After pancreatic surgery the patient developed hemorrhagic syndrome with disturbed 3rd stage of blood clotting. What will be the most likely mechanism of the hemostatic disorder?

Answer options

1. Fibrin-stabilizing factor deficiency
2. Decrease of prothrombin synthesis
3. Decrease of fibrinogen synthesis
4. Fibrinolysis activation
5. Qualitative abnormalities of fibri-nogenesis

Explanation

Primary activation of the fibrinolytic system, most commonly in the setting of SURGERIES, IN THIS CASE, the patient has primary fibrinolysis, which may occur due to the PANCREATIC surgery. In this setting, urokinase is released from the tissue causing activation of plasminogen and the release of plasmin. Plasmin degrades multiple coagulation factors (e.g., V, VIII, fibrinogen). This increases the PT and PTT because factors V and VIII are in the final common pathway. The degradation products of fibrinogen interfere with platelet aggregation causing an increase in the bleeding time. The platelet count is not affected.