血栓
医学
羊水栓塞
纤维蛋白
肺栓塞
病理
内科学
心脏病学
免疫学
生物
怀孕
遗传学
作者
Atsushi Yamashita,Tomoaki Oda,Michael G. Aman,T. Wakasa,Toshihiro Gi,Reiko Ide,Yusuke Todo,Naoaki Tamura,Yuichiro Sato,Hiroaki Itoh,Yujiro Asada
标识
DOI:10.1111/1471-0528.17532
摘要
Abstract Objective To identify pulmonary/uterine thrombus formation in amniotic fluid embolism (AFE). Design Retrospective, observational. Setting Nationwide. Population Eleven autopsy cases of AFE and control cases. Methods We assessed pulmonary and uterine thrombus formation and thrombus area in AFE and pulmonary thromboembolism (PTE) as a control. The area of platelet glycoprotein IIb/IIIa, fibrin, neutrophil elastase, citrullinated histone H3 (a neutrophil extracellular trap marker) and mast cell chymase immunopositivity was measured in 90 pulmonary emboli, 15 uterine thrombi and 14 PTE. Main outcome measures Pathological evidence of thrombus formation and its components in AFE. Results Amniotic fluid embolism lung showed massive thrombus formation, with or without amniotic emboli in small pulmonary arteries and capillaries. The median pulmonary thrombus size in AFE (median, 0.012 mm 2 ; P < 0.0001) was significantly smaller than that of uterine thrombus in AFE (0.61 mm 2 ) or PTE (29 mm 2 ). The median area of glycoprotein IIb/IIIa immunopositivity in pulmonary thrombi in AFE (39%; P < 0.01) was significantly larger than that of uterine thrombi in AFE (23%) and PTE (15%). The median area of fibrin (0%; P < 0.001) and citrullinated histone H3 (0%; P < 0.01) immunopositivity in pulmonary thrombi in AFE was significantly smaller than in uterine thrombi (fibrin: 26%; citrullinated histone H3: 1.1%) and PTE (fibrin: 42%; citrullinated histone H3: 0.4%). No mast cells were identified in pulmonary thrombi. Conclusions Amniotic fluid may induce distinct thrombus formation in the uterus and lung. Pulmonary and uterine thrombi formation may contribute to cardiorespiratory collapse and/or consumptive coagulopathy in AFE.
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