Mechanism of Intra-abdominal Hemorrhage Coagulopathy

🥼 Practice and Clinical
1

The mechanism mainly includes the following points:

  1. Physical mechanism, which is also the most commonly used explanation — the mechanical movement of intra-abdominal viscera (such as the intestines) causes the cord-like fibrinogen in the blood to adhere to them, producing a “defibrination effect.” Blood that has lost fibrinogen becomes non-coagulable. If the bleeding volume is large and defibrination is not complete, coagulation clots may still form. There is an experiment in physiology class where blood is poured onto a glass plate and stirred with a glass rod (?), and after a certain time, a bundle of white fibrous material can be seen wrapped around the glass rod. This phenomenon, if too severe, can even lead to intestinal adhesions and intestinal obstruction[1].
  2. Chemical mechanism[2]
    1. Local coagulation actually occurs after bleeding, consuming a large amount of coagulation factors and platelets, which are then insufficient for subsequent coagulation.
    2. The peritoneum and intra-abdominal viscera secrete plasminogen activators, activating plasmin, leading to fibrinolysis hyperactivity that directly dissolves the fibrin formed by previous coagulation.

  1. Consultation: “Defibrination effect” of the thoracic and abdominal membranes ↩︎

  2. Shi Hongqi, Song Qidong, Wu Jianbo. Study on the mechanism of blood non-coagulation in traumatic intra-abdominal hemorrhage [J]. Chinese Journal of Trauma, 1999, 15(5):363-364. DOI:10.3760/j:issn:1001-8050.1999.05.013. ↩︎