Haemostasis Impairment in Patients with Obstructive Jaundice

182is characterized by a broad spectrum of manifestationsvarying from simple oedematous pancreatitis to necrotizingforms of the disease. A common denominator of thesemanifestations has been an increased thrombogenicity,documented as early as 20 years ago in hypothermic patientswho presented intrapancreatic thrombosis.In a recent paper, a strong prognostic value was reportedfor extensive coagulation activation and a poor outcome insevere necrotizing pancreatitis. Changes in protein C,antithrombin III (AT III), D-dimer and plasminogen activatorinhibitor - 1 (PAI-1) levels indicating exhaustion offibrinolysis and coagulation inhibitors, predicted a badprognosis (83). This is in keeping with the results of anotherrecent article, where it was claimed that the D-dimers levelsin plasma reflect the expression of pancreatitis and theextension of systemic involvement (84).Two of our recently published articles assessed plateletactivation in mild forms of acute pancreatitis. In the firststudy, we focused on two successive end points: (i) theactivation of platelets during acute pancreatitis and (ii) thealterations of platelet number and indexes between onsetand remission of the disease, which reflect the bone marrowresponse (10). In a group of 54 patients with acutepancreatitis, activated platelet ratio (APR) was estimatedusing flow cytometry at onset and remission. The first endpointof the study was reached at patient 14 as APR wasfound elevated at the onset of acute pancreatitis (p=0.01).The second end-point was fulfilled at patient 12 for the meanplatelet volume (MPV), platelet large cell ratio (P-LCR) andplatelet distribution width (PDW), which were foundelevated at remission of the disease (p

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