Evidence for participation of granulocytes in the pathogenesis of the generalized Shwartzman reaction: a review.

Abstract

Evidence is reviewed that indicates that granulocytes are involved in the syndrome of intravascular clotting produced by sequential injections of endotoxin, i.e., the generalized Shwartzman reaction (GSR). Animals are not susceptible to the GSR during the phase of granulocytopenia induced by treatment with nitrogen mustard. Transfusion of granulocytes, infusion of polymorphonuclear-leukocyte granules, or infusion of a granule-supernatant fraction induces an immediate state of preparation for the GSR; in this state, one injection of endotoxin will trigger massive clotting. There is substantial evidence suggesting that acid mucosubstance and/or lysosomal cationic proteins from granulocytes may interact with endotoxin-induced soluble fibrin-monomer complexes or related fibrinogen derivatives, leading to formation of the fibrinous or fibrinlike coagulum that characterizes the GSR.