Plasminogen 

Plasminogen 

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Plasminogen (PLG) is a glycoprotein (molecular weight 92 kDa) synthesized in the liver, and it circulates in the blood, with a half-life of 2.2 days. Plasminogen is the precursor of plasmin, which lyses fibrin clots to fibrin degradation products (FDP) and D-dimer; the conversion to active protease is mediated by tissue-type (tPA) and urokinase-type (uPA) plasminogen activators. Generated plasmin is quickly inactivated by its main inhibitor alpha2-antiplasmin. [1, 2, 3]

The reference ranges for plasminogen are as follows:

Newborns: 50-90%

Children and adults: 80-120%

Plasma concentration: 10-16 mg/dL

Increased PLG levels are observed in the following clinical situations:

Anabolic steroids treatment

Hypothyroidism

Hormonal contraceptives

After liver/kidney transplantation

Pregnancy

Inherited decreased PLG levels are observed in the following clinical situations:

Type I: Both functional and immunological PLG level is decreased (hypoplasminogenemia).

Type II: Only functional activity is decreased while protein concentration is normal (dysplasminogenemia).

Acquired decreased PLG levels are observed in the following clinical situations:

Disseminated intravascular coagulation

Thrombolytic therapy

Liver disease

Hyperthyroidism

L-asparaginase therapy

Postoperative period

Severe congenital hypoplasminogenemia is associated with pseudomembranous disease (or ligneous inflammation) of mucous membranes (eye, middle ear, mouth, pharynx, duodenum, upper and lower respiratory tract, and female genital tract).

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Specimen – Citrated plasma

Collection – Tube with sodium citrate 3.2% citrate, blue top

Centrifugation – 2000-2500 g for 15 min or similar regime to produce platelet-poor plasma

Storage – Up to 24 hours at room temperature, or plasma sample should be frozen; specimen is stable for 1 month at -20 º C, or 6-9 months at -80 º C

A high concentration of hemoglobin, bilirubin, triglycerides and fibrin degradation products might affect PLG measurement. The presence of aprotinin in the sample may lead to underestimation of PLG levels in plasma.

Plasminogen is a glycoprotein (molecular weight 92 kDa) synthesized in the liver, and it circulates in the blood, with a half-life of 2.2 days. Plasminogen is the precursor of plasmin, which lyses fibrin clots to fibrin degradation products (FDP) and D-dimer; the conversion to active protease is mediated by tissue-type (tPA) and urokinase-type (uPA) plasminogen activators. Generated plasmin is quickly inactivated by its main inhibitor alpha2-antiplasmin. [1, 2, 3]

See the list below:

Pseudomembranous disease (eg, ligneous conjunctivitis, gingivitis)

Idiopathic thromboembolic disease (if other causes of thrombophilia are excluded)

No clear association exists between sole plasminogen deficiency and increased risk of thrombosis. PLG testing should not be included in routine thrombophilia workup.

Mehta R, Shapiro AD. Plasminogen deficiency. Haemophilia. 2008 Nov. 14(6):1261-8. [Medline].

Schuster V, Hügle B, Tefs K. Plasminogen deficiency. J Thromb Haemost. 2007 Dec. 5(12):2315-22. [Medline].

Brandt JT. Plasminogen and tissue-type plasminogen activator deficiency as risk factors for thromboembolic disease. Arch Pathol Lab Med. 2002 Nov. 126(11):1376-81. [Medline].

Jun Teruya, MD, DSc, FCAP Professor of Pathology and Immunology, Vice Chairman for Education, Professor of Pediatrics, Professor of Medicine, Director, Tranfusion Medicine/Blood Banking Fellowship Program, Head, Division of Baylor Transfusion Medicine, Baylor College of Medicine; Director, Division of Transfusion Medicine and Coagulation, Texas Children’s Hospital

Jun Teruya, MD, DSc, FCAP is a member of the following medical societies: American Association of Blood Banks, American Society for Clinical Pathology, American Society of Hematology, College of American Pathologists, International Society on Thrombosis and Haemostasis, Massachusetts Medical Society

Disclosure: Nothing to disclose.

Vadim Kostousov, MD Research Associate, Transfusion Medicine and Coagulation, Department of Pathology and Immunology, Texas Children’s Hospital, Baylor College of Medicine

Disclosure: Nothing to disclose.

Eric B Staros, MD Associate Professor of Pathology, St Louis University School of Medicine; Director of Clinical Laboratories, Director of Cytopathology, Department of Pathology, St Louis University Hospital

Eric B Staros, MD is a member of the following medical societies: American Medical Association, American Society for Clinical Pathology, College of American Pathologists, Association for Molecular Pathology

Disclosure: Nothing to disclose.

Plasminogen 

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