Serum enzyme changes after intramuscular bleeding in patients with haemophilia and Christmas disease

Serum creatine kinase, lactate dehydrogenase, aspartate and alanine transaminases, and aldolase were determined in 41 hospital inpatients with haemophilia or Christmas disease and no significant differences from the normal ranges were found.(3) Levels of these enzymes in a further 10 such patients who had sustained muscle haematomata were determined: in all of these there was a consistent rise in the level of creatine kinase, the peak occurring between 36 and 96 hours. In bleeding disorders a rise in serum creatine kinase levels may be useful as a diagnostic test for intramuscular haemorrhage.

Haemostatic changes during dialysis associated with thrombus formation on dialysis membranes

Platelet counts, coagulation factors, and the fibrinolytic system were studied in seven regular dialysis patients during the course of haemodialysis by parallel flow (Gambro-Alwall) and coil (Travenol Ultra-Flo 100) dialysers. Significant falls in the patients' platelet counts and rises in their factor V levels were found with both dialysis systems. The changes were more pronounced over the course of a Gambro-Alwall dialysis, when significant falls in the partial thromboplastin clotting time and in the plasminogen levels were also noted. These haemostatic changes were associated with the retention of platelets on the dialysis membranes and, in the case of the Gambro-Alwall dialyser, with the formation of platelet-fibrin thrombus. This thrombus formation may take place in spite of efficient heparin anticoagulation and may cause excessive blood loss to the regular dialysis patient.

Serum and urine fibrinogen-fibrin-related antigen (F.R.-antigen) levels in renal disease

The concentration of serum fibrinogen-fibrin-related antigen (F.R.-antigen) was measured in a group of 142 patients with various renal disorders, in 38 of whom urine F.R.-antigen was also estimated. Raised serum F.R.-antigen levels were present in 48% of the patients, with no particular preponderance in any diagnostic category apart from acute reversible intrinsic renal failure in which high levels were invariably present. Significantly-raised serum levels were also present in the patients with microangiopathic haemolytic anaemia and in those with the more severe degrees of renal impairment. Urine F.R.-antigen was increased in 34 of the 38 patients. The amount of F.R.-antigen in the urine correlated with the degree of proteinuria but not with the serum F.R.-antigen levels. The evidence relating to intravascular coagulation in renal disease is reviewed, and it is suggested that there is a high incidence of localized fibrinogen or fibrin degradation in the kidney, which is related more to factors such as the presence of uraemia and microangiopathic haemolytic anaemia rather than to the diagnostic category.

Effect of feeding fat on fibrinolysis, stypven time, and platelet aggregation in elderly Africans

The effects of acute fat feeding on fibrinolytic activity, platelet aggregation, and stypven time in six elderly Africans are presented. These indicate that there is no alteration in the pattern of response seen in Africans with advancing age.

Tranexamic acid in control of haemorrhage after dental extraction in haemophilia and Christmas disease

In a double-blind trial tranexamic acid (AMCA, Cyclokapron), 1 g three times a day for five days, significantly reduced blood loss and transfusion requirements after dental extraction in patients with haemophilia and Christmas disease. No side effects were seen in either group of patients. Screening tests showed no toxic action of tranexamic acid on the liver, kidney, or heart.

Effect in vitro on platelet function of two compounds developed from the pyrimido-pyrimidines

VK 774 and VK 744, two new compounds developed from the pyrimido-pyrimidines, have been found to be powerful inhibitors of platelet function tested in vitro. They inhibit adenosine diphosphate (ADP)-induced platelet aggregation, and the release of platelet factor 3 by kaolin, and VK 774 also reduces platelet adhesiveness and inhibits platelet aggregation (;snowstorm' effect) in the Chandler tube system. Although measured percentage whole blood clot retraction was uninfluenced by these drugs the clot produced with VK 774 was friable and soft. VK 774 appears to be the most powerful of these compounds reported so far, being active in some test systems at 10(-6)M, and, if the results of toxicity testing are satisfactory, it should be an important agent for therapeutic trial.

Aggregation of human platelets by commercial preparations of bovine and porcine antihaemophilic globulin

Infusion of commercial preparations of porcine and bovine antihaemophilic globulin into three haemophilic patients produced transient thrombocytopenia. This platelet-aggregating activity has been shown to be present in a wide range of animal plasmas and is related to the fibrinogen fraction. The mechanism of platelet aggregation by animal fibrinogen is discussed and some inhibitors of the reaction are described.