[Acute thrombopenia during treatment with digoxin in an infant].
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The authors observed 9 patients submitted to prophylactic treatment with adequately doses subcutaneous heparin, for orthopaedic or traumatic surgery (chiefly total hip arthroplasty) who presented between the 7 and 9 day after starting heparin therapy, thrombotic complications including recurrent arterial occlusions and venous thrombosis associated with a profound thrombocytopenia, with a maximum platelet count below 30,000 per cubic millimeter. A rapid increase of platelet count after heparin withdrawal is observed, and the profound thrombocytopenia seems to be immune mediated with heparin dependent platelet antibodies, in most of the reported cases. We propose a platelet count for all surgical patients with heparin therapy, and if a thrombocytopenia appears, with a platelet count in the range of: 80,000 clinical inspection and platelet aggregation investigations, and immediate cessation of heparin therapy at 30,000 platelets/mm3.
Long-term determinations of haemostasis factors in a case of Osler's telangiectasia revealed the temporarily simultaneous existance of periods of thrombocytopenia, a decrease of prothrombine and a reduction of the fibrinogen and plasminogen level. These findings considered as signs of consumption coagulopathy coincided with an increased bleeding tendency of the patient. The correlation existing between the clinical symptoms and the observed disorders of coagulation may possibly be explained by the appearance of an intravascular coagulation during the late period of the haemorrhagic diathesis, which could be proved by the simultaneous increase of fibrinogen degradation products. Moreover, the patient's plasma was capable of strongly inhibiting factor VIII of a normal plasma. The possible influence of plasmatic disorders of coagulation which are caused by secondary reasons on the clinical picture of a haemorrhagic diathesis primarily based on vascular conditions is discussed.
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