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*It is only for medical professionals to read for reference.
"Mr.
Albumin" also plays a significant role in blood coagulation! The circulatory system is an important "logistics transportation" system in the human body.
It helps the human body to transport nutrients to the tissues and organs that it needs, and to transport waste generated by metabolism in time, working tirelessly day and night to maintain human health.
The integrity of the "transportation pipeline" function is the key to its normal transportation function.
Abnormal blood coagulation often leads to damage to "pipelines" and obstruction of "logistics and transportation".
What is coagulation function? The coagulation function refers to the ability of the blood to change from a flowing state to a non-flowing gel state, and essentially refers to the conversion of soluble fibrinogen in plasma to insoluble fibrin.
Abnormal coagulation function includes hemostatic diseases and bleeding diseases.
When blood in the "pipe" forms a clot and "blocks the pipe" or bleeding "damages the pipe", many problems will follow one after another, such as the occurrence of disease or pre-existing diseases The aggravation may even lead to organ dysfunction [1].
The main factors affecting coagulation function are blood vessels, platelets, coagulation system and fibrinolytic system.
Among them, vascular endothelial cells can secrete both procoagulant and anticoagulant substances, and they occupy the beginning and the end of the coagulation process.
The key position of blood platelets; platelets have both coagulation and anticoagulation effects.
The fibrinolytic system and coagulation system are activated during the process of coagulation, so that fibrinogen becomes fibrin coagulation [1].
The role of albumin in blood coagulation As the highest protein in human plasma, albumin, like a repairman in the "transportation pipeline", it can effectively help the human body regulate abnormal blood coagulation function and relieve clinical symptoms through a variety of mechanisms.
On the one hand, albumin can protect vascular endothelial function and prevent tissue factor synthesized by endothelial cells from entering the blood to cause rapid coagulation activation and fibrin formation [2].
On the other hand, albumin has the effect of binding anticoagulant factors [2] 1], such as can inhibit platelet accumulation [2]. In addition, hypoalbuminemia often leads to hypercoagulability [1].
Since albumin is the main component of plasma colloidal osmotic pressure, as the level of plasma albumin decreases, the water in the blood in the blood vessel will leak out of the blood vessel, the blood will become viscous, and the flow rate will slow down.
The shear force between the vascular endothelium and the vascular endothelium increases, and the vascular endothelial cells become easily damaged, leading to thrombosis [1].
In clinical practice, when a patient's blood coagulation function is abnormal, how to use this characteristic of albumin to evaluate and treat the disease? Please listen to Mr.
Albumin's answer.
Patients with sepsis need to be evaluated and treated as soon as possible with coagulation dysfunction.
Patients with sepsis often have a large number of microthrombosis and microcirculation disorders in their bodies, resulting in multiple organ dysfunction [3].
Coagulation dysfunction is a common complication of patients with sepsis and is closely related to the prognosis of patients [3].
A clinical investigation study showed that after investigating the correlation between coagulation disorders and the degree of disease in 153 patients with infectious diseases and sepsis, the D-dimer value of patients in severe sepsis group was higher than that in common infection group And sepsis group, platelet count is lower than common infection group and sepsis group, and the sequential organ failure score shows severe sepsis group> sepsis group> common infection group, all of which are statistically significant, proving blood coagulation function The severity of the disorder is correlated with the severity of sepsis.
The higher the abnormal value of D-dimer and the fewer platelets in patients with sepsis, the higher the severity, the higher the mortality rate, and the worse the prognosis effect [4].
Disseminated intravascular coagulation (DIC) is an independent risk factor for death in patients with sepsis.
However, the use of DIC to predict the prognosis of patients with sepsis has the disadvantage of lagging behind.
Another study showed that compared with the diagnosis of DIC, sepsis-associated coagulopathy (Sepsis-associated coagulopathy, SAC) has more value in predicting the prognosis of patients [3].
A retrospective analysis of the SAC status and disease prognosis of EICU patients found that the severity of SAC is closely related to the patient’s prognosis.
The more severe the SAC, the higher the patient’s hospital mortality, the longer the EICU stay, the higher the cost, and the higher the mortality rate.
[3].
Therefore, when the patient is diagnosed with sepsis, SAC severity can be graded to assess the prognosis and start anticoagulation therapy as soon as possible [3].
The Chinese guidelines for the treatment of septic shock recommend that albumin be considered for the initial fluid resuscitation of patients with severe sepsis and septic shock [5].
Patients with nephrotic syndrome are prone to hypercoagulability due to hypoalbuminemia.
Complications of patients with nephrotic syndrome include not only kidney damage, but also infection, thrombosis and embolism, protein and fat metabolism disorders, among which thrombosis and embolism are serious One of the fatal complications of [2].
Patients with nephrotic syndrome lose a large amount of protein in their bodies, often accompanied by hypoalbuminemia (plasma albumin <30g/L).
Hypoalbuminemia can often cause increased blood viscosity and affect blood flow speed.
When the plasma albumin is less than 20g/L, it is clinically believed to indicate that the patient has a hypercoagulable state, which is likely to cause venous thromboembolism [2].
A study of different albumin levels on the coagulation function of patients with nephrotic syndrome showed that the activated partial prothrombin time, fibrinogen, thrombin time and D-dimer values of patients with nephrotic syndrome were higher than those of ordinary people.
It suggests that there is coagulation dysfunction, and thrombin time and D-dimer values are negatively correlated with plasma albumin.
Nephrotic syndrome patients with albumin <20g/L are compared with patients with albumin ≥20g/L.
The function is worse, indicating that the coagulation function and albumin level of patients with nephrotic syndrome are positively correlated within a certain range [2].
Intravenous infusion of albumin can improve hypoalbuminemia in patients with nephrotic syndrome and help to improve the coagulation dysfunction caused by hypoalbuminemia in patients.
Burn patients should pay attention to the diagnosis and treatment of coagulopathy.
Burn patients, especially severe burn patients, often have different degrees of hypoproteinemia.
The prognosis of patients with severe burns is related to the degree of plasma albumin reduction, and the lower the albumin level, the higher the incidence of sepsis and the worse the outcome [7].
Hypoproteinemia can often cause increased blood viscosity and affect blood flow speed.
Patients with very severe burns often have abnormal blood coagulation function, which is related to post-burn infection, immunity, organ function, and wound repair.
The patient's exogenous coagulation system is activated due to infection or the body's stress response, which in turn leads to a series of coagulation dysfunction [8].
Studies have shown that the shock stage of the death group of severely burned patients has varying degrees of prothrombin time, prolonged activated partial prothrombin time and an increase in the international standardized ratio.
Among them, the death group is significantly higher than the survival group, indicating that severe burn shock Severe damage to the existing procoagulant function (both endogenous and exogenous coagulation pathways) is associated with the prognosis.
It shows that the characteristics of coagulation function in patients with severe burns in the shock stage have a certain early warning value [8].
The expert consensus on the use of albumin in burn patients suggests that for burn patients who have been supplemented with sufficient energy and nutritional substrates but still have hypoalbuminemia, albumin treatment can be used, and albumin should be supplemented when the serum albumin concentration is less than 30g/L.
It is recommended to use more than 10% hypertonic albumin solution [9].
Summary Albumin can help the human body to regulate blood coagulation through some mechanisms.
Some diseases that are prone to hypoalbuminemia, such as sepsis, nephrotic syndrome, burns, etc.
, are prone to coagulation dysfunction.
Therefore, when patients have hypoalbuminemia It is necessary to be alert to the possibility of coagulation dysfunction in patients, measure the coagulation index of the patient as soon as possible and classify the function, and take corresponding treatment. Reference materials: [1] "Pathophysiology" Human Health 9th Edition [2] Zhou Lin, Fang Jiejie.
Comparison of coagulation function in patients with nephrotic syndrome with different albumin levels[J].
Medical Information, 2020, 33(20) :94-95+98.
[3]Xie Xingwen, Yang Zhenning, Ge Xin, Bai Xiaocui, Han Xiaoqin.
The evaluation value of sepsis-related coagulation dysfunction on the prognosis of patients with sepsis[J].
Southeast National Defense Medicine, 2020,22(02 ):161-164.
[4].
Analysis of the correlation between coagulopathy and sepsis in 153 emergency patients with infectious diseases and its prevention and treatment[J].
Anti-infective Pharmacy,2021,18(02): 264-266.
[5]Guidelines for the treatment of severe sepsis/septic shock in China (2014)[J].
Clinical and Education of General Practice,2015,13(04):365-367.
[6]Wang Shanghong,Wang Yaoyong ,.
Research progress of human albumin in the treatment of septic shock[J].
Medical Review, 2020,26(18):3653-3657.
[7] Lu Yanhua.
The trend of early plasma albumin changes in severely burned patients and Influencing factors[D].
Shandong University,2016.
[8]Ma Qimin, Liu Xiaobin, Wu Guosheng, Hou Wenjia, Fan Xiaoming, Shen Tuo, Wang Kangan, Zhu Feng.
A retrospective cohort study on the shock stage coagulation characteristics and early warning value of severely severe adult burn patients[ J].
Chinese Journal of Burns, 2021, 37(02): 150-156.
[9] Chai Jiake, Xia Zhaofan, Hu Dahai, Tao Baijiang, Liu Yi, Meng Qingyan, Chen Jinhe, Shen Chuanan, Peng Yizhi, Liu Hongqi, Shi Fusheng, Ye Xiangbai .
Expert consensus on the use of albumin in burn patients[J].
Medical Journal of Chinese People's Liberation Army,2012,37(10):925.
"Mr.
Albumin" also plays a significant role in blood coagulation! The circulatory system is an important "logistics transportation" system in the human body.
It helps the human body to transport nutrients to the tissues and organs that it needs, and to transport waste generated by metabolism in time, working tirelessly day and night to maintain human health.
The integrity of the "transportation pipeline" function is the key to its normal transportation function.
Abnormal blood coagulation often leads to damage to "pipelines" and obstruction of "logistics and transportation".
What is coagulation function? The coagulation function refers to the ability of the blood to change from a flowing state to a non-flowing gel state, and essentially refers to the conversion of soluble fibrinogen in plasma to insoluble fibrin.
Abnormal coagulation function includes hemostatic diseases and bleeding diseases.
When blood in the "pipe" forms a clot and "blocks the pipe" or bleeding "damages the pipe", many problems will follow one after another, such as the occurrence of disease or pre-existing diseases The aggravation may even lead to organ dysfunction [1].
The main factors affecting coagulation function are blood vessels, platelets, coagulation system and fibrinolytic system.
Among them, vascular endothelial cells can secrete both procoagulant and anticoagulant substances, and they occupy the beginning and the end of the coagulation process.
The key position of blood platelets; platelets have both coagulation and anticoagulation effects.
The fibrinolytic system and coagulation system are activated during the process of coagulation, so that fibrinogen becomes fibrin coagulation [1].
The role of albumin in blood coagulation As the highest protein in human plasma, albumin, like a repairman in the "transportation pipeline", it can effectively help the human body regulate abnormal blood coagulation function and relieve clinical symptoms through a variety of mechanisms.
On the one hand, albumin can protect vascular endothelial function and prevent tissue factor synthesized by endothelial cells from entering the blood to cause rapid coagulation activation and fibrin formation [2].
On the other hand, albumin has the effect of binding anticoagulant factors [2] 1], such as can inhibit platelet accumulation [2]. In addition, hypoalbuminemia often leads to hypercoagulability [1].
Since albumin is the main component of plasma colloidal osmotic pressure, as the level of plasma albumin decreases, the water in the blood in the blood vessel will leak out of the blood vessel, the blood will become viscous, and the flow rate will slow down.
The shear force between the vascular endothelium and the vascular endothelium increases, and the vascular endothelial cells become easily damaged, leading to thrombosis [1].
In clinical practice, when a patient's blood coagulation function is abnormal, how to use this characteristic of albumin to evaluate and treat the disease? Please listen to Mr.
Albumin's answer.
Patients with sepsis need to be evaluated and treated as soon as possible with coagulation dysfunction.
Patients with sepsis often have a large number of microthrombosis and microcirculation disorders in their bodies, resulting in multiple organ dysfunction [3].
Coagulation dysfunction is a common complication of patients with sepsis and is closely related to the prognosis of patients [3].
A clinical investigation study showed that after investigating the correlation between coagulation disorders and the degree of disease in 153 patients with infectious diseases and sepsis, the D-dimer value of patients in severe sepsis group was higher than that in common infection group And sepsis group, platelet count is lower than common infection group and sepsis group, and the sequential organ failure score shows severe sepsis group> sepsis group> common infection group, all of which are statistically significant, proving blood coagulation function The severity of the disorder is correlated with the severity of sepsis.
The higher the abnormal value of D-dimer and the fewer platelets in patients with sepsis, the higher the severity, the higher the mortality rate, and the worse the prognosis effect [4].
Disseminated intravascular coagulation (DIC) is an independent risk factor for death in patients with sepsis.
However, the use of DIC to predict the prognosis of patients with sepsis has the disadvantage of lagging behind.
Another study showed that compared with the diagnosis of DIC, sepsis-associated coagulopathy (Sepsis-associated coagulopathy, SAC) has more value in predicting the prognosis of patients [3].
A retrospective analysis of the SAC status and disease prognosis of EICU patients found that the severity of SAC is closely related to the patient’s prognosis.
The more severe the SAC, the higher the patient’s hospital mortality, the longer the EICU stay, the higher the cost, and the higher the mortality rate.
[3].
Therefore, when the patient is diagnosed with sepsis, SAC severity can be graded to assess the prognosis and start anticoagulation therapy as soon as possible [3].
The Chinese guidelines for the treatment of septic shock recommend that albumin be considered for the initial fluid resuscitation of patients with severe sepsis and septic shock [5].
Patients with nephrotic syndrome are prone to hypercoagulability due to hypoalbuminemia.
Complications of patients with nephrotic syndrome include not only kidney damage, but also infection, thrombosis and embolism, protein and fat metabolism disorders, among which thrombosis and embolism are serious One of the fatal complications of [2].
Patients with nephrotic syndrome lose a large amount of protein in their bodies, often accompanied by hypoalbuminemia (plasma albumin <30g/L).
Hypoalbuminemia can often cause increased blood viscosity and affect blood flow speed.
When the plasma albumin is less than 20g/L, it is clinically believed to indicate that the patient has a hypercoagulable state, which is likely to cause venous thromboembolism [2].
A study of different albumin levels on the coagulation function of patients with nephrotic syndrome showed that the activated partial prothrombin time, fibrinogen, thrombin time and D-dimer values of patients with nephrotic syndrome were higher than those of ordinary people.
It suggests that there is coagulation dysfunction, and thrombin time and D-dimer values are negatively correlated with plasma albumin.
Nephrotic syndrome patients with albumin <20g/L are compared with patients with albumin ≥20g/L.
The function is worse, indicating that the coagulation function and albumin level of patients with nephrotic syndrome are positively correlated within a certain range [2].
Intravenous infusion of albumin can improve hypoalbuminemia in patients with nephrotic syndrome and help to improve the coagulation dysfunction caused by hypoalbuminemia in patients.
Burn patients should pay attention to the diagnosis and treatment of coagulopathy.
Burn patients, especially severe burn patients, often have different degrees of hypoproteinemia.
The prognosis of patients with severe burns is related to the degree of plasma albumin reduction, and the lower the albumin level, the higher the incidence of sepsis and the worse the outcome [7].
Hypoproteinemia can often cause increased blood viscosity and affect blood flow speed.
Patients with very severe burns often have abnormal blood coagulation function, which is related to post-burn infection, immunity, organ function, and wound repair.
The patient's exogenous coagulation system is activated due to infection or the body's stress response, which in turn leads to a series of coagulation dysfunction [8].
Studies have shown that the shock stage of the death group of severely burned patients has varying degrees of prothrombin time, prolonged activated partial prothrombin time and an increase in the international standardized ratio.
Among them, the death group is significantly higher than the survival group, indicating that severe burn shock Severe damage to the existing procoagulant function (both endogenous and exogenous coagulation pathways) is associated with the prognosis.
It shows that the characteristics of coagulation function in patients with severe burns in the shock stage have a certain early warning value [8].
The expert consensus on the use of albumin in burn patients suggests that for burn patients who have been supplemented with sufficient energy and nutritional substrates but still have hypoalbuminemia, albumin treatment can be used, and albumin should be supplemented when the serum albumin concentration is less than 30g/L.
It is recommended to use more than 10% hypertonic albumin solution [9].
Summary Albumin can help the human body to regulate blood coagulation through some mechanisms.
Some diseases that are prone to hypoalbuminemia, such as sepsis, nephrotic syndrome, burns, etc.
, are prone to coagulation dysfunction.
Therefore, when patients have hypoalbuminemia It is necessary to be alert to the possibility of coagulation dysfunction in patients, measure the coagulation index of the patient as soon as possible and classify the function, and take corresponding treatment. Reference materials: [1] "Pathophysiology" Human Health 9th Edition [2] Zhou Lin, Fang Jiejie.
Comparison of coagulation function in patients with nephrotic syndrome with different albumin levels[J].
Medical Information, 2020, 33(20) :94-95+98.
[3]Xie Xingwen, Yang Zhenning, Ge Xin, Bai Xiaocui, Han Xiaoqin.
The evaluation value of sepsis-related coagulation dysfunction on the prognosis of patients with sepsis[J].
Southeast National Defense Medicine, 2020,22(02 ):161-164.
[4].
Analysis of the correlation between coagulopathy and sepsis in 153 emergency patients with infectious diseases and its prevention and treatment[J].
Anti-infective Pharmacy,2021,18(02): 264-266.
[5]Guidelines for the treatment of severe sepsis/septic shock in China (2014)[J].
Clinical and Education of General Practice,2015,13(04):365-367.
[6]Wang Shanghong,Wang Yaoyong ,.
Research progress of human albumin in the treatment of septic shock[J].
Medical Review, 2020,26(18):3653-3657.
[7] Lu Yanhua.
The trend of early plasma albumin changes in severely burned patients and Influencing factors[D].
Shandong University,2016.
[8]Ma Qimin, Liu Xiaobin, Wu Guosheng, Hou Wenjia, Fan Xiaoming, Shen Tuo, Wang Kangan, Zhu Feng.
A retrospective cohort study on the shock stage coagulation characteristics and early warning value of severely severe adult burn patients[ J].
Chinese Journal of Burns, 2021, 37(02): 150-156.
[9] Chai Jiake, Xia Zhaofan, Hu Dahai, Tao Baijiang, Liu Yi, Meng Qingyan, Chen Jinhe, Shen Chuanan, Peng Yizhi, Liu Hongqi, Shi Fusheng, Ye Xiangbai .
Expert consensus on the use of albumin in burn patients[J].
Medical Journal of Chinese People's Liberation Army,2012,37(10):925.
