The formation of a CA2+-dependent complex of C-reactive protein and very low density lipoprotein causes the biphasic transmittance waveform

Clinical background The "biphasic transmittance waveform" (BTW) refers to a time-dependent decrease in light transmittance that often occurs prior to clotting when performing the activated partial thromboplastin time (aPTT) assay with plasmas of critically ill patients on the MDA® coagulation analyzer [1]. Early observations showed an association of the BTW with disseminated intravascular coagulation (DIC) and clinical outcome. (See Table 1) The magnitude of the BTW was assessed against in-patient mortality. A total of 346 patients were found to have a BTW on admission to the ITU with a mortality rate of 44%, as compared with 26% for those with normal waveforms. A stepwise increase in the likelihood of mortality was directly correlated with the from 3rd International Conference on cGMP Generators, Effectors and Therapeutic Implications Dresden, Germany. 15–17 June 2007