d. 内科領域におけるConsumption Coagulopathy

抄録

This paper is being presented to relate the course of 13 patients with special type of acute leukemia, soalled promyelocytic leukemia, studied before and during treatment, and 11 patients with bone-marrow carcinosis seen in our clinic; and to present the data on therapeutic trials.
Early symptomes consisted predominantly of hemorrhagic manifestations. Oozing from the sites of venipuncture was observed in most of the cases. Almost invariably, our patients ran a fulminating course with severe hemorrhagic tendency.
Studies for coagulation factors showed marked abnormalities of the consumption coagulopathy type. There were marked thrombocytopenia. Levels of factor II, V and VIII were highly depressed, and some reduction occurred in fibrinogen and factor VII+X and IX. Factor XIII was sometimes reduced. Qualitative abnormality in fibrinogen was suggested with a thrombelastographic observation.
Blood coagulation studies were performed upon patients with other types of leukemia piror to therapy. eduction of the clotting factors in the promyelocytic leukemia was more prominent than that in the patients with common form of the acute leukemia.
In our cases, increased fibrinolysis was demonstrated in half of the patients judged by plasma clot lysis time method, fibrin plate method and thrombin time method. The relation of the fibrinopathy to the abnormal promyelocytes remain obscure.
Heparin infusion, platelet transfusion and administration of fibrinolysis inhibitors arrested the bleeding episodes at least temporary and prolonged the life.
In many cases, proof of disseminated intravascular coagulation has not been definitive because no microhrombi were detected at autopsy.