ACTIVATION OF THE INTRINSIC PATHWAY OF COAGULATION IN CHILDREN WITH MENINGOCOCCAL SEPTIC SHOCK

Meningacoccal septic shock (MSS) is complicated by activation of coagu lation, fibrinolytic, and complement systems. We studied the contact s ystem of the intrinsic pathway of coagulation in thirteen children wit h MSS. Activation was assessed upon admittance to the intensive care u nit and 48 h thereafter, based on the measurement of factor XII- (FXII ), prekallikrein- and factor XI (FXI) antigen levels, as well as on th e detection of FXTIa-FXIa inhibitor, FXIIa-C1-inhibitor, and kallikrei n-C1-inhibitor complexes, respectively. Levels of FXII, prekallikrein and FXI were reduced to about 50% in all patients on admission, and we re significantly higher 48 h later. FXIIa-C1-inhibitor complexes were elevated in 7 patients, and kallikrein-C1-inhibitor complexes in 2 pat ients. FXIa-alpha(1)-antitrypsin complexes were elevated in all patien ts, FXIa-C1-inhibitor complexes in nine, and FXIa-antithrombin III com plexes in one patient. We conclude that patients with MSS have activat ion of the contact system, which may contribute to activation of coagu lation, and thus to morbidity and mortality.