Significance of blood coagulation and platelet profiles in relation to pulmonary thrombosis in beta-thalassemia/Hb E.

In beta-Thalassemia hemoglobin E (beta-thal Hb E), hypoxemia with abnormal lung function was described and postmortem examination in these patients showed organized pulmonary trombi with thickened arterial wall, particularly in post-splenectomized cases. Coagulation and platelet profiles were studied in 58 beta-thal Hb E patients. In 35 cases with intact spleen, the fibrinolytic activity was significantly decreased with high antithrombin III activity, while coagulation tests revealed mild abnormality. The platelet aggregation to ADP, adrenaline, collagen and ristocretin were defective and platelet 5-hydroxytryptamine content was lower than normal. Twenty-three patients who had been splenectomized for 5-18 years, decreased fibrinolytic activity and high antithrombin III activity were also observed. The coagulation profiles and platelet aggregation in response to ADP, adrenaline and collagen showed better results. Fourteen cases exhibited thrombocytosis and their thrombin generation was in the hypercoagulable range. Platelet aggregation in response to ristocetin remained defective and platelet 5-hydroxytryptamine content was lower than in cases with intact spleens. Defective aggregation to ristocetin would indicate abnormal von Willebrand's factor (vWF). Decreased fibrinolysis should very likely have a role in the occurrence of thrombosis and the better hemostatic profiles in post-splenectomized cases would contribute to the more frequent thrombotic incidence in these cases.

Factor VIII, factor IX and fibrinogen content in cryoprecipitate, fresh plasma and cryoprecipitate-removed plasma.

In order to provide accurate information for physicians, factor VIII, factor IX and fibrinogen content were determined in 40 bags of cryoprecipitate, fresh plasma and cryoprecipitate-removed plasma. A cryoprecipitate bag with a volume of 21.8 +/- 5.3 ml contained 139.5 +/- 42.9 units of factor VIII and 200.0 +/- 80.0 mg of fibrinogen. Fresh plasma with a volume of 208.0 +/- 22.5 ml contained 180.9 +/- 45.3 of factor IX, significantly higher than in cryoprecipitate-removed plasma. It was also found in this study that group O blood showed a significantly lower level of factor VIII.

Dark green pit viper (Trimeresurus popeorum) bite: clinical and serial coagulation profiles in 51 cases.

Trimeresurus popeorum, a dark green pit viper, is commonly found in Southeast Asia. This study describes the clinical picture and blood studies of 51 patients bitten by this snake. Affected limbs were swollen; and hemorrhagic blebs in fingers and toes were found in 12 patients. Lymphangitis was observed in 4 instances. Six individuals exhibited hypofibrinogenemia of 0-84 mg/dl, and 2 cases developed thrombocytopenia and bleeding. The presence of venom in the blood of these patients was demonstrated. Positive fibrin degradation products of 40-320 micrograms/ml were observed in 6 cases with hypofibrinogenemia, and in 8 other cases. Nineteen patients had short euglobulin lysis times of 51.8 +/- 24.7 min. Hyperfibrinogenemia of 626.7 +/- 288.9 mg/dl was found in 18 cases. Apart from bleeding, there were no systemic symptoms. Hypofibrinogenemia became normal in 3-12 days. The clinical course in all patients was uneventful, and none received antivenin.

Blood coagulation and platelet profiles in persistent post-splenectomy thrombocytosis. The relationship to thromboembolism.

To clarify the possible role of persistent thrombocytosis after splenectomy being a predisposing factor causing development of thromboembolism, blood coagulation profiles and platelet functions were studied in 34 cases being 1-18 years post-splenectomy from non-malignant diseases. Persistent thrombocytosis was observed in 16 with significant negative correlation between hemoglobin level and platelet count indicated the role of anemia on persistent post-splenectomy thrombocytosis. Blood coagulation profiles showed accelerated thrombin formation or hypercoagulability as measured by thrombin generation test especially in cases with thrombocytosis, together with decreased fibrinolytic activity and high fibrinogen, but in presence of high antithrombin III activity. Concerning the platelet, the aggregation to ristocetin was defective, the improved aggregation to ADP and adrenaline was achieved only in whom with intact spleen giving defective platelet aggregation. The finding indicated the role of spleen contributing to abnormal platelet aggregation. Another interesting observation was the decreased platelet 5-hydroxytryptamine content in splenectomized cases. The overall changes on blood coagulation and platelets post-splenectomy including those with persistent thrombocytosis did not thoroughly shift to hypercoagulable state, since a high antithrombin III activity and some platelet defect remained. These present findings, therefore, unlikely predisposed to the occurrence of thromboembolism even in those with persistent thrombocytosis.

The relationship between high fibrinolytic activity and daily capsicum ingestion in Thais.

Capsicum, a hot appetizer and seasoning, has been found to induce increased fibrinolytic activity and simultaneously cause hypocoagulability of blood when ingested or when retained in the mouth for a short time. The effect on fibrinolysis and blood coagulation of capsicum can be reproduced in the same subjects within a short time after the first stimulation. More investigations on this effect may lead to the discovery of some ideal drugs for both treatment and prevention of thromboembolism. Fibrinolytic activity measured by euglobulin lysis time in 88 Thai subjects (mean +/- SD = 167 +/- 66.84 min) was significantly higher than in 55 American whites (mean +/- SD = 254 +/- 126.70 min) residing in Thailand for a period of time (p less than 0.001). The Thai people consume capsicum with their meals. Their fibrinolytic activity, therefore, is activated several times during the day and this activation could be an important factor in causing high fibrinolytic activity. This customary habit of food ingestion is very likely a factor contributing to the racial difference in fibrinolysis. Furthermore, the Thais also have lower plasma fibrinogen and higher antithrombin III compared to Americans. These could certainly be additional factors, in addition to fibrinolytic activity, that play a role in the rarity of thromboembolism among Thais.