Haemostasis Impairment in Patients with Obstructive Jaundice

182is characterized by a broad spectrum of manifestationsvary<strong>in</strong>g from simple oedematous pancreatitis to necrotiz<strong>in</strong>gforms of the disease. A common denom<strong>in</strong>ator of thesemanifestations has been an <strong>in</strong>creased thrombogenicity,documented as early as 20 years ago <strong>in</strong> hypothermic patientswho presented <strong>in</strong>trapancreatic thrombosis.In a recent paper, a strong prognostic value was reportedfor extensive coagulation activation and a poor outcome <strong>in</strong>severe necrotiz<strong>in</strong>g pancreatitis. Changes <strong>in</strong> prote<strong>in</strong> C,antithromb<strong>in</strong> III (AT III), D-dimer and plasm<strong>in</strong>ogen activator<strong>in</strong>hibitor - 1 (PAI-1) levels <strong>in</strong>dicat<strong>in</strong>g exhaustion offibr<strong>in</strong>olysis and coagulation <strong>in</strong>hibitors, predicted a badprognosis (83). This is <strong>in</strong> keep<strong>in</strong>g <strong>with</strong> the results of anotherrecent article, where it was claimed that the D-dimers levels<strong>in</strong> plasma reflect the expression of pancreatitis and theextension of systemic <strong>in</strong>volvement (84).Two of our recently published articles assessed plateletactivation <strong>in</strong> mild forms of acute pancreatitis. In the firststudy, we focused on two successive end po<strong>in</strong>ts: (i) theactivation of platelets dur<strong>in</strong>g acute pancreatitis and (ii) thealterations of platelet number and <strong>in</strong>dexes between onsetand remission of the disease, which reflect the bone marrowresponse (10). In a group of 54 patients <strong>with</strong> acutepancreatitis, activated platelet ratio (APR) was estimatedus<strong>in</strong>g flow cytometry at onset and remission. The first endpo<strong>in</strong>tof the study was reached at patient 14 as APR wasfound elevated at the onset of acute pancreatitis (p=0.01).The second end-po<strong>in</strong>t 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