Influence of Trauma and Hemolysis on Hemorrhagic Shock in Dogs

摘要

A small amount (20 ml.) of endogenous hemolyzed blood causes an increase in mortality of dogs in hemorrhagic shock from 13% to 91%. This lethal effect is due to the stimulation by hemolyzed blood of disseminated intravascular coagulation (DIC), (3) which is also stimulated by hemorrhage and shock. The lethal factor is a clotting factor in the red cell. Large amounts (100 ml.) of hemolyzed blood alone is harmless, but even a small amount (20 ml.) is lethal in the presence of shock. Hemolyzed blood causes the conversion of fibrinogen to fibrin. Fibrinolysin will prevent death in irreversible hemorrhagic shock both as produced by hemorrhage alone (10) or as influenced by hemolyzed blood. Endogenous heparin is stimulated by DIC which is produced either by hemorrhage alone, hemolyzed blood alone, or by a combination of both. It is probably a protective mechanism. A markedly prolonged silicone clotting time occurring during hemorrhagic shock is an accurate prognostication of irreversibility. Irreversibility is correlated with a fibrinogen fall, when the fibrinogen fall is due to consumption in DIC. Central venous pressure is not elevated even though the shock is proven to be irreversible. Irreversibility is due to an episode of DIC. (3)