Abstract
Haemorrhagic disorders are known to occur during septicaemia. We studied the role of elastase-like protease (ELP) of human granulocytes in the activation and consumption of clotting factors and their specific inhibitors. Patients with septicaemia and severe bacterial infection were examined for ELP content in polymorphonuclear leukocytes (PNL), as well as plasma levels of ELP complexed to α-1 protease inhibitor, total α-1 protease inhibitor (α-1 PI), clotting factor VII and partial thromboplastin time (PTT). In all patients, a decrease in ELP content of PNL was accompanied by an increase in plasma ELP complexes. The degree to which ELP content of PNL was lowered was related both to the clinical diagnosis and the course of illness. The ELP content of PNL showed a significant positive correlation with plasma factor VII and significant negative correlations with PTT and α-1 PI. These data suggest that ELP release is accompanied by stimulation of the production of α-1 PI, and may contribute in vivo to the consumption of coagulation factors.
The correlation with PTT might point to an activation of Hageman factor, which may activate both intrinsic coagulation and ELP release. The estimation of ELP content in PNL in patients with septicaemia is likely to represent intravascular ELP release during the inflammatory process. It appears to be useful in combination with the assay of ELP complex in plasma the level of which is influenced by the capacity of the reticuloendothelial system for clearance.