1082 the lowest number of platelets at the commencement of treatment also showed the most rapid and striking rise. So great was the rise in this case that, as pointed out above, there is reason to believe that it led to a certain degree of intravascular clotting of the blood, with two attacks of pulmonary embolism, fortunately both very mild.
but not in any other way selected. of :Case. Age.
SUMMARY.
1. In the
relapse phase of pernicious ansemia the blood-platelets fall to a low level. 2. With improvement of the blood-picture due to treatment by liver or dried stomach the platelets rapidly rise in numbers. 3. This rise in the platelets may give rise to thrombotic accidents.
FracturedAge. Case 6 77 Neck of femur. 72
Fractured-
1 14 Rib. 2 67 Radius. 3 26 Humerus, radius and ulna. 4 40 Patella. 5 23 Left transverse processes of 3rd and 4th lumbar vertebrae.
They consisted
7
11
8 42
35 9 10 59
I
"
Right temporal
and
occipital bones.
Tibia and fibula. Right tibia and fibula, and left tibia.
It was obviously impossible to do platelet counts before the fractures occurred, so the first count done after fracture in each case was used as a basis for comparison and called 100 per cent., subsequent
FIG. 2.
THE BLOOD-PLATELETS AFTER FRACTURE. BY J. FORBES GALLOWAY, M.D. LIVERP., FORMERLY HOLT FELLOW IN PATHOLOGY IN THE UNIVERSITY OF LIVERPOOL.
IT has been pointed out by Howel Evans and his co-workers1 that thrombosis and embolism follow parturition and surgical operations at a time which corresponds to the maximum of the rise in the number of blood-platelets that succeeds these conditions. Thrombosis and embolism tend especially to follow operations which involve the anterior abdominal
DAYS AFTER FRACTURE cases showing percentage increase of platelets following fracture.
Composite chart of the ten
FiG. 1. counts being expressed as a percentage of this figure. In seven cases the first count was done within 24 hours of fracture, in two cases within 48 hours, and in the remaining cases within 72 hours. The results of individual cases are shown in Fig. 1, and a composite result of all the cases has been constructed in Fig. 2. From these figures it is seen that a definite increase in the blood-platelets occurs after fracture, reaching a maximum between the fourth and the fifteenth days. This increase resembles so closely those which occur after parturition and surgical operations that it suggests a cause common to them all. These different conditions are all associated with damage to tissues and extravasation of blood, followed by its ultimate absorption, and in this absorption of damaged tissues lies a possible common cause. Chart showing variation in platelet counts following fracture in ten
JACKSONIAN EPILEPSY TREATED WITH TUBERCULIN.
cases.
with resulting venous stasis due to diminution of muscular activity and of diaphragmatic respiration. An increase in the number of circulating bloodplatelets and venous stasis seem therefore to be important factors in the onset of thrombosis. Fracture of the femur is a condition which has a high incidence of pulmonary embolism as a complication (Lister 2). Its treatment differs from that of most other fractures in that it involves marked immobilisation of the patient, with resulting venous stasis. This suggests that another factor in postoperative thrombosis-an increase in the bloodplatelets-may also occur after fracture. Accordingly, the blood-platelets were studied in a roup of ten cases of fracture, which were all simple
wall,
BY WALTER BROADBENT, M.D.
CAMB., F.R.C.P.,
SENIOR PHYSICIAN TO THE ROYAL SUSSEX COUNTY
HOSPITAL,
BRIGHTON.
IN October, 1928,was asked by Dr. W. G. Orchard see a girl of 13, who was having right-sided fits, affecting the face and hand, several times a day, followed by a short period of unconsciousness, and affection of speech for half an hour after. She had complained of headaches since July, the fits had begun early in September, at first with a week’s interval, but becoming rapidly more frequent. She was a pale, delicate-looking child. There was no apparent weakness of the right arm. Reflexes were exaggerated. The left optic disc was pinker 1 Dawbarn, R. Y., Earlam, F., and Evans, W. Howel : Jour. than normal, and the vein large. The right disc Path. and Bact., 1928, xxxi., 833. was paler, but the vein looked large also. There 2 Lister, W. A. : THE LANCET, 1927, i., 111. to