Lymfokoagulace
Coagulation factors
- Present in both blood and lymph
- Difference
- Quantitative
- Thrombocytes are not normally present in lymph (Howell,1914)
- Clots in the lymph specimens did not retract
- Deficiency of thrombocytes (Hayem,1896)
- Formation of thromboplastin in lymph is in a qualitative respect similar to that of blood
- Thrombocytes are not required for the formation of thromboplastin [49]
- Test for ?brinolytic activity
- Performed in lymph specimens failed to show any ?brinolytic activity.
- Concentration of antithrombin
- Was found to be identical between lymph and plasma [53]
- Plasminogen
- And proactivator activities of the lymph samples were 63 and 36% lower than in plasma
- Antiplasmin
- Inhibiting effects of lymph on plasminogen activation by streptokinase and urokinase
- 0 to 58% and 15% of those recorded in plasma [53]
- Human thoracic duct lymph contains phospholipid components
- Similar to those present at the platelet surface
- ?brinolytic activity of the lymph
- Remarkably higher than that observed in blood
- Lymphocytes present in the lymph
- Were ef?cient surrogates of blood platelets during lymph clotting [53]
- Hypocoagulation and hyper?brinolysis observed in blood
- Was accompanied by incoagulability of lymph
- Attributed to a sharp increase of heparin [53]
- Von Willebrand factor (VWF) antigen
- Most probably produced by lymphatic endothelial cells
- Was also very low (i.e., 5%, range 2 to 10%) as compared with plasma [53]
- TPA and PAI-1 are effectively produced and released by the lymphatic endothelium
- ?brinolytic activity is present in the lymph
- Might play a crucial role in the regulation of endogenous ?brinolytic activity within the lymphatic vascular lumen for the maintenance of lymph ?uidity [53]
Lymphatic thrombosis
- Rare occurrence
- Frequency is likely underestimated
- Substantially lower than that of venous or arterial thrombosis
- Fibrin generation is substantially inhibited under physiological conditions
- Making the lymph a hypocoagulable biological fluid
- Factor VIIa-tissue factor-catalyzed activation of factor X is possible in the lymph
Fibrin generation is largely counteracted by
- The unavailability of cell surface anionic phospholipids
- Such as those physiologically present on blood platelets
- Only low levels of coagulation factors
- Strong inhibitory activity of
- Heparin,
- Antithrombin,
- And tissue factor pathway inhibitor
- Enhanced fibrinolytic activity [54]
- Jídlem a lipidy v lymfě
Occasionally detected
- Especially in the thoracic duct
- Axillary
- Inguinal lymphatics [54]
Pathogenetic mechanisms
- Release of thromboplastin substances from the injured lymphatic endothelium
- Accompanied by chronic obstruction of lymph flow
- In the presence of a hypercoagulable milieu [54]
- Any source of lymphatic vessel occlusion might predispose to localized lymphatic thrombosis
- Internal obliteration
- External compression
- Increased lymphatic pressure [54]
- Could be triggered by liberation of thrombokinase by the tissues in the wall of the lymphatic
- Necrosis of cells in contact with the lymph stream
- Injection of bacteria
- Bacillus pyocyaneus
- Staphylococcus pyogenes aureus into the blood
- Infection of the tissues in the neighborhood of the lymphatic channel
Leading pathologies that can trigger thrombosis in the lymphatic vessels include
- Cancer
- External compression
- Neoplastic obliteration of the lymphatic lumen by metastatic cells
- Lymphatic dysfunction after lymph node dissection
- Infections
- Especially lymphatic filariasis [54]
- Sustained by Chlamydia trachomatis [54]
- Mycobacterium tuberculosis
- Treponema pallidum
- Streptococcus pyogenes [54]
- Uterine tract during puerperal fever
- Congestive heart failure
- Chronic edema and inflammation of the distal lower limb
- Complications of central venous catheterization
- Coronary artery bypass grafting
- Thoracic outlet syndrome
- Amyloidosis [54]
- Brugia malayi [54]
Kazuistiky
- Acute onset of cervical lymphedema following minor trauma or exceptional physical strain
- Using high-resolution ultrasound, it was possible to detect a thrombus formation in the terminal parts of the thoracic duct or the lymph duct.
- Within a few weeks all patients recovered without relapse for several years
www.researchgate.net/publication/317016927_Lymph_Vessel_Thrombus_Detection_in_Cervical_Lymphedema_A_Case_Series
Koagulace lymfy a lipidy
- Zvířata po 48 lačnění
- 10-20 minut
- Lymfa mléčná po tučném jídle
- 1-3 hodiny
www.physiology.org/doi/abs/10.1152/ajplegacy.1914.35.4.483?journalCode=ajplegacy
Heparin a lymfedem
- Logicky dobrý nález než dojde ke zvazivovatění fibrinu
- Dobré téma na grantovou práci
- Ke zvážení po vlekých operacích na lymfat. systému
Lymfatická obstrukce a oběh tekutin
- Neexistuje nyní antikoagulační terapie prevent. po chirrugickém výkonu nebo radioterapii
- Logické by bylo něco nasadit proti vzniku obstrukce v lymfatických cévách
- Lymfa obsahuje 30% koagulačních proteinů plasmy
- Může koagulovat při oblenění toku
- Vzniknou lymfatické zátky - obdoba bílých trombů
- Za 24h v klidu sdrce vytlačí více než 7 000 litrů krve
- Zátěží objem stoupne až na 4 násobek
- Subklinicky dekompenzovaní kardiálně
- Náhlé horšení se pacientů s lymfatickými otoky
- Různé faktory zatěžující na oběhový systém
- Kardiální složka otoků a může být i normální EKG a ECHO
- Ale jde pomalu, zadýchává se a jsou měkké otoky DK...
- Kardiální složka tam může být
- Snaha ovlivnit kardiologa k opakování vyšetření
Lymfokoagulace - lymph coagulation
- Lymph is clotting slower than the blood
Thrombin
- In the development of interstitial fibrosis
- Interstitial thrombin has not been demonstrated by the direct determination of activity
- Presence is inferred by products of thrombin action such as fibrin and activated fibroblasts [55]
Tkáňový faktor
- FVIIa binding to cell-surface TF mobilizes intracellular TF from the Golgi and increases TF expression at the cell surface
- Je exprimován i monocyty / při poranění cévní stěny
- Resultant TF-FVIIa triggers the activation of blood coagulation cascade
- TF, as with caveolin-1, associates with lipid rafts probably through its direct interaction with cholesterol
- TF in ?broblasts
- FVIIa spouští transport intracellular TF to the cell surface
- Allows increase in TF concentration at the cell surface
- Could play an important role in hemostasis
- TF in short-term cultures of endotoxin-stimulated monocytes was
- Transported selectively to the cell membrane
- Shed into conditioned media in membrane vesicles
- Increased TF antigen expression on stimulation with LPS onto the monocyte surface
- With a clear depletion of TF staining from the cytoplasm
Zvýšená střeví propustnost při přerůstání hnilobných Gram negativních bakterií tedy zvýšeně zatíží tělo LPS toxiny, které se translokují do krve a tím pádem mohou přispívat k prokoagulačnímu stavu / chronicky vyšší aktivaci koagulace a antikoagulace - a zároveň u disponovaných jedinců s lymfedémem toto si myslím, že může být i rizikovým / přispívajícím faktorem k rozvoji fibrotizace lymfedému a případného následného vzniku vaziva jako všude, kde delší dobu v těle stojí fibrin a není včas odbourán. U některých lymfedémů tak toto může přispívat k "jizvení" zůžování se lymfatických cév až k jejich zániku. A u některých jedinců toto nemusí způsobovat ani střevní nebo zubní bakterie, ale přímo přežívající mikrobi v samotném terénu lymfedému, kde i jimi vyvolané záněty mohou opakovaně recidivovat ve stejném místě.
