A study of pancreatic enzymes as a factor in the pathogenesis of disseminated intravascular coagulation during acute pancreatitis

Disseminated intravascular thrombosis with changes of consumption coagulopathy was observed in three patients with acute pancreatitis. In two patients, this ocurred in the early postpartum period and was associated with pyelonephritis; in the third, this followed a bout of excessive alcohol intake. The effect of pancreatic enzymes on blood coagulation in vivo was studied in dogs, using intravenous and intraductal pancreatic infusions of trypsin, and intravenous infusions of pancreatic lipase and phospholipase A. A severe consumption coagulopathy was produced by intravenous trypsin, but not by other methods attempted. The changes included marked thrombocytopenia, hypofibrinogenemia, fall in factors V and VIII, sharp increase in plasminogen activator, and prolongation of thrombin time. Microthrombi were present in the lungs three hours after infusion, many of which were in the process of lysis. This finding supports the concept that pancreatic trypsin escaping into circulating blood during acute pancreatitis may precipitate a disseminated intravascular coagulation.