HAEMOSTASIS


excessive bleeding linked to this high- risk procedure can lead to acquired fibrinogen deficiency.5–7


It is known by survivors and their clinical teams as ‘the mother of all surgeries’.8


The procedure involves


removing part of the peritoneum, several abdominal organs and administering HIPEC directly into the peritoneal cavity.


Value of thrombin generation testing Thrombin is both a pro- and anticoagulant molecule.9


On the one hand, it activates The fully automated ST Genesia combines pre-analytics, diagnostic validation and standardisation.


“We accept that the surgical approach involves extensive blood loss, but this offers the best chance of improving morbidity and mortality. We need to better understand what is happening to our patients, their coagulation profile and evaluate which product is more effective at stabilising it. “We hope the clinical insights provided by the ST Genesia will enable surgeons to more easily maintain haemostasis, and so reduce the post-operative bleeding as well as thrombotic risk for patients.” Dr Stanford started her professional life as a scientist in histopathology and then moved to haematology where she gained experience of TG testing and the insights it could deliver. She moved into clinical research after previously working closely with stroke patients at an acute teaching hospital in Wales where she completed her PhD. She explained: “My background as a scientist with a focus on haemostasis and an understanding of the crucial role of thrombin in clot formation has proved invaluable to working in clinical research. “But other aspects of pathology training have also helped. For instance, the discipline of calibration and quality control when assessing a patient’s blood profile is routine to anyone working in a clinical laboratory. We need to trust in our findings, know that they are comparable – and to receive the results quickly enough for clinicians to intervene if necessary.”


Peritoneal tumours Pseudomyxoma peritonei (PMP) is an extremely rare, slowly progressive tumour, that affects around two people per million of all ages, both men and women.3,4


not known and the name pseudomyxoma peritonei means ‘false mucinous tumour of the peritoneum’. In most cases, PMP starts from a polyp on the inner lining of the appendix. At this early stage, the tumour is rarely discovered as it doesn’t cause any symptoms. More rarely, it can start in other parts of the body such as the ovary and occasionally the urachus. It varies in its aggressiveness and clinical course. However, left untreated the tumour eventually bursts through the wall of the appendix into the abdominal cavity where more tumours then develop. These produce a large amount of mucus, the build-up of which causes symptoms, with the abdomen swelling and vital organs compressed, starving the body of normal function. Currently, invasive cytoreductive


surgery (CRS) along with hyperthermic intraperitoneal chemotherapy (HIPEC) is the main treatment, but the


platelets through its receptor on platelets while regulating its own generation by activating coagulation factors FV, FVIII and even FXI. By activating pro-coagulant plasma proteins, it leads to the initial thrombin ‘burst’ that results in fibrin formation.


Changes in thrombin generation can


have a profound effect on the rate of thrombin production and the activation of plasma antithrombins, and regulatory proteins such as thrombin activatable fibrinolysis inhibitor (TAFI), which regulate fibrinolysis.


The value of TG testing is that it can evaluate the complicated balance between these two forces in the blood, which other assays such as prothrombin time (PT) and activated partial thromboplastin time (APTT) cannot. Only TG testing is able to investigate thrombin generation itself and the entire process of thrombin inhibition.


While clotting occurs at the start of


the thrombin burst, the full clinical picture can only be determined when most thrombin has been generated. This occurs after clotting and is therefore missed by traditional clotting assays that are far less responsive to this type of bleeding. Excessive in vivo thrombin generation


Unlike cancers that spread via the lymphatic system, pseudomyxoma peritonei normally spreads only within the abdominal or peritoneal cavity. Its cause is


19


Typical curve showing thrombin generation activation in plasma. FEBRUARY 2022 WWW.PATHOLOGYINPRACTICE.COM


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