Diseases associated with low cpillary resistance

Abstract

B LEEDING is a symptom which arrests attention. Nosebleeds in rheumatic or hypertensive patients, menorrhagia in purpura, and severe bleeding which follows an operation or minor injury can cause deep concern to both patient and physician. Individuals who show a bleeding tendency usually have a low capillary resistance. The lqwer the capillary resistance, the greater is the bleeding time.’ Although some causes of capillary fragility are known, our knowledge on the subject is far from complete. An analysis is presented of diseases or symptoms found to be present in sixty patients on the day their capillary resistance was extremely low (5 cm. of mercury suction). Solely because of their marked capillary fragility, these sixty patients were chosen for review from among 580 patients in a general practice upon whom some 3,000 capillary resistance determinations were routinely performed. Analysis of these symptoms is given for what light it may shed on factors responsible for undue bleeding. Capillary resistance was determined with a suction cup apparatus previously described:2 The minimal amount of negative pressure (suction), applied for one minute to the antecubital space, which produces one petechia or more, is the capillary resistance of the individual. Intervals of .5 cm. of mercury are used, readings being taken from a vacuum gauge. Normal values for capillary resistance are 20 cm., or higher. Definite fragility of capillaries exists when petechiae are produced at 10 cm. of suction, and fragility is extreme when petechiae are produced at a suction of 5 cm. of mercury. Low capillary resistance has been recorded in scarlet fever,*,3 measles,’ scurvy, 5-8 rheumatic fever,g’10 thrombocytopenic purpura,lJl allergic purpura,lz allergy,13 asthma,14 bronchopneumonia,15 ulcerlfi and colitis,16 ,hypertension,l7,‘8 myxedema,lg diabetes, I8 during menses or in the prernenstrual phase,20~21~2* and with increasing age.2.18,22-24 Extremely low values, 5 cm., have been noted in toxic scarlet fever, early measles, and in the acute stages of purpura and rheumatic fever. Summaries are presented on sixty patients, all showing extreme capillary fragility (5 cm.) on at least one occasion (Table I). The word “negative” in the column Symptoms on Day of Low Capillary Resistance is used to signify that no symptoms or signs were noted on that particular day to account for the low capillary resistance obtained. Dates are included mainly to allow the reader a chance to interpret a possible sequential relation of disease to capillary resistance.