Milz und Blutgerinnung

  • D. Harms

Spleen and Blood Coagulation

Summary

  1. 1

    There is strong evidence for (a) synthesis and (b) pooling of antihemophilic globulin (factor VIII) in the spleen: after transplantation of the spleen in canine hemophilia factor VIII levels rise considerably. Perfusion of isolated spleens with hemophilic blood causes release of factor VIII from the spleen. Following injection of adrenalin the factor VIII level rises, but not in spleenless subjects.

     
  1. 2

    There is evidence of clearance function of the spleen a as part of the reticuloendothelial system for coagulation products (thromboplastin and fibrin aggregates).

     
  1. 3

    3. We distinguish four types of local clotting processes in the spleen:

     
  1. a)

    Macrothrombosis of arteries and veins, a rare condition.

     
  2. b)

    Microthrombosis of the red pulp in 3.5% of unselected autopsies, but more often in the generalized Shwartzman reaction.

     
  3. c)

    Fibrin imbibition of the walls of splenic arterioles in 15.9% of autopsies.

     
  4. d)

    Fibrin deposits in the white pulp of the spleen in 12% of autopsies and under experimental conditions especially in immune reactions, but also in the generalized Shwartzman reaction.

     

Die Beziehungen zwischen Milz und Thrombocyten werden seit langem intensiv beforscht und diskutiert. Demgegenüber waren die Beziehungen zwischen Milz und Blutgerinnung bisher nur Gegenstand relativ weniger und nicht-synoptischer Untersuchungen; diese Beziehungen schienen auch in praktisch-therapeutischer Hinsicht ziemlich unwichtig zu sein. Nun aber hat das Thema aufgrund neuerer Untersuchungsergebnisse plötzlich an Aktualität gewonnen!

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Literatur

  1. Albrechtsen, O. K.: The fibrinolytic activity of human tissues. Brit. J. Haemat. 3, 284–291 (1957).PubMedCrossRefGoogle Scholar
  2. Barnhart, M. I., Cress, D. C.: Plasma clearance of products of fibrinolysis. In: N. R. Diluzio, and R. Paoletti (eds.), The reticuloendothelial system and atherosclerosis, p. 492–502. New York: Plenum press 1967.Google Scholar
  3. Böhmig, H. J., Fritsch, A., Kux, M., Lechner, G., Lechner, K., Reich, N., Stockin-Ger, L., Zeitelberger, P.: Gerinnungsveränderungen bei orthotoper Lebertransplantation am Hund. Thrombos. Diathes. haemorrh. (Stuttgart-New York) 21, 332–345 (1969).Google Scholar
  4. Bohle, A., Krecke, H. J.: Über das Sanarelli-Shwartzman-Phänomen (sog. generalisiertes Shwartzman-Phänomen) des Menschen. Klin. Wschr. 37, 803–814 (1959).PubMedCrossRefGoogle Scholar
  5. Caesar, R.: Gefäße und Herz im elektronenmikroskopischen Bild. In: M. Staemmler (Hrsgb.), Lehrbuch der speziellen pathologischen Anatomie, Erg.-Bd. I, 1, S. 701–812. Berlin: Walter de Gruyter 1969.Google Scholar
  6. Covelli, V. H., Sise, H. S., Norman, J. C.: Factor VIII (AHF) activity: Index of normal and transplanted splenic function in the rat. Fed. Proc. 27, 442 (1968).Google Scholar
  7. Dodds, W. J., Miller, K. D.: Storage and synthesis of coagulation factors in the isolated perfused liver, kidney and spleen. Fed. Proc. 27, 373 (1968).Google Scholar
  8. Egeberg, O.: On the nature of the blood antihaemophilic A factor (AHA = F. VIII) increase associated with muscular exercise. Scand. J. clin. Lab. Invest. 15, 202 — 203 (1963a).CrossRefGoogle Scholar
  9. Egeberg, O.: Changes in the activity of antihaemophilic A factor (F. VIII) and in the bleeding time associated with muscular exercise and adrenalin infusion. Scand. J. clin. Lab. Invest. 15, 539–549 (1963b).PubMedCrossRefGoogle Scholar
  10. Gardikas, C, Bakaloudis, P., Hatziannou, J., Kokkinos, D.: The factor-VIII concentration of the hepatic venous blood. Brit. J. Haemat. 11, 380–381 (1965).PubMedCrossRefGoogle Scholar
  11. Hardaway, R. M.: Shock and disseminated intravascular coagulation. Thrombos. Diathes. haemorrh. (Stuttg.), Suppl. 20, 121–146 (1966).Google Scholar
  12. Harms, D., Lehmann, H.: Untersuchungen über die periphere Mikrothrombose in einem unausgewählten Sektionsgut. Virchows Arch. Abt. A Path. Anat. 347, 57–68 (1969).CrossRefGoogle Scholar
  13. Hathaway, W. E., Mull, M. M., Githens, J. H., Groth, C. G., Marchioro, T. L., Starzl, T. E.: Attempted spleen transplant in classical hemophilia. Transplantation 7, 73–75 (1969).PubMedGoogle Scholar
  14. Herxheimer, G.: Über das Verhalten der kleinen Gefäße der Milz. Berl. klin. Wschr. 54, 82–84 (1917).Google Scholar
  15. Huth, K., Müller-Berghaus, G., Krecke, H. J., Lasch, H. G.: Das Verhalten der Blutlipide beim generalisierten Sanarelli-Shwartzman-Phänomen. Verh. dtsch. Ges. inn. Med. 70, 437–441 (1964).PubMedGoogle Scholar
  16. Huth, K., Schoenborn, W., Knorpp, K.: Experimentelle Verbrauchskoagulopathie nach intravenöser Zufuhr von Fett und Endotoxin. Thrombos. Diathes. haemorrh. (Stuttg.) 17, 129–143 (1967).Google Scholar
  17. Ingram, G. I. C.: Increase in antihaemophilic globulin activity following infusion of adrenaline. J. Physiol. (Lond.) 156, 217–224 (1961).Google Scholar
  18. Ingram, G. I. C.: (Diskussion) in: K. M. Brinkhous (ed.), The hemophilias. Internat. Symposium, Washington, D.C. Chapel Hill: Univ. of North Carolina Press 1964.Google Scholar
  19. Jores, L.: Arterien. In: F. Henke u. O. Lubarsch (Hrsg.), Handbuch der speziellen pathologischen Anatomie und Histologie, Bd. I I. Berlin: Springer 1924.Google Scholar
  20. Kasabach, H. H., Merritt, K. K.: Capillary hemangioma with extensive purpura; report of a case. Amer. J. Dis. Child. 59, 1063–1070 (1940).Google Scholar
  21. Kleinmaier, H., Georgen, K., Lasch, H. G., Krecke, H. J., Bohle, A.: Untersuchungen zur Frage der Gerinnungsstörung beim Sanarelli-Shwartzman-Phänomen des Kaninchens. Z. ges. exp. Med. 132, 275–294 (1959).PubMedCrossRefGoogle Scholar
  22. Lasch, H. G.: Zur Pathophysiologie und Klinik des Sanarelli-Shwartzman-Phänomens. Thrombos. Diathes. haemorrh. (Stuttg.), Suppl. 14, 63–78 (1964).Google Scholar
  23. Lasch, H. G.: Pathophysiologie des Endotoxinschocks. Med. Welt 1967, 1780 — 1785.Google Scholar
  24. Lasch, H. G.: Rodriguez-Erdmann, F.: Etude de l’influence du choc sur le système de coagulation dans le phénomène de Sanarelli-Shwartzman. Hémostase 1, 161–166 (1961).PubMedGoogle Scholar
  25. Lasch, H. G.: Roka, L., Heene, D.: The defibrination syndrome. Thrombos. Diathes. haemorrh. (Stuttg.), Suppl. 20, 97 — 105 (1966).Google Scholar
  26. Lee, L.: Reticuloendothelial clearance of circulating fibrin in the pathogenesis of the generalized Shwartzman-reaction. J. exp. Med. 115, 1065–1082 (1962).PubMedCrossRefGoogle Scholar
  27. Lee, L., Mccluskey, R. T.: Immunohistochemical demonstration of the reticuloendothelial clearance of circulating fibrin aggregates. J. exp. Med. 116, 611–618 (1962).PubMedCrossRefGoogle Scholar
  28. Lennert, K.: Unveröff. Befunde.Google Scholar
  29. Libre, E. P., Cowan, D. H., Watkins, S. P., JR., Shulman, R. N.: Relationship between spleen, platelets and factor VIII levels. Blood 31, 358–368 (1968).PubMedGoogle Scholar
  30. Lubarsch, O.: Pathologische Anatomie der Milz. In: F. Henke u. O. Lubarsch (Hrsg.), Handbuch der speziellen pathologischen Anatomie und Histologie, Bd. I, 2. Berlin: Springer 1927.Google Scholar
  31. Marchioro, TH. L., Rowlands, D. T., JR., Rifkind, D., Waddell, W. R., Starzl, TH. E., Fudenberg, H.: Splenic homotransplantation. Ann. N.Y. Acad. Sci. 120, 626–651 (1964).PubMedGoogle Scholar
  32. Marx, R.: Zur Pathogenese von Thrombosen. Fortschr. Med. 82, 708–714 (1964).Google Scholar
  33. Marx, R.: Persönl. Mitt. 1969.Google Scholar
  34. Matsuno, G.: Über die Wandveränderungen der kleinen Milzarterien. Virchows Arch, path. Anat. 240, 69–80 (1923).CrossRefGoogle Scholar
  35. Mckay, D. G.: Disseminated intravascular coagulation. An intermediary mechanism of disease. New York-Evanston-London: Hoeber Medical Division, Harper & Row, Publishers 1965.Google Scholar
  36. Montague, A. C. W., Greenberg, J. B., Dammin, G. J., Moore, F.D.: The effect of nitrogen mustard in altering the histocompatibility rejection sequence in splenic homo-transplantation in the dog. J. surg. Res. 2, 130–135 (1962).PubMedCrossRefGoogle Scholar
  37. Norman, J. C., Covelli, V. H., Sise, H. S.: Transplantation of the spleen. Ann. intern. Med. 68, 700–704 (1967).Google Scholar
  38. Norman, J. C., Covelli, V. H., Sise, H. S.: Transplantation of the spleen: Experimental cure of hemophilia. Surgery 61, 1–14 (1968).Google Scholar
  39. Norman, J. C., Covelli, V. H., Sise, H. S.; Sise, H. E.: An auxiliary source of A.H.F. for hemophilia. Experimental studies on isolated spleen perfusions. J. nat. med. Ass. (N.Y.) 59, 330–331 (1967).Google Scholar
  40. Prose, P. H., Lee, L., Balk, S. D.: Electron microscopic study of the phagocytic fibrin-clearing mechanism. Amer. J. Path. 47, 403–417 (1965).PubMedGoogle Scholar
  41. Rabiner, S. F., Friedman, L. H.: The role of intravascular haemolysis and the reticuloendothelial system in the production of a hypercoagulable state. Brit. J. Haemat. 14, 105–118 (1968).PubMedCrossRefGoogle Scholar
  42. Rizza, C. R.: Effect of exercise on the level of antihaemophilic globulin in human blood. J. Physiol. (Lond.) 156, 128–135 (1961).Google Scholar
  43. Rodriguez-Erdmann, F.: Pathogenesis of bilateral renal cortical necrosis: its production by means of exogenous fibrin. Arch. Path. 79, 615–618 (1965).PubMedGoogle Scholar
  44. Schimpf, KL., Hansen, B., Meier, J.: Gleichzeitige Untersuchung der Aktivitäten von Prothrombin, Faktor X, antihämophilem Globulin, Thrombinzeit, Fibrinpolymerisationszeit und der Thrombocytenzahlen in rechtem Herzen, Aorta, Vena renalis, Vena portae und Vena cava caudalis des Kaninchens. Klin. Wschr. 46, 332–333 (1968).PubMedCrossRefGoogle Scholar
  45. Schlüter, E.: Inaug.-Diss. Kiel (in Vorbereitung).Google Scholar
  46. Spaet, TH. H., Horowitz, H. I., Zucker-Franklin, D., Cintron, J., Biezenski, J. J.: Reticuloendothelial clearance of blood thromboplastin by rats. Blood 17, 196–205 (1961).Google Scholar
  47. Thatcher, L. G., Clatnoff, D. V., Stiehn, E. R.: Splenic hemangioma with thrombocytopenia and afibrinogenemia. J. Pediat. 73, 345–354 (1968).PubMedCrossRefGoogle Scholar
  48. Webster, W. P., Reddick, R. L., Roberts, H. R., Penick, G. D.: Release of factor VIII (antihaemophilic factor) from perfused organs and tissues. Nature (Lond.) 213, 1146–1147 (1967).CrossRefGoogle Scholar
  49. Wheeler, H. B., Balankura, O., Pendower, J. E. H., Greenberg, J. B., Dammin, G. J., Moore, F. D.: The homograft response to whole-organ transplantation of the canine spieen. J. Surg. Res. 2, 114–123 (1962)PubMedCrossRefGoogle Scholar
  50. Zervos, N., Vlachos, J., Karpathios, T., Mantas, J.: Giant hemangioma of the spieen with thrombocytopenia and flbrinogen defiency. Acta pediat. scand. Suppl. 172, 206–209 (1967).CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin · Heidelberg 1970

Authors and Affiliations

  • D. Harms
    • 1
  1. 1.Pathologisches InstitutUniversität KielDeutschland

Personalised recommendations