The factors of coagulation in primary pernicious anemia / Cecil K. Drinker, M.D. and Samuel H. Hurwitz, M.D. Boston.

  • Drinker, Cecil Kent, 1887-1956
Date:
1915
Catalogue details

Licence: In copyright

Credit: The factors of coagulation in primary pernicious anemia / Cecil K. Drinker, M.D. and Samuel H. Hurwitz, M.D. Boston. Source: Wellcome Collection.

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    Extremities: There are no edema, scars, cyanosis, or sclerosis of peripheral vessels. Color of the skin everywhere is very light yellow. Reflexes: Knee, ankle, biceps, triceps, supinator, and pronator reflexes are easily obtained and very active. There is a marked patellar clonus. No ankle clonus, Gordon sign, Oppenheim sign, nor Babinski sign made out. On admission the temperature was 99.2 F. Pulse, 128. Respiratory rate, 21. BLOOD EXAMINATIONS AND CLINICAL NOTES June 4. Blood: Hemoglobin .29 per cent. R. B. C.752,000 W. B. C. 3,200 Platelets (23) . 2,800 Differential Count: Polymorphonuclear neutrophils, 54 per cent; large mononuclear cells, 4 per cent.; lymphocytes, 41 per cent.; eosinophils, 1 per cent. Red cells show very slight anisocytosis and poikilocytosis, no polychromatophilia, stippling, or basophilia. No myelocytes, normoblasts, or megaloblasts are seen. The puncture wound from which blood was taken for counting bled for forty-five minutes and was finally checked with nitrate of silver. This pro¬ longed bleeding time was constant and necessitated subsequently the use of a very fine needle. Warned by this experience, the venous punctures recorded later were made with a fine needle and no trouble occurred. Urine: Negative. Wassermann reaction blood serum, negative. The patient was at once placed on ascending doses of Fowler’s solution, dilute hydrochloric acid with meals, and forced house diet. He was kept at rest in bed out of doors all of the time. June 5, blood obtained by venous puncture. Coagulation time, twenty-seven minutes. (Howell’s method.) TABLE 2.—Case P. L. C. Determination of Antithrombin Thrombin, Drops Heated Plasma, Drops • Fibrinogen, Drops Result 4 1 10 Clot in 7 hours. 5 1 10 Clot in 34 minutes. 6 1 10 Clot in 18 minutes. CONTKOL C. K. D. 4 1 10 Faint clot in 27 minutes; firm clot in 7 hours. 5 1 10 Clot in 37 minutes. 6 1 10 Clot in 18 minutes. PROTOCOLS The following protocols illustrate the methods used for determining anti¬ thrombin and prothrombin. For further studies of these factors and for their correlation with the changing blood picture, reference must be made to Table 1. Antithrombin was determined by Howell’s method. The test plasma is heated slowly to 60 C. and then centrifugalized to throw down the fibrinogen which has been precipitated. If a drop of the supernatant fluid is added to a known thrombin solution it can be shown to delay the action of this thrombin on fibrinogen most markedly. In every test the supposedly abnormal plasma