightly elevated VA was established in patients with diabetes with no vascular-degenerative syndrome, corresponding to the activation of platelet functions and to enhanced adhesiveness in particular, contributing to thrombotic complications. The data obtained are discussed in connection with the etiopathogenesis of the separate kinds of thrombocytopathies and the necessity of substitutive therapy.

In 35 patients with decompensated diabetes mellitus the following hemostatic indices were studied: glycohemoglobin, prothrombin time, partial thromboplastin time, fibrin monomers (determined by protamine sulfate test), fibrinogen and platelet count. A statistically significant decrease of the prothrombin time (p less than 0.001) and of the partial thromboplastin time (p less than 0.001) was found. Glycohemoglobin was significantly increased in all patients. The remaining indices were in the normal ranges. A syndrome of increased latent coagulability emerges which explains the tendency to thromboembolism in diabetes.

In 28 diabetics, classified into two groups according to the presence or absence of diabetic retinopathy, the following indices were examined: glycohemoglobin, factor VIII/von Willebrand, alpha-I-antitrypsin and alpha-2-macroglobulin. Factor VIII/von Willebrand and alpha-2-macroglobulin showed no changes in diabetes mellitus. Alpha-I-antitrypsin was statistically significantly decreased (p less than 0.05). Glycohemoglobin was significantly increased. No statistically significant differences were found between the two groups of diabetic patients (with and without retinopathy) studied for all indices examined.