EUROMEDICA  Hanover 3-4  Juni 2010	Advanced methods of diagnosis, treatment and prophylactics
	European Academy of Natural Sciences, Hanover European Scientific Society, Hanover Berliner Medizinischen Gesellschaft, Berlin

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It is common that when applying traditional hemostatic therapy in hemorrhages of portal genesis, blood’s aggregative state disorders are not taken into account, as well as the necessity of their correction.

We observed 144 patients. They were separated in the following order: 1^st control group – patients with portal hypertensia with no hemorrage, 2^nd control group – patients with gastro-duodenal hemorrhage of ulcerative etiology– 25.

Results and discussion. The most manifesting differences with etiologically different hemorrhages are connected with erythrocyte aggregation coefficient. It has been revealed that in hemorrhages induced by portal hypertensia the stable increasing of this number takes place(р<0,01). The same time the tendency towards decreasing of erythrocyte deformability was also marked. In hemostasis system of group Child A normocagulation prevails, in group B, due to anticoagulative system activation, the fact of hypocoagulation is marked, while keeping sufficient fibrinase activity and relatively decrease hematocrit. Decrease in numbers for factors of coagulation (protrombin, fibrinogen, fibrinase), as well as the activity anticoagulative system (plasma tolerance to heparin, euglobulin fibrinolis), provides the evidence for hemostasis system disorder and large decrease of liver functional activity, which is most common for Child C group.

The progression of this condition together with the increase of erythrocytes’ aggregative capability, decrease of their deformability and hematocrit, is recognized as negative diagnostic sign. When analyzing the activity of lipid peroxidation process (LPO), the increase of MDA level in both plasma and erythrocytes, as well as decrease of catalase activity were revealed in the group of patients with hemorrhage of portal etiology. And if the level of erythrocyte MDA in hemorrhages of this etiology was higher than in group with ulcerative hemorrhage on 8.6% (group A) – 27.2% (group C) - р<0,05, the differences for plasma MDA are in Child groups, relatively:15,7 (р>0,05); 33,6 (р<0,05) and 68,9 % (р<0,01). According to levels of average mass molecules, the proved increase of this factor in group of patients with hemorrhages of portal etiology - Child В and С was revealed,

- this marks an increase in level of endogenous intoxication in this patients’ category? While having normal numbers in patients with ulcerative hemorrhage and Child A group. It means that for patients with hemorrhages of portal genesis it is common to have severe disorders of blood rheology which are expressed with the relation to severity of functional liver disorder. In group Child B, especially in C, LPO system was activated, antioxidant protection was decreased, and the content of MSM (as factor of endogenous intoxication), which is not taken into prognostic criteria Child. At this point, the defining of condition severity only on the base of criteria for functional Child groups, and, following this, treatment tactics, should be done not only on common biochemical indexes, but also with the appliance of revealed physicochemical and homeostatic defects. If group C patients can be defined basing on 9 indexes, defining of group A is possible on the base erythrocyte aggregation coefficient (not less than4,5 n/m 10^-5), the molecule of average blood mass(less than 300,0 U), total bilirubin presence in blood (less than 20,5 mcmol/l) and catalase activity (more than 270,0 U).

Conclusion. Conducted analysis demonstrated the necessity of implementing such blood rheology indexes, as viscosity and erythrocyte aggregation coefficient, LPO indexes (MDA), and endogenous intoxication (MCM), which let to modify and make the therapy in hemorrhages of portal etiology pathogenetically better grounded and effective.

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