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The Effect of Intramuscular Injections of Whole Blood on the Prothrombin Index of the Newborn Infant
THE
EFFECT OF INTRAMUSCULAR INJECTIONS BLOOD ON THE PROTHROMBIN INDEX THE NEWBORN INFANT
SIDNEY (From
S.
GELLIS,
M.D.,
AND
ROBERT
A.
LYON,
OF WHOLE OF
M.D., CINCINNATI,
Children’s Hospital Research ~owndatiim and Pediatrics of the Unniuersity of Cincinnati College the
the
Department
OHIO of
of Medkhe)
T
injections of whole blood in the preHE value of intramuscular vention and treatment of hemorrhagic disease of the newborn infant has been questioned for many years. The history of this therapeutic procedure has been reviewed by Sanford and Leslie1 and Quick and Grossman.2 Now that the majority of hemorrhagic diseases of the neonatal period have been shown to be due to deficiencies of prothrombin, it is important to measure the influence of intramuscular injections of blood upon the prothrombin indices. Lawson3 has recently reviewed the subject and contributed experimental evidence of the inadequacy of such intramuscular injections in raising the prothrombin levels. He reported that ten newborn infants who received intramuscular injections of their mothers’ blood had levels of prothrombin during the first ten days of life which were comparable to t.hose of ten other infants who had receivd no such injections. PROCEDURE The prothrombin clotting time was determined by the micro-technique devised by Kato as a modification of the Quick method.4 The values were expressed in terms of prothrombin index, derived from the formula Normal clotting time x 100 = Prothrombin Infant’s clotting time
index.
The blood was collected in small test tubes 7 mm. in internal diameter and 15 mm. in length instead of ground glass hollow slides. The thromboplastin* was extracted from rabb.it’s brain. Normal clotting time by the Kato method was 20 t 2 seconds. The initial prothrombin determination was made within an hour or two after the infant was born and on each of the next five days. All of the infants received the same type of feeding during the neonatal period. They were put at the breast for the first time when they were twelve hours old and at intervals of four hours thereafter. RESULTS The first group of 35 infants who received no injection of blood had prothrombin indices which are shown in Fig. 1. The second group of 44 infants received 20 C.C. of their mothers’ blood by intramuscular injection immediately after the first prothrombin determination was made. Their prothrombin indices are shown in Fig. 2. To summarize these observations, averages were determined of the initial values of the prothrombin index, of the lowest values, and of the final values. In Table I, *The
thromboplastin
was supplied
by The
519
Difco
Co.
520
AMERICAN
JOURNAL
OF
OBSTETRICS
AND
GYNECOLOGY
it will be noted that the average of the initial indices was 80.2 per cent for the untreated group and 78.2 for the group of infants who received the blood injections. The lowest average value was 37.2 per cent for the untreated group and 39.3 for the treated group. The average final value, at the end of five days, was 61.2 for the un100-j . .
b;a . Le’ c’ i . .C . .. .* * . . .
90 -I
. o-‘,,,
0 6 12 Birth
.
.
.
.
,
,
,
,
,
,
,
24
36
48
60
72
84
36
Babies
on Breast Fig.
(
,
II
132 140 108 I20 Hours after Birth
Only
1.
looi: 90 3 80-a
i
. - .
1 r
470-i
. * *: -. : a.’* k . . . -4.: * . . i’!. * *” .
” l
‘.
.
. I .
*
‘.* ”
U 11 30h 20
‘.‘.*.
f: .
). .
l
.
.
10 1 o-Jr
, 0
I2
I 24
36
1 I 48
60
84
Birth Babies
on Breast
- Given
2Occ. Fig.
.. .
,
.
1 I 72
. . . * ... ‘i ..a . . I *.a, ,*
Maternal
1 96
I
I 1 110 I20 Hours after
Blood
140 Birth
Intramuscularh
2.
treated group and 61.6 for the treated group. These trends were generally alike with only slight advantages in favor of the group of infants who received the injections of blood. The figures of this table are shown graphically in Fig. 3. The number of infants who regained their initial prothrombin levels and the number who reached 100per cent by the end of five days were approximately the same in the two groups (Table II),
GELLIS
AND
LYON
PROTHROMBIN
:
I. PROTHR~MBIN
TABLE
INDEX
INDICES
OF
IN 2 GROUPS
521
INFANT
OF INFANTS
AVERAGE PROTHROMBIN INDEX FIRST VALUE LOWEST VALUE FINAL
Group 1: 35 infants Untreated Group 2: 44 infants Received 20 C.C.of whole blood, intramuscularly
I 0
12
Birth
1 24
37.2
61.2
78.2
39.3
61.6
I
I
f
I
36
48
60
72
1 84
I
I
I
96
120 after
140
Hours Fig.
TABLE
80.2
1. - Untreated. 2Occ. Maternal Blood Intramuscularly.
2.-
o J,
II.
Birth
3.
PATIENTS REGAINING INITIAL VALUES A?JD REACHING 100 PER CENT OF NORMAL WITHIN FIVE I)AYS REGAINED INITIAL VALUE
Group 1: 35 infants Untreated Group 2: 44 infants Received 20 CA. of whole blood, intramuscularly
TABLE
VALUE
III.
9
0
8
1
CHANGE IN PROTHROMBIN PERCENTAGE OF INITIAL
INDEX CALCULATED VALUE
AS
AS 70 OF INITIAL VALUE
FINAL VALUES AS % OF INITIAL VALUE
52.3
78.3
MAXIMUM
Group 1: 35 infants Untreated Group 2: 44 infants Received 20 C.C. of whole blood, intramuscularly
REACHED 100%
-
LOSS
49.1
81.3 __
522
m3mw.xN
JOURNAL
0~
OBSTETRICS
AND
G~i~3~20~0~y
When the changes in prothrombin indicses were calculated in terms of the initial values, it was found that the untreated group of infants lost an average of 52.:1 per cent of their initial values and returned to 78.3 per cent within the five-day period of observation. The group of infants who had received the injections of blood lost an average of 49.1 per cent of their initial values and ret,urned to 81.3 per cent during the same period of time. The differences between the two groups was not striking (Table III). SUMMARY
The prothrombin indices of 78 newborn breast-fed infants were determined for the first five days of life. Forty-four of these infants received intramuscular injections of whole blood and 35 did not. When the prothrombin indices of the two groups were compared, it was observed that a single intramuscular injection of 20 C.C. of maternal blood had little or no effect in checking the decline of the prothrombin index during the neonatal period, or in hastening its return to normal values. REFERENCES (1) Sanford, and Grossman, 18: 224, 1941.
H. N., and Leslie, E. I. : J. Pediat. A. M. : Am. J. M. SC. 199: 1, 1940. (4) Hato, K.: Am. J. Clin. Path.
A PRIMARY HERMAN
TUBAL CARCINOMA PRIMARY OVARIAN L.
GARDNER,
M.D.,
OMAHA,
ROCHESTER, (From
the
Department Pathology,
12: 16, 1938. (2) Quick, A. J., (3) Lawson, R. B.: J. Pediat. 10: 147, 1940.
ASSOCIATED SARCOMA NEB.,
AND
J. C.
WITH CAIN,
A
M.D.
MINN.
of Obstetrics and Gynecology ad the Department University of Texas School of Medicine)
of
P
RIMARY carcinoma of the Fallopian tubes still stands as a gynecologic rarity. Though Renaudl called attention to this affection of the Fallopian tubes in 1847. it was probably Orthmannz who, in 1888, gave the first accurate pathologic description of this type of cancer. According to Baron s there were 363 cases of primary tubal carcinoma reported in the literature up to February, 1939. The incidence of primary tubal carcinoma is probably one in five to ten thousand gynecologic admissions. There has been only one other case of primary carcinoma of the Fallopian tube recorded in the files of John Scaly Hospital during the period from July, 1920, to July, 1940, from a total of 11,300 gynecologic admissions. In making this report, we are adding another case of primary tubal carcinoma to the literature, but of greater interest is the fart that it was associated with a primary ovarian sarcoma. We are unable to discover the report of a similar case in the literature, and we offer no speculation as to why these two types of rare malignancy should occur together in the same individual. CASE R.EcoRn.-Patient F. C., a 39-year-old married negro woman entered John Scaly Hospital on March 22, 1940, complaining of soreness and a dull aching pain Her symptoms had been present for only three weeks during in the lower abdomen. For twelve which time she had been conscious of a mass in the lower abdomen. months the patient had experienced a watery vaginal discharge which necessitated the She claims to have lost 50 pounds during the wearing of a pad most of the time. eighteen-month period preceding her hospital admission. though she weighed 180 pounds on admission and showed no signs of recent loss. She had never experienced and she denied symptoms referable to the urinary or gastrointestinal symptoms,
EFFECT OF INTRAMUSCULAR INJECTIONS BLOOD ON THE PROTHROMBIN INDEX THE NEWBORN INFANT
SIDNEY (From
S.
GELLIS,
M.D.,
AND
ROBERT
A.
LYON,
OF WHOLE OF
M.D., CINCINNATI,
Children’s Hospital Research ~owndatiim and Pediatrics of the Unniuersity of Cincinnati College the
the
Department
OHIO of
of Medkhe)
T
injections of whole blood in the preHE value of intramuscular vention and treatment of hemorrhagic disease of the newborn infant has been questioned for many years. The history of this therapeutic procedure has been reviewed by Sanford and Leslie1 and Quick and Grossman.2 Now that the majority of hemorrhagic diseases of the neonatal period have been shown to be due to deficiencies of prothrombin, it is important to measure the influence of intramuscular injections of blood upon the prothrombin indices. Lawson3 has recently reviewed the subject and contributed experimental evidence of the inadequacy of such intramuscular injections in raising the prothrombin levels. He reported that ten newborn infants who received intramuscular injections of their mothers’ blood had levels of prothrombin during the first ten days of life which were comparable to t.hose of ten other infants who had receivd no such injections. PROCEDURE The prothrombin clotting time was determined by the micro-technique devised by Kato as a modification of the Quick method.4 The values were expressed in terms of prothrombin index, derived from the formula Normal clotting time x 100 = Prothrombin Infant’s clotting time
index.
The blood was collected in small test tubes 7 mm. in internal diameter and 15 mm. in length instead of ground glass hollow slides. The thromboplastin* was extracted from rabb.it’s brain. Normal clotting time by the Kato method was 20 t 2 seconds. The initial prothrombin determination was made within an hour or two after the infant was born and on each of the next five days. All of the infants received the same type of feeding during the neonatal period. They were put at the breast for the first time when they were twelve hours old and at intervals of four hours thereafter. RESULTS The first group of 35 infants who received no injection of blood had prothrombin indices which are shown in Fig. 1. The second group of 44 infants received 20 C.C. of their mothers’ blood by intramuscular injection immediately after the first prothrombin determination was made. Their prothrombin indices are shown in Fig. 2. To summarize these observations, averages were determined of the initial values of the prothrombin index, of the lowest values, and of the final values. In Table I, *The
thromboplastin
was supplied
by The
519
Difco
Co.
520
AMERICAN
JOURNAL
OF
OBSTETRICS
AND
GYNECOLOGY
it will be noted that the average of the initial indices was 80.2 per cent for the untreated group and 78.2 for the group of infants who received the blood injections. The lowest average value was 37.2 per cent for the untreated group and 39.3 for the treated group. The average final value, at the end of five days, was 61.2 for the un100-j . .
b;a . Le’ c’ i . .C . .. .* * . . .
90 -I
. o-‘,,,
0 6 12 Birth
.
.
.
.
,
,
,
,
,
,
,
24
36
48
60
72
84
36
Babies
on Breast Fig.
(
,
II
132 140 108 I20 Hours after Birth
Only
1.
looi: 90 3 80-a
i
. - .
1 r
470-i
. * *: -. : a.’* k . . . -4.: * . . i’!. * *” .
” l
‘.
.
. I .
*
‘.* ”
U 11 30h 20
‘.‘.*.
f: .
). .
l
.
.
10 1 o-Jr
, 0
I2
I 24
36
1 I 48
60
84
Birth Babies
on Breast
- Given
2Occ. Fig.
.. .
,
.
1 I 72
. . . * ... ‘i ..a . . I *.a, ,*
Maternal
1 96
I
I 1 110 I20 Hours after
Blood
140 Birth
Intramuscularh
2.
treated group and 61.6 for the treated group. These trends were generally alike with only slight advantages in favor of the group of infants who received the injections of blood. The figures of this table are shown graphically in Fig. 3. The number of infants who regained their initial prothrombin levels and the number who reached 100per cent by the end of five days were approximately the same in the two groups (Table II),
GELLIS
AND
LYON
PROTHROMBIN
:
I. PROTHR~MBIN
TABLE
INDEX
INDICES
OF
IN 2 GROUPS
521
INFANT
OF INFANTS
AVERAGE PROTHROMBIN INDEX FIRST VALUE LOWEST VALUE FINAL
Group 1: 35 infants Untreated Group 2: 44 infants Received 20 C.C.of whole blood, intramuscularly
I 0
12
Birth
1 24
37.2
61.2
78.2
39.3
61.6
I
I
f
I
36
48
60
72
1 84
I
I
I
96
120 after
140
Hours Fig.
TABLE
80.2
1. - Untreated. 2Occ. Maternal Blood Intramuscularly.
2.-
o J,
II.
Birth
3.
PATIENTS REGAINING INITIAL VALUES A?JD REACHING 100 PER CENT OF NORMAL WITHIN FIVE I)AYS REGAINED INITIAL VALUE
Group 1: 35 infants Untreated Group 2: 44 infants Received 20 CA. of whole blood, intramuscularly
TABLE
VALUE
III.
9
0
8
1
CHANGE IN PROTHROMBIN PERCENTAGE OF INITIAL
INDEX CALCULATED VALUE
AS
AS 70 OF INITIAL VALUE
FINAL VALUES AS % OF INITIAL VALUE
52.3
78.3
MAXIMUM
Group 1: 35 infants Untreated Group 2: 44 infants Received 20 C.C. of whole blood, intramuscularly
REACHED 100%
-
LOSS
49.1
81.3 __
522
m3mw.xN
JOURNAL
0~
OBSTETRICS
AND
G~i~3~20~0~y
When the changes in prothrombin indicses were calculated in terms of the initial values, it was found that the untreated group of infants lost an average of 52.:1 per cent of their initial values and returned to 78.3 per cent within the five-day period of observation. The group of infants who had received the injections of blood lost an average of 49.1 per cent of their initial values and ret,urned to 81.3 per cent during the same period of time. The differences between the two groups was not striking (Table III). SUMMARY
The prothrombin indices of 78 newborn breast-fed infants were determined for the first five days of life. Forty-four of these infants received intramuscular injections of whole blood and 35 did not. When the prothrombin indices of the two groups were compared, it was observed that a single intramuscular injection of 20 C.C. of maternal blood had little or no effect in checking the decline of the prothrombin index during the neonatal period, or in hastening its return to normal values. REFERENCES (1) Sanford, and Grossman, 18: 224, 1941.
H. N., and Leslie, E. I. : J. Pediat. A. M. : Am. J. M. SC. 199: 1, 1940. (4) Hato, K.: Am. J. Clin. Path.
A PRIMARY HERMAN
TUBAL CARCINOMA PRIMARY OVARIAN L.
GARDNER,
M.D.,
OMAHA,
ROCHESTER, (From
the
Department Pathology,
12: 16, 1938. (2) Quick, A. J., (3) Lawson, R. B.: J. Pediat. 10: 147, 1940.
ASSOCIATED SARCOMA NEB.,
AND
J. C.
WITH CAIN,
A
M.D.
MINN.
of Obstetrics and Gynecology ad the Department University of Texas School of Medicine)
of
P
RIMARY carcinoma of the Fallopian tubes still stands as a gynecologic rarity. Though Renaudl called attention to this affection of the Fallopian tubes in 1847. it was probably Orthmannz who, in 1888, gave the first accurate pathologic description of this type of cancer. According to Baron s there were 363 cases of primary tubal carcinoma reported in the literature up to February, 1939. The incidence of primary tubal carcinoma is probably one in five to ten thousand gynecologic admissions. There has been only one other case of primary carcinoma of the Fallopian tube recorded in the files of John Scaly Hospital during the period from July, 1920, to July, 1940, from a total of 11,300 gynecologic admissions. In making this report, we are adding another case of primary tubal carcinoma to the literature, but of greater interest is the fart that it was associated with a primary ovarian sarcoma. We are unable to discover the report of a similar case in the literature, and we offer no speculation as to why these two types of rare malignancy should occur together in the same individual. CASE R.EcoRn.-Patient F. C., a 39-year-old married negro woman entered John Scaly Hospital on March 22, 1940, complaining of soreness and a dull aching pain Her symptoms had been present for only three weeks during in the lower abdomen. For twelve which time she had been conscious of a mass in the lower abdomen. months the patient had experienced a watery vaginal discharge which necessitated the She claims to have lost 50 pounds during the wearing of a pad most of the time. eighteen-month period preceding her hospital admission. though she weighed 180 pounds on admission and showed no signs of recent loss. She had never experienced and she denied symptoms referable to the urinary or gastrointestinal symptoms,