Colloid Transfusion, Natural Anticoagulant Depletion, and Symmetric Peripheral Gangrene

This letter presents two cases of symmetric peripheral gangrene (SPG) in critically ill patients with septic shock and disseminated intravascular coagulation. The authors highlight a key observation: profound depletion of natural anticoagulants (antithrombin, protein C, and protein S) coincided with colloid transfusions (albumin and intravenous immune globulin) shortly before the onset of ischemic limb necrosis. Laboratory data showed severe drops in these anticoagulants after transfusion, raising concern that colloids lacking coagulation factors may exacerbate microthrombotic risk in patients already prone to hemodynamic shock and coagulopathy. The letter recommends cautious use of colloids in such patients and suggests plasma may be preferable for volume replacement to preserve anticoagulant balance. The authors call for further research into how colloid infusion affects coagulation dynamics and peripheral tissue injury in septic shock

This letter presents two cases of symmetric peripheral gangrene (SPG) in critically ill patients with septic shock and disseminated intravascular coagulation. The authors highlight a key observation: profound depletion of natural anticoagulants (antithrombin, protein C, and protein S) coincided with colloid transfusions (albumin and intravenous immune globulin) shortly before the onset of ischemic limb necrosis. Laboratory data showed severe drops in these anticoagulants after transfusion, raising concern that colloids lacking coagulation factors may exacerbate microthrombotic risk in patients already prone to hemodynamic shock and coagulopathy. The letter recommends cautious use of colloids in such patients and suggests plasma may be preferable for volume replacement to preserve anticoagulant balance. The authors call for further research into how colloid infusion affects coagulation dynamics and peripheral tissue injury in septic shock