Charles A. Owen

Hypercoagulability Associated with Chronic Ulcerative Colitis: Changes in Blood Coagulation Factors

Summary Blood coagulation factors were studied in 16 patients with ulcerative colitis. Increased factor VIII activity was the most frequent, and perhaps the most important, coagulation abnormality found. It appears to be the basis of the accelerated thromboplastin generation in this disease. Increased factor VIII activity, acceleration of thromboplastin generation, and an increase in fibrinogen seem to be related to the activity of the disease and the extent of colon involvement. The relationship of these changes to the occurrence of thrombosis is discussed. The most frequent coagulation defect in active ulcerative colitis is prolongation of the one-stage prothrombin time, due to mild to moderate decreases in factors VII and X. These changes are probably due to vitamin K deficiency. The possibility of a mild qualitative platelet defect in certain patients is suggested by the occasional finding of abnormal prothrombin consumption corrected by Inosithin, a platelet substitute.

Hypercoagulability Associated with Malignant Disease and with the Postoperative State: Evidence for Elevated Levels of Antihemophilic Globulin

Excerpt The increased incidence of venous thrombo-embolism associated with malignant (1, 2) disease and with the postoperative state (3, 4) is well recognized. Although thrombophlebitis may occur i...

Hemostatic Evaluation of Patients Undergoing Liver Transplantation

A detailed coagulation and thromboelastographic study was done on the first 50 liver transplantation procedures performed at the Mayo Clinic between March 1985 and June 1986. Most of the patients suffered from primary sclerosing cholangitis, primary biliary cirrhosis, or chronic active hepatitis. Seven patients required a second liver transplantation, and six patients died, none intraoperatively. Most of the patients had distorted hemostatic mechanisms preoperatively, as would be expected because the liver generates most of the clotting factors. The outstanding exception was factor VIII, which was usually in the high-normal range or even more elevated. Substantial deterioration of coagulation factors occurred regularly during reperfusion of the donor liver. In some instances, this trend was corrected within 1 hour, but platelet counts continued to decrease, and some coagulation factors rebounded only partially. Because thromboelastographic tracings are quickly available to the liver transplant team and because they tend to forewarn of impending hemostatic problems, we believe that thromboelastography is a reasonably effective procedure for monitoring coagulation during liver transplantation.

Prothrombin conversion factor of dicumarol plasma.

Summary Evidence is presented that suggests the disappearance not only of prothrombin in dogs treated with dicumarol, but also of a factor important in the conversion of prothrombin to thrombin. Like prothrombin, this factor is associated with the plasma pseudoglobulins, but unlike prothrombin it is plentiful in serum. Addition of plasma, serum or serum pseudoglobulin corrects the delayed prothrombin convertibility of early dicu-marolization or of stored plasma. The discrepancy between the one-stage and 2-stage methods of estimating prothrombin seems to reside in this conversion factor.

Evaluation of Preoperative Hematology-Coagulation Screening in Liver Transplantation

We retrospectively reviewed the results of preoperative hematology-coagulation studies in 66 patients who underwent orthotopic liver transplantation-24 with the primary diagnosis of chronic active hepatitis (CAH), 22 with primary sclerosing cholangitis (PSC), and 20 with primary biliary cirrhosis (PBC). The mean prothrombin time was above normal in all three diagnostic groups, patients with CAH having the highest values. The mean activated partial thromboplastin time was normal in patients with PSC or PBC but elevated in those with CAH. Fibrinogen levels were above normal in patients with PBC but decreased in 1 patient (5%) with PSC and 10 (42%) with CAH. Mean platelet counts were below normal in 68% and 55% of patients with PSC and PBC, respectively, but in 96% of those with CAH. The mean Ivy bleeding time was normal in patients with PSC or PBC but prolonged in those with CAH. Patients with PSC or PBC had normal mean activity levels of factors II, V, VII, IX, and X, whereas those with CAH had below normal mean values for factors II and VII. The antithrombin III activity level was normal in patients with PSC or PBC but reduced in those with CAH. Thus, patients with CAH have a greater derangement in results of clotting studies in comparison with those who have PSC or PBC, but the use of blood did not differ among the three diagnostic groups.

Absorption of Iron from the Small Bowel of Dogs

Summary Absorption of radioactive iron from segments of duodenum and ileum in anesthetized dogs was concurrently measured by three different methods. Agreement among the results of the three methods was close. Iron was given in either ferric or ferrous form in doses of 0.5 to 10 μg. In some instances ascorbic acid (100 mg.) was added to the test solution of iron in Tyrodes solution; the pH of the solution was adjusted to 2 or 7 before placement in the intestinal loops. Most tests lasted 5 hours. A linear relationship was obtained on a log/log scale between the amount of iron absorbed and the amount in the test solution. The relationship was most significant when the test solution was at pH 2 and contained ascorbic acid. The addition of ascorbic acid or acidifying the iron solution to pH 2 caused similar increases in absorption of iron; the effects were additive. When the iron was in a solution at pH 2 with ascorbic acid added, significantly more iron was absorbed from the duodenum per square centimeter of serosa than from the ileum. The rate of absorption of iron was fastest in most cases in the 15-minute period from 15 to 30 minutes after introduction of iron into the lumen of the bowel. This maximal rate did not bear any relation to the total amount of absorption of iron. In most cases absorption did not continue longer than 120 minutes. Three doses of radioactive iron given at 2-hour intervals into the same segment of duodenum resulted in only slight diminution of absorption of iron, showing that the so called mucosal block did not operate at these dose levels. It is suggested that after about 1 hour the iron remaining in the lumen of the bowel had no further influence on absorption of iron; only the iron accumulated in the intestinal wall during the first hour was subsequently absorbed. During the absorptive period, the radioiron left the fluid contents of the intestinal loop more rapidly than it left the intestine. The resulting accumulation in the mucosa was demonstrated autoradiographically.

Limitations of the I131-Labeled Triolein Tests in the Diagnosis of Steatorrhea

Summary The I 131 -labeled triolein urinary excretion and fecal excretion tests for steatorrhea were evaluated in 36 patients with steatorrhea proven by chemical analysis of the feces for fat, and in an additional 28 patients who served as controls. The 24-hour urinary excretion test was found to be insensitive. The fecal excretion test was uniformly positive in patients with severe steatorrhea but was unreliable in patients with mild and moderate impairment of fat absorption. Because I 131 -labeled triolein provides only an insensitive and empiric index of fat absorption, its usefulness in clinical and physiologic studies seems limited.

Erythrokinetics in Myxedema

Excerpt Normochromic anemia of modest degree is common in myxedematous patients and may persist for months after institution of thyroid hormone therapy (1-3). The bone marrow tends to be hypocellul...

Serum and plasma antithrombin.

Summary A method of estimating the rate of natural antithrombic activity is suggested. When this method was used, dog plasma, regardless of the prothrombin level after dicumarolization, seemed to exert about the same antithrombic activity. On the other hand, dog serum antithrombin tended to vary inversely with the prothrombin content of its original plasma, and serum obtained from blood containing little prothrombin was antithrombic to about the same extent as plasma. These observations suggest that antithrombic activity be determined on plasma unless due consideration is given to the antithrombic activity already performed by serum.

Accelerated Thromboplastin Generation in Acute Arterial Occlusion Complicating Arteriosclerosis Obliterans

Excerpt What part, if any, thrombosis plays in the development of arteriosclerosis is still unsettled; however, there is agreement that thrombosis is the terminal event in the arterial occlusion of...