Coagulation Abnormalities In Patients Research Articles

Coagulation abnormalities in patients with arterial, venous, and combined arterial and venous thromboses.

Thrombotic disorders are much more common than hemorrhagic disorders. Nonetheless, most knowledge of coagulation relates to the hemorrhagic disorders. We have done extensive coagulation evaluations in patients with arterial thromboses only, venous thromboses only, and in patients with combined arterial and venous thromboses. Prominent abnormalities in platelet aggregation, factors VIII, IX, and XI levels, and fibrinogen were noted in all groups. These types of studies should eventually lead to a fuller understanding of thrombotic disorders.

Efficacy of selective splanchnic arteriography and vasopressin perfusion in diagnosis and treatment of gastrointestinal hemorrhage

Vasopressin infusion initially controlled 80 per cent of patients bleeding from portal hypertension, and 53 per cent did not rebleed after removal of the catheter. This figure is significantly greater than the 28 per cent of patients totally controlled by esophageal tamponade (p <0.075). Similar rates of success were achieved by vasopressin infusion for gastric, duodenal, and colonic bleeding sites. These results suggest that visceral arterial infusion of vasopressin is the method of choice for the short-term therapeutic management of massive gastrointestinal bleeding from portal hypertension. Vasopressin infusion also appears to be a valuable means of treating patients with massive gastrointestinal bleeding secondary to shallow gastric ulcers, gastritis, Mallory-Weiss tears, colonic bleeding and “poor risk” patients with deep gastric, marginal, or duodenal ulcers when conventional medical therapy has failed. The presence of a coagulation abnormality in patients with portal hypertension significantly reduced the complete control of bleeding to only 27 per cent (p <0.010) and survival rate to 14 per cent (p <0.050). Visceral arterial perfusion proved to be an effective means of arresting hemorrhage, but the overall improvement in hospital mortality in this group of poor risk patients remains unproved.

Clinical and morphological correlations in acute promyelocytic leukemia.

Thirty adults with acute leukemia and greater than 20% bone marrow infiltrate by promyelocytes were studied. Eighteen patients had acute promyelocytic leukemia (APML) as defined by the presence of malignant promyelocytes, and the remaining 12 patients had acute myelocytic leukemia (AML) with an elevated percentage of normal promyelocytes. Malignant promyelocytes were characterized by abundant, abnormal, cytoplasmic granules, by Auer rods in meshwork pattern, and by splinter cytoplasmic granulations and dilatation of the cisternae of endoplasmic reticulum. Patients with APML had, in general, greater than 35% bone marrow infiltrate by promyelocytes. The degree of bone marrow infiltrate by these cells correlated with the clinical status of the patients. Diffuse intravascular coagulation with bleeding occurred in 61% of patients with APML, and the bone marrows of these patients had greater than 50% promyelocytes. No coagulation abnormalities were seen among patients with elevated bone marrow promyelocytes infiltrate and without APML. Coagulation abnormalities in patients with APML were only corrected by controlling the leukemia itself. When this occurred, patients with APML had an excellent rate of complete remission, and the duration of remission and survival were comparable to the results obtained in adults with AML.

Coagulation abnormalities in patients with hydrocephalus and ventricular-jugular

The presence of silastic prostheses and tubing in the circulation is now recognized to produce alterations in hemostasis. Stimulated by the observation of severe disseminated intravascular coagulation in a child with a clotted V.J. shunt and the recognition that obstruction to such catheters is one of the undesirable complications of its use in children with hydrocephalus, coagulation studies were performed in 25 asymptomatic children with V.J. shunts. Prothrombin and partial thromboplastin times, Factor V and VIII levels and platelet counts were normal in all. In 2 of the patients the thrombin time was prolonged and in 1 of these patients significant increases in the level of fibrin split products were demonstrable. In 4 patients platelet survivals, using Cr51 labeled platelets, were performed. In 2 the survival was; significantly reduced. Patients in whom coagulation abnormalities or shortened platelet survival were present developed obstructive complications in their shunts. It would appear that catheter problems can be anticipated by performance of coagulation studies. The use of aspirin and dipyridamole, agents which inhibit platelet aggregation in vivo, may provide a means. of eliminating the complication of shunt obstruction.