Biomedical subjects
Publications and source records attributed to G Lutze.
The experiment of a self-injury by permanent intoxication with the coumarin derivative Warfarin is described. Various isolated haemostatic defects as differential-diagnostically demarcated causes for the leading symptom decrease of the value of the thromboplastin time which concern the effect of coumarin are mentioned. It is referred to the coagulation-analytic and chemical-toxic methods of proof of coumarins.
For the laboratory control of a heparin therapy thrombin time, partial thromboplastin time and activated recalcification time are used. On account of distinct differences in the heparin sensitivity of these reactions an indication-related application is necessary. The ability of evidence and the possibility of establishing test-specific therapeutic regions are restricted by differences caused by reagents, individual variability and influence by accompanying haemostasiological changes. The own approach, taking into consideration the so-called heparin resistance, it presented.
Seven members of one family over three generations were found to have a characteristic reduction to about 0.5 of the ratio between factor II clotting activity and factor II concentration, which was not seen when measuring prothrombin after activation with staphylocoagulase. In addition to the "normal" prothrombin, two abnormal prothrombins, with higher molecular weights and lower isoelectric points, were found by SDS-polyacrylamide gel electrophoresis. This is an autosomal hereditary dysprothrombinemia, the affected persons being heterozygotes. Five of the seven persons had a slightly increased bleeding tendency which manifested itself especially in more marked or prolonged posttraumatic and postoperative bleedings.
In a female patient with a von Willebrand's disease type II (ristocetin cofactor less than 20%) shortly before and after birth of a son the factor VIII-related antigen and the ristocetin cofactor showed considerable increases, which some weeks later again decreased to the original values. Despite additional thrombocytopenia only on the 4th day post partum an easily controllable uterine haemorrhage was to be established. The risk of haemorrhage in von Willebrand's disease during pregnancy, birth and puerperium seems to be insignificant; nevertheless on the basis of the heterogeneity of this disease a peripartal coagulation-analytic control is regarded necessary.
Pathologic inhibitors of blood coagulation as cause of acquired haemostatic failure are rare. We report about a 23 years old primigravida with a life-threatening haemorrhage post partum. Analysis of coagulation parameters showed the presence of inhibitor to factor VIII. We reacted successfully with cyclophosphamid and cryoprecipitated factor VIII. References to diagnostic and therapy of pathologic clotting factor inhibitors are described.
Experiences are notified about production and employment of a lyophilised standard plasma for designation of thromboplastin time-value in the district Magdeburg. In addition to testing the homogeneity and the methodology for declaration the 100% - value results of ring tests are exhibited, which underline the necessity of a unitary standard plasma pool, secured to various criterions.
Rare causes of decreases of the thromboplastin time value are hereditary coagulopathies, coagulation inhibitors and application of acetyl salicylic acid. They require a special diagnostic approach including other global and group tests, functional tests of thrombocytes, analyses of individual factors as well as methods of inhibitor proofs.
Pathological inhibitors of the coagulation which are recognized by characteristic laboratory findings may cause an increased inclination to haemorrhage, may be clinically mute or also may effect an increased inclination to thrombosis (lupus inhibitors). It is reported on patients with rare coagulation inhibitors, a pathologic antithrombin with normal reptilase time and an antithromboplastin with protracted effect, in which thromboses appeared. The occurrence of thromboses in these patients up to now does not allow the assumption of an effect of these inhibitor substances furthering thrombosis, but only the statement that despite coagulation-analytically recognizable inhibition effects the development of a thrombosis is not prevented. A prophylactic factor substitution in operative interventions is not indicated.
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Arterial embolism or thrombosis are very rare complications of the fibrinolytic therapy of deep venous thrombosis. The characteristics symptoms of these illness are the acute arterial failure of the concerned extremity during venous thrombolysis. The diagnosis take place by angiography, by ultrasonics, and in particular cases by the skin thermographic method. If the arterial occlusion is not operable, the thrombolysis by urokinase is discussed. This seems to be the last possible method to support the extremity.
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The influence of physical stress (bicycle ergometer and track) on 13 parameters of the plasmatic coagulation system was investigated in trained and untrained test persons. Shortenings of the coagulation times as well as distinct increases of the activity or concentration were observed in the partial thromboplastin time (PTT), the factor VIII activity (VIII:C) and the factor VIII-associated antigen (VIIIR:Ag). The results are discussed with regard to their causes and their clinical importance.
The authors report on a kin affected with PTA deficiency. The person with homozygous features and a factor XI content below 1% is solely characterized by prolongations of ART and PTT, which were clinically correlated as severe secondary hemorrhages after injuries and surgical treatments. Three heterozygous persons had normal results in global and group tests at 40-50% of factor XI with objectively unambiguous bleeding episodes being absent. As a peculiarity of the recessive heredity of this kin the marriage of two descendants in the fourth generation deserves to be mentioned.
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By means of genealogical and laboratory-diagnostic examinations in the district of Magdeburg 59 patients with a von-Willebrand-Jürgens-syndrome and 2 patients with thrombasthenia were detected. On the basis of the laboratory data and the severity of the inclination to haemorrhage in patients with von-Willebrand-Jürgens-syndrome a subdivision into type I (severe from), type I (easy form) and type II was made. The diagnosis was rendered difficult by the appearance of clinically asymptomatic carriers of signs. The experiences hitherto made in the dispensary care and the use of the laboratory programme are estimated.
By genealogic and laboratory-diagnostic investigations in the county of Magdeburg 79 patients with haemophilia A and 23 patients with haemophilia B were established. Characteristic coagulation-analytic findings in patients without and with additional thrombocytic functional disturbances are shown. In female conductors of haemophilia A the reliability in the diagnostics could be increased with the help of the discriminance analysis by combination of the genealogic tree information with the coagulation-analytic findings.
Tasks and organisation of a dispensary for patients with hereditary haemorrhagic diatheses are explained. A laboratory programme which was used for the diagnostics of these diseases, particularly of haemophilia and von Willebrand-Jürgens syndrome, is demonstrated.