"Heparinization" and hyperfibrinogenolysis by wasp sting

The American Journal of Emergency Medicine
Cristina LombardiniPaolo Merlani

Abstract

We report on a patient with coagulation abnormalities induced by a wasp sting anaphylaxis. First, we observed an unclottable activated partial thromboplastin time and a significant anti-Xa activity (equivalent to a therapeutic heparin range), whereas the patient had received no heparin. This phenomenon is probably due to activated mast cells that release mediators such as heparin and tryptase. Heparin can then act as an anticoagulant by binding to antithrombin. This "heparinization" explains the anti-Xa activity contributing to the unclottable activated partial thromboplastin time detected in our patient. Second, we noted an extremely low fibrinogen level in the presence of normal platelet count and only a slight increase of D-dimers (absence of important disseminated intravascular coagulation). This is probably due to serum tryptase released during massive mast cell activation. Tryptase cleaves the alpha and beta chains of fibrinogen. This results in the removal of the thrombin cleavage site and of the critical polymerization site from the fibrinogen beta chain. Thrombin- initiated clot formation is therefore inhibited. Tryptase also acts directly on the fibrinolytic pathway by activating the single-chain urinary-type plasmino...Continue Reading

References

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Citations

Nov 5, 2011·Future Cardiology·Nicholas G KounisJohn Goudevenos
Apr 22, 2014·Immunology and Allergy Clinics of North America·Alicia Prieto-GarcíaRichard L Stevens
Nov 15, 2011·The American Journal of Emergency Medicine·Nicholas G KounisAndreas Mazarakis
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Jul 13, 2021·Frontiers in Immunology·Alma Yuste-MontalvoVanesa Esteban
Jul 24, 2021·Wilderness & Environmental Medicine·Dong LaiChing-Feng Weng
Dec 2, 2020·The American Journal of Emergency Medicine·Yao-Chen WangMeng-Yu Wu
Aug 8, 2021·International Journal of Molecular Sciences·Samantha Minh Thy NguyenGuha Krishnaswamy

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