[Immunoglobulins A in chronic diseases of the lungs and bronchi. II. Influence of serum transudate on the variations of IgA levels in the sputum].
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Intrapleural fibrin deposition commonly accompanies pleural injury and may contribute to the organization of exudative pleural effusions, which leads to lung entrapment. Previous investigators have observed an increase in procoagulant proteins in pleural effusions but very little thrombin formation. FVa is the protein cofactor in the prothrombinase complex that dramatically enhances the generation of thrombin from prothrombin by the serine protease fXa. The presence of fVa within the pleural space could influence fibrin formation and pleural scarification. We examined pleural fluids obtained from patients who had lung cancer, CHF, and empyema for the presence of fV/fVa. The fV antigen was increased in exudative pleural fluids, in comparison with transudates. However, the specific activity of fV antigen present in exudates was significantly less than that observed for the lower concentration of antigen present in transudate and could not be activated to the same degree by thrombin. Immunoblots of fV antigen in exudates indicated that fV was partially cleaved and inactivated by unidentified proteases. We conclude that although fV is present in pleural fluid, it may be present in a degraded form, which may partially account for a lack of thrombin-generating capacity in these pleural fluids. The presence of fV does not necessarily correlate with pleural loculation.
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The concentrations of prostaglandin E (PgE) were measured in pleural fluid samples from 26 consecutive patients with pleural effusions of varying causes. The PgE concentrations were significantly increased in exudates when compared with transudates and provided a single measurement to separate these 2 classifications of pleural fluid. The highest concentrations of PgE were found in exudates associated with tuberculous pleuritis and metastatic lung cancer. Simultaneous measurement of pleural fluid and plasma PgE concentrations in patients with malignant effusions revealed that pleural fluid concentrations did not reflect plasma concentrations.
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