- Email: [email protected]
Terminal coagulopathy in meningococcal septicaemia
ABSTRACTS OF A N N U A L SCIENTIFIC MEETING
1969
75
The analogies between folk acid deficiency in man and in L. casei suggest that a study of the bacterial system may help to clarify the biochemical basis of megaloblastosis in man. TERMINAL COAG U LO PATHY I N MEN I NGOCOCCAL SEPTICAEMIA
DAVIES, D. W. Commonwealth Health Laboratory, Canberra, A.C. T . During the course of an outbreak of meningococcal septicaemia, detailed coagulation studies were carried out on two patients with fulminating infections in which there were massive purpuric reactions and associated renal failure. N . meningitidis, serotype C , was isolated from both patients. In these patients there were severe thrombocytopenia, procoagulant depletion and abnormally high fibrinogen levels. In the second case heparin was started after the first coagulation studies were made and was continued until death 20 hr. later. Autopsy findings on this patient suggested a generalized Schwartzmann reaction. It is considered that death in both patients was due to an explosive intravascular coagulation process for which anticoagulant therapy, in the second case, was too late to be effective. In the presence of an acute, and apparently irreversible ‘thrombophilic’ shift in the coagulation mechanisms, it is suggested that a good case can be made for an active programme of thrombolytic therapy as a primary line of attack. THE ANAEMIA OF CHRONIC RENAL FAILURE
O’NEILL,B. J., EVANS,R. A. & STREETER, A. M. Repatriation General Hospital, Sydney, New South Wales The anaemia accompanying chronic renal failure was studied in 58 patients. Investigations carried out included bleeding studies, bone marrow preparations (including iron and PAS stains), serum iron, TIBC, folk acid and vitamin B,, levels, 51Crred cell survival times, external body scan, estimation of 5-day faecal blood loss, and 5 8 Fferrokinetic ~ studies. The anaemia in these cases was commonly found to be due to multiple factors, in particular haemolysis, bone marrow failure and folic acid deficiency. The need to exclude anaemia due to other causes unrelated to the chronic renal failure was also shown in this series. THE SYNDROME OF MARROW HYPOPLASIA WITH RELATIVE INCREASE I N PRIMARY BLAST CELLS I N ELDERLY PATIENTS
WOODS, W. E. & O’NEILL,B. J.
Repatriation General Hospital, Sydney, New South Wales Eight patients were presented who appeared to represent a not uncommon syndrome in the older age groups. The main features of this syndrome are pancytopenia (chiefly neutropenia), hypoplastic bone marrow with an increase in primitive blast cells, obvious ringed siderohlasts in the marrow and often a prolonged course, with death usually due to intercurrent infection. At autopsy, tissue infiltration by primitive cells may be present, The aetiology of this condition is not known. Similar cases have been described as ‘preleukaemia’ or ‘hypoplastic leukaemia’, but none of the eight cases reported terminated in frank leukaemia. It was the authors’ impression that if such cases are treated as leukaemia their prognosis is worse than if they are treated conservatively. BLOOD LEAD ESTIMATIONS
EDWARDS, R. G., BERRIMAN, H. & GEARY, T. D . Institute of Medical and Veterinary Science, Adelaide, South Australia Whole blood or red cell lead content estimations are known to be the best indications of exposure to lead, but these measurements are not used as frequently as is desirable in Australia apparently because of the supposed technical difficulty of the laboratory methods. A simple method of estimating blood lead is presented. This can be established in any good laboratory and is based on lysis of an aliquot of blood, chelation of the lead, concentration of the complex in an organic phase and the spraying of this extract into an atomic absorption spectro-photometer. Values obtained from a group of 40 adults not exposed to a lead hazard ranged from 5-2Opg. of lead / 100 ml. of whole blood with a median value of 15pg. As lead is bound to red cells it has been recommended that results be expressed as micrograms of lead jml. of erythrocytes (mean erythrocyte lead
1969
75
The analogies between folk acid deficiency in man and in L. casei suggest that a study of the bacterial system may help to clarify the biochemical basis of megaloblastosis in man. TERMINAL COAG U LO PATHY I N MEN I NGOCOCCAL SEPTICAEMIA
DAVIES, D. W. Commonwealth Health Laboratory, Canberra, A.C. T . During the course of an outbreak of meningococcal septicaemia, detailed coagulation studies were carried out on two patients with fulminating infections in which there were massive purpuric reactions and associated renal failure. N . meningitidis, serotype C , was isolated from both patients. In these patients there were severe thrombocytopenia, procoagulant depletion and abnormally high fibrinogen levels. In the second case heparin was started after the first coagulation studies were made and was continued until death 20 hr. later. Autopsy findings on this patient suggested a generalized Schwartzmann reaction. It is considered that death in both patients was due to an explosive intravascular coagulation process for which anticoagulant therapy, in the second case, was too late to be effective. In the presence of an acute, and apparently irreversible ‘thrombophilic’ shift in the coagulation mechanisms, it is suggested that a good case can be made for an active programme of thrombolytic therapy as a primary line of attack. THE ANAEMIA OF CHRONIC RENAL FAILURE
O’NEILL,B. J., EVANS,R. A. & STREETER, A. M. Repatriation General Hospital, Sydney, New South Wales The anaemia accompanying chronic renal failure was studied in 58 patients. Investigations carried out included bleeding studies, bone marrow preparations (including iron and PAS stains), serum iron, TIBC, folk acid and vitamin B,, levels, 51Crred cell survival times, external body scan, estimation of 5-day faecal blood loss, and 5 8 Fferrokinetic ~ studies. The anaemia in these cases was commonly found to be due to multiple factors, in particular haemolysis, bone marrow failure and folic acid deficiency. The need to exclude anaemia due to other causes unrelated to the chronic renal failure was also shown in this series. THE SYNDROME OF MARROW HYPOPLASIA WITH RELATIVE INCREASE I N PRIMARY BLAST CELLS I N ELDERLY PATIENTS
WOODS, W. E. & O’NEILL,B. J.
Repatriation General Hospital, Sydney, New South Wales Eight patients were presented who appeared to represent a not uncommon syndrome in the older age groups. The main features of this syndrome are pancytopenia (chiefly neutropenia), hypoplastic bone marrow with an increase in primitive blast cells, obvious ringed siderohlasts in the marrow and often a prolonged course, with death usually due to intercurrent infection. At autopsy, tissue infiltration by primitive cells may be present, The aetiology of this condition is not known. Similar cases have been described as ‘preleukaemia’ or ‘hypoplastic leukaemia’, but none of the eight cases reported terminated in frank leukaemia. It was the authors’ impression that if such cases are treated as leukaemia their prognosis is worse than if they are treated conservatively. BLOOD LEAD ESTIMATIONS
EDWARDS, R. G., BERRIMAN, H. & GEARY, T. D . Institute of Medical and Veterinary Science, Adelaide, South Australia Whole blood or red cell lead content estimations are known to be the best indications of exposure to lead, but these measurements are not used as frequently as is desirable in Australia apparently because of the supposed technical difficulty of the laboratory methods. A simple method of estimating blood lead is presented. This can be established in any good laboratory and is based on lysis of an aliquot of blood, chelation of the lead, concentration of the complex in an organic phase and the spraying of this extract into an atomic absorption spectro-photometer. Values obtained from a group of 40 adults not exposed to a lead hazard ranged from 5-2Opg. of lead / 100 ml. of whole blood with a median value of 15pg. As lead is bound to red cells it has been recommended that results be expressed as micrograms of lead jml. of erythrocytes (mean erythrocyte lead