Disorders in the blood system in cancer patients with purulent-septic complications

Despite the efforts of the world community, a steady increase in the incidence of sepsis and high mortality rates persist. The search for reliable and simple methods for the timely diagnosis of septic conditions and effective control of the treatment of the disease is one of the topical areas of laboratory diagnosis of critical conditions in surgical practice. The purpose of the work is to evaluate the diagnostic significance of indicators of the functional activity of albumin, the state of the hemostasis system and the morphology of neutrophils in cancer patients with purulent-septic complications during treatment. Results. We observed 32 cancer patients with tumors of various localizations. All patients in the postoperative period developed purulent-septic complications (peritonitis, pancreatic necrosis, acute endobronchitis, acute cholangitis, pneumonia, etc.). From the first day of the development of purulent-septic complications (GSO), patients showed a significant decrease in detoxification activity, binding and transport capacity of serum albumin. Protein dysfunctions persisted almost throughout the entire observation period, especially pronounced in patients with an unfavorable course of GSO. Of the 32 patients with purulent-septic complications, 16 patients died due to the development of septic shock, multiple organ failure, which was accompanied by both bleeding and micro and macrothrombosis; 16 patients were successfully treated and discharged from the hospital. A retrospective analysis of successfully treated patients and deceased patients with purulent-septic complications was carried out. In the case of successful treatment of sepsis, the restoration of the detoxification and transport efficiency of albumin to the lower limits of the norm was observed. In the group of deceased patients, a sharp decrease in the detoxification efficiency of serum albumin (DTE) was revealed on the 1st day of the development of purulent-septic complications, significantly different from the indicators of successfully treated patients. The results of the study allow us to recommend the parameter of albumin detoxification activity for early diagnosis and prediction of the severity of purulent-septic complications in cancer patients. In cancer patients with purulent-septic complications, there is a significant activation of blood coagulation and the development of various forms of the DIC syndrome with the consumption of natural thrombin inhibitors, components of fibrinolysis and platelets, which must be taken into account in the complex therapy of septic conditions. Revealed neutrophilia with a pronounced shift of the blood formula to the left, combined with a slight leukocytosis or leukopenia. The appearance in the peripheral blood of patients with sepsis of a significant population of young neutrophils and degenerative segmented forms (toxogenic granularity, vacuolization of the cytoplasm, pycnosis of the nuclei) indicate endogenous intoxication, impaired maturation and differentiation in the bone marrow. The data obtained can be used in monitoring the clinical course of sepsis. Conclusion. The results of assessing the parameter of the detoxification efficiency of blood serum albumin, assessing the intensity of intravascular coagulation, and analyzing the morphology of neutrophils can be used to accompany cancer patients during surgical treatment. The data obtained will help to timely identify, monitor and control the effectiveness of intensive care for purulent-septic complications that aggravate the course of the postoperative period, lengthen the time of hospital stay and increase the cost of treatment.