• Barbara Bain


Haematological perturbations are almost universal in critically ill patients and can aggravate the primary disease and complicate management. Shock, infection, and renal and hepatic failure are common in critically ill and injured patients; some of their deleterious effects are mediated through the haemopoietic system, and in turn haematological dysfunction may contribute to shock, infection and failure of one or more organs. Since almost every haematological disorder is seen at some time during intensive care, it is not practicable to deal with all aspects. The coagulopathies are described in this chapter and blood transfusion in Chapter 6.Blood coagulation abnormalities and their management are of major importance in critically ill patients, who frequently suffer from abnormal bleeding, thromboembolism, or both. Depression of erythropoiesis is usual in critically ill patients but there is no effective management beyond the maintenance of adequate nutrition, which is described in Chapter 1. Megaloblastic arrest can be of vital importance and is dealt with together with other causes of thrombocytopenia. This chapter is based on my experience as the haematologist associated with a busy ICU in the Princess Alexandra Hospital, Brisbane. This unit admits 700 patients per year, and detailed coagulation studies were performed on many of these patients. Where management is controversial, I have made this clear.


Depression Sludge Aspirin Serotonin Warfarin 


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  1. 1.
    Wessler, S. and Yin, E. T. (1974). Role of animal models in thrombosis: a point of departure. Thromb. Diath. Haemorrh., 59, (Supp!.), 83Google Scholar
  2. 2.
    Gulliver, G. (1846). The Works 0/ William Hewson FRS, p. 46. ( London: Sydenham Society )Google Scholar
  3. 3.
    Turpini, R. and Stefanini, M. (1959). The nature and mechanism of the hemostatic breakdown in the course of experimental hemorrhagic shock. J. Clin. Invest., 38, 53CrossRefGoogle Scholar
  4. 4.
    Bergentz, S. (1976). On bleeding and clotting problems in post-traumatic states. Crit. Care Med., 4, 41PubMedCrossRefGoogle Scholar
  5. 5.
    Innes, D. and Sevitt, S. (1964). Coagulation and fibrinolysis in injured patients. J. Clin. Pathol., 17, 1PubMedCrossRefGoogle Scholar
  6. 6.
    Scott, R. and Crosby, W. H. (1954). Changes in the coagulation mechanism following wounding and resuscitation with stored blood. A study of battle casualties in Korea. Blood, 9, 609PubMedGoogle Scholar
  7. 7.
    Simmons, R. L., Collins, J. A., Heisterkamp, C. A., Mills, D. E., Andren, R. and Phillips, L. L. (1969). Coagulation disorders in combat casualties. I. Acute changes after wounding. 11. Effects of massive transfusion. III. Postresuscitative changes. Ann. Surg., 169, 455PubMedCrossRefGoogle Scholar
  8. 8.
    Avikainen, V. (1977). Coagulation disorders in severe\y and critically injured patients. Ann. Chir. Gynaecol., 66, 269PubMedGoogle Scholar
  9. 9.
    Bradford, D. S., Foster, R. R. and Nossei, H. L. (1970). Coagulation alterations, hypoxaemia, and fat emboli sm in fracture patients. J. Trauma, 10, 307PubMedCrossRefGoogle Scholar
  10. 10.
    Crosby, W. H. and Howard, J. M. (1954). The hematologic response to wounding and resuscitation accomplished by large transfusions of stored blood. A study of battle casualties in Korea. Blood, 9, 439PubMedGoogle Scholar
  11. 11.
    McKay, D. G. (1979). Trauma and disseminated intravascular coagulation. J. Trauma, 9, 646CrossRefGoogle Scholar
  12. 12.
    Slichter, S. J., Funk, D. D., Leandoer, L. E. and Harker, L. A. (1974). Kinetic evaluation of haemostasis during surgery and wound healing. Br. J. Haematol., 27, 115PubMedCrossRefGoogle Scholar
  13. 13.
    Hardaway, R. M. (1966). Syndromes of Disseminated Intravascular Coagulation. ( Springfield: Charles C. Thomas )Google Scholar
  14. 14.
    Ingram, G.I.C., Jones, R. V., Hershgold, E. J., Denson, K. W. E. and Perkins, J. R. (1977). Factor VIII activity and antigen, platelet count and biochemical changes after adrenocortical stimulation. Br. J. Haematol., 35, 81PubMedCrossRefGoogle Scholar
  15. 15.
    Hardaway, R. M., Johnson, D. G., Houchin, D. N., Jenkins, E. B., Bums, J. W. and Jackson, D. R. (1964). Influence of stress on fibrinogen. J. Trauma, 4, 673CrossRefGoogle Scholar
  16. 16.
    Warner, W. A. (1969). Release of free fatty acids following trauma. J. Trauma, 9, 692PubMedCrossRefGoogle Scholar
  17. 17.
    Modig, J., Hedstrand, U., Fischer, J. and Lundstrom, J. (1976). Early recognition and treatment of post-traumatic pulmonary microembolism. Crit. Care Med., 4, 180PubMedCrossRefGoogle Scholar
  18. 18.
    Fearnley, G. R. (1964). Measurement of spontaneous fibrinolytic activity. J. Clin. Pathol., 17, 316CrossRefGoogle Scholar
  19. 19.
    Borowiecki, B. and Sharp, A. A. (1969). Trauma and fibrinolysis J. Trauma, 9, 522PubMedGoogle Scholar
  20. 20.
    Attar, S., Hanashiro, P., Mansbergen, A., McLaughlin, J., Firminger, H. and Cowley, R. A. (1970). Intravascular coagulation - reality or myth. Surgery, 68, 27PubMedGoogle Scholar
  21. 21.
    Moriau, M., Masure, R., Hurlet, A., Debeys, C., Chalant, C., Ponlot, R., Jaumain, P., Servaye-Kestens, Y., Ravaux, A., Louis, A. and Goenen, M. (1977). Hemostasis disorders in open heart surgery with extracorporeal circulation. Importance of the platelet function and heparin neutralization Vox Sang., 32, 41PubMedCrossRefGoogle Scholar
  22. 22.
    String, T., Robinson, J. and Blaisdell, F. W. (1971). Massive trauma. Effect of intravascular coagulation on prognosis. Arch. Surg. 102, 406PubMedGoogle Scholar
  23. 23.
    Lilienberg, G., Rammer, L., Saldeen, T., Thorin, L. and Uddströmer, L. (1970). Intravascular coagulation and inhibition of fibrinolysis and fat embolism. Acta Chir. Scand., 136, 87PubMedGoogle Scholar
  24. 24.
    Bagge, L. and Saldeen, S. (1978). The primary fibrinolysis inhibitor and trauma. Thromb. Res., 13, 1131PubMedCrossRefGoogle Scholar
  25. 25.
    Kunz, F., Hortnagl, H., Kroesen, G. and Rumpi, E. (1978). Plasma lipids, coagulation factors and fibrin formation after severe multiple trauma, and in adult respiratory distress syndrome. J. Trauma, 18, 115PubMedCrossRefGoogle Scholar
  26. 26.
    Wardrop, C. A. J., Heatley, R. V., Tennant, G. B. and Hughes, L. E. (1975). Acute folate deficiency in surgical patients on amino acid/ethanol intravenous nutrition. Lancet, 2, 640PubMedCrossRefGoogle Scholar
  27. 27.
    Blackwell, E. A., Hawson, G. A. T., Leer, J. and Bain, B. J. (1978). Acute pancytopenia due to megaloblastic arrest in association with cotrimoxazole. Med. J. Aust. 2, 38PubMedGoogle Scholar
  28. 28.
    Ibbotson, R. M., Colvin, B. T. and Colvin, M. P. (1975). Folic acid deficiency during intensive therapy. Br. Med. J., 2, 145CrossRefGoogle Scholar
  29. 29.
    Amess, J. A. L., Burman, J. F., Rees, G. M., Nancekievill, D. G. and Mollin, D. G. (1978). Megaloblastic haemopoiesis in patients receiving nitrous oxide. Lancet, 2, 339PubMedCrossRefGoogle Scholar
  30. 30.
    Lassen, H. C. A., Henriksen, E., Neukirch, F. and Kristensen, H. S. (1956). Treatments of tetanus. Severe bone-marrow depression after prolonged nitrous oxide anaesthesia. Lancet, 1, 527CrossRefGoogle Scholar
  31. 31.
    Linnell, J. C., Quadros, E. V., Matthews, D. M., Jackson, B. and Hoffbrand, A. V. (1978). Nitrous oxide and megaloblastosis: biochemical mechanism. Lancet, 2, 1372PubMedCrossRefGoogle Scholar
  32. 32.
    Brown, C., Natelson, E., Bradshaw, M., Williams, T. and Alfrey, C. (1974). The hemostatic defect produced by carbenicillin. N. Eng. J. Med. 291, 265CrossRefGoogle Scholar
  33. 33.
    Andrassy, K., Weishchedel, E., Ritz, E. and Andrassy, T. (1976). Bleeding in uraemic patients after carbenicillin. Thromb. Haemost. 36, 115PubMedGoogle Scholar
  34. 34.
    Andrassy, K., Ritz, E., Hasper, B., Scherz, M., Walter, E., Storch, H. and Vomel, W. (1976). Penicillin induced coagulation disorder. Lancet, 2, 1039PubMedCrossRefGoogle Scholar
  35. 35.
    Cazenave, J. P., Reimers, H. J., Senyi, A. F., Hirsh, J., Packham, M. A. and Mustard, J. F. (1976). Effects of penicillin G and cephalothin on platelet function in vivo. Proc. Soc. Exp. BioI. Med., 152, 641Google Scholar
  36. 36.
    Allen, F. B., Girson, J. I. and Davey, F. R. (1979). Platelet inhibition by nitroprusside and nitroglycerin. Anesthesiology 51 (Suppl.), 75CrossRefGoogle Scholar
  37. 37.
    Atik, M. and Matini, K. (1972). Platelet dysfunction: an important factor in massive bleeding from stress ulcer. 1. Trauma, 12, 834CrossRefGoogle Scholar
  38. 38.
    Bengmark, S., Hafstrom, L. O. and Korsan-Bengtsen, K. (1969). Effects on blood clotting and circulation of autologous connective tissue homogenate infusion in dogs. 1. Trauma, 9, 236CrossRefGoogle Scholar
  39. 39.
    Saldeen, T. (1970). The importance of intravascular coagulation and inhibition of the fibrinolytic system in experimental fat embolism. J. Trauma, 10, 287PubMedCrossRefGoogle Scholar
  40. 40.
    Saldeen, T. (1970). Fat embolism and signs of intravascular coagulation in a post-traumatic autopsy material. 1. Trauma, 10, 273CrossRefGoogle Scholar
  41. 41.
    Modig, J. (1977). Post-traumatic pulmonary microembolism. Pathophysiology and treatment. Ann. Clin. Res., 9, 164PubMedGoogle Scholar
  42. 42.
    Gamain, J., Bernard, F., Ossart, M., Legars, D. and Delcour, J. (1974). Consumption coagulopathy in cranial trauma. N. Presse Med., 3, 259Google Scholar
  43. 43.
    Berman, J. R., Smulson, M. E., Pattengale, P. and Schoenbach, S. F. (1971). Pulmonary microembolism after soft tissue injury in primates. Surgery, 70, 246PubMedGoogle Scholar
  44. 44.
    Peer, R. M. and Schwartz, S. I. (1975). Development and treatment of posttraumatic pulmonary platelet trapping. Ann. Surg., 181, 447PubMedCrossRefGoogle Scholar
  45. 45.
    Heideman, M., Kaijser, B. and Gelin, L. (1978). Complement activation and hematologic, hemodynamic and respiratory reactions early after soft tissue injury. J. Trauma, 18, 696PubMedCrossRefGoogle Scholar
  46. 46.
    Connell, R. S., Swank, R. L. and Webb, M. C. (1975). The development of pulmonary ultrastructural lesions during hemorrhagic shock. 1. Trauma, 15, 116CrossRefGoogle Scholar
  47. 47.
    Whitaker, A. N., McKay, D. G. and Csavossy, J. (1969). Studies of catecholamine shock. I. Disseminated intravascular coagulation. Am. 1. Pathol., 56, 153Google Scholar
  48. 48.
    Mehta, B., Briggs, D. K., Sommers, S. C. and Karpatkin, M. (1972). Disseminated intravascular coagulation following cardiac arrest: a study of 15 patients. Am. J. Med. Sci., 264, 353PubMedCrossRefGoogle Scholar
  49. 49.
    Latour, T. G., McKay, D. G. and Parrish, M. H. (1972). Activation of Hageman factor by cardiac arrest. Throm. Diath. Haemorrh., 27, 543Google Scholar
  50. 50.
    Hardaway, R. M., Johnson, D. G., Elovitz, M. J., Houchin, D. N., Jenkins, E. B., Burns, J. W. and Jackson, D. R. (1964). Influence of trauma and hemolysis on hemorrhage shock in dogs. J. Trauma, 4, 624PubMedCrossRefGoogle Scholar
  51. 51.
    Birndorf, N. I., Lopas, H. and Robboy, S. J. (1971). Disseminated intravascular coagulation and renal failure. Production in the monkey with autologous red blood cell stroma. Lab. Invest., 25, 314PubMedGoogle Scholar
  52. 52.
    Riedler, G., Frick, P. G. and Straub, P. W. (1968). The effect of acute intravascular haemolysis on coagulation and fibrinolysis. I. Near-drowning haemoglobinaemia. Helv. Med. Acta, 34, 205PubMedGoogle Scholar
  53. 53.
    Golden, F. St. C. (1980). Problems of immersion. Br. J. Hosp. Med., 23, 371PubMedGoogle Scholar
  54. 54.
    Kwaan, H. C., Anderson, M. C. and Gramatica, L. (1971). A study of pancreatic enzymes as a factor in the pathogenesis of disseminated intravascular coagulation during acute pancreatitis. Surgery, 69, 663PubMedGoogle Scholar
  55. 55.
    Effeney, D. J., Blaisdell, F. W., McIntyre, K. and Graziano, C. J. (1978). The relationship between sepsis and disseminated intravascular coagulation. J. Trauma, 78, 689CrossRefGoogle Scholar
  56. 56.
    Counts, R. B., Haish, C., Simon, T. L., Maxwell, N. G., Heinbach, D. M. and Carrico, C. J. (1979). Hemostasis in massively transfused trauma patients. Ann. Surg., 190, 91PubMedCrossRefGoogle Scholar
  57. 57.
    Miller, R. D., Robbins, T.O., Tong, M. J. and Barton, S. L. (1971). Coagulation defects associated with massive blood transfusions. Ann. Surg., 174, 794PubMedCrossRefGoogle Scholar
  58. 58.
    Siegal, T., Seligsohn, U., Aghai, E. and Moden, M. (1978). Clinical and laboratory aspects of disseminated intravascular coagulation (DIC): A study of 118 cases. Thromb. Haemostas., 39, 122Google Scholar
  59. 59.
    Lindquist, 0., Rammer, L. and Saldeen, T. (1972). Pulmonary insufficiency, microembolism and fibrinolysis inhibition in a post-traumatic autopsy material. Acta Chir. Scand., 138, 545Google Scholar
  60. 60.
    Cafferata, H. T., Aggeler, P. M., Robinson, A. J. and Blaisdell, F. W. (1969). Intravascular coagulation in the surgical patient. Its significance and diagnosis. Am. J.Surg., 118, 281PubMedCrossRefGoogle Scholar
  61. 61.
    Curreri, P. W., Katz, A. J., Dotin, L. N. and Pruitt, B. A. (1970). Coagulation abnormalities in the thermally injured patient. Curro Top. Surg. Res.,, 401Google Scholar
  62. 62.
    Spero, J. A., Lewis, J. H. and Hasiby, U. (1980). Disseminated intravascular coagulation. Findings in 346 patients. Thromb. Haemostas., 43, 28Google Scholar
  63. 63.
    Robboy, S., Colman, R. and Minna, J. (1969). Fibrinolysis vs disseminated intravascular coagulation. N. Engl. J. Med., 281, 222PubMedGoogle Scholar
  64. 64.
    Chary tan, C. and Purtilo, D. (1969). Glomerular capillary thrombosis and acute renal failure after epsilon-aminocaproic acid therapy. N. Eng/. J. Med., 280, 1102CrossRefGoogle Scholar
  65. 65.
    Bayley, T., Clements, J. A. and Osbahr, A. J. (1967). Pulmonary and circulatory effects of fibrinopeptides Circ. Res., 21, 469PubMedGoogle Scholar
  66. 66.
    Richardson, D. L., Pepper, D. S. and Kay, A. B. (1976). Chemotaxis forhuman monocytes by fibrinogen derived peptides. Br. J. Haematol., 32, 507PubMedCrossRefGoogle Scholar
  67. 67.
    Gerdin, B. and Saldeen, T. (1978). Effect of fibrin degredation products on microvascular permeability. Thromb. Res., 13, 995PubMedCrossRefGoogle Scholar
  68. 68.
    Comroe, 1. H., Van Lingen, B. V., Stroud, R. C. and Roncoroni, A. (1953). Reflex and direct cardiopulmonary effects of 5-0H-tryptamine (Serotonin). Am. J. Physiol., 173, 379Google Scholar
  69. 69.
    Blaisdell, F. W., Lim, R. C. and Stallone, R. I. (1970). The mechanism of pulmonary damage following traumatic shock. Surg. Gynecol. Obstet., 130, 15PubMedGoogle Scholar
  70. 70.
    Hardaway, R. M. and McKay, D. G. (1959). Disseminated intravascular coagulation: a cause of shock. Ann. Surg., 149, 462PubMedCrossRefGoogle Scholar
  71. 71.
    Broermsa, R. 1., Bullemer, G. D. and Memmen, E. F. (1970). Acidosis induced disseminated intravascular microthrombosis and its dissolution by streptokinase. Thromb. Diath. Haemorrh., 24, 55Google Scholar
  72. 72.
    Rodriguez-Erdman, F. (1965). Bleeding due to increased intravascular blood coagulation. N. Engl. J. Med., 273, 1370CrossRefGoogle Scholar
  73. 73.
    Boyd. A. D., Engleman, R. M., Beauder, R. L. and Lakner, H. (1972). Disseminated intravascular coagulation following extracorporeal circulation. J. Thorac. Cardiovasc. Surg., 64, 685Google Scholar
  74. 74.
    Colman, R. W., Robboy, S. J. and Minna, J. D. (1972). Disseminated intravascular coagulation: an approach. Am. J. Med., 52, 679PubMedCrossRefGoogle Scholar
  75. 75.
    Hassman, G. C. and Keirn, H. A. (1974). Disseminated intravascular coagulation (DIC) in orthopedic surgery. Clin. Orthop., 103, 118CrossRefGoogle Scholar
  76. 76.
    Bain, B. J., Forster, T. H. and Sleigh, B. (1980). Heparin and the activated partial thromboplastin time (aPTT) - a difference between the in vitro and in vivo effect and implications for the therapeutic range. Am. J. Clin. Pathol., 74, 668PubMedGoogle Scholar
  77. 77.
    Arfors, K. E., Busch, C., Jakobson, S., Lindquist, O., Malmberg, P., Rammer, L. and Saldeen, T. (1972). Pulmonary insufficiency following intravenous infusion of thrombin and AMCA (tranexamic acid) in the dog. Acta Chir. Scand., 138, 445Google Scholar
  78. 78.
    Corrigan, J. J., Walker, L. R. and May, N. (1968). Changes in the blood coagulation system associated with septicaemia. N. Engl. J. Med., 279, 851PubMedCrossRefGoogle Scholar
  79. 79.
    Isaacson, S. and Nilsson, J. M. (1972). Coagulation and fibrinolysis in acute cholecystitis. Acta Chir. Scand., 138, 179Google Scholar
  80. 80.
    Goodwin, N. M. (1976). Coagulation disorders in severe shock states. Presented at the 5th Annual Meeting of the Society of Critical Care Medicine, PittsburgGoogle Scholar
  81. 81.
    Goldenfarb, P. B., Zucker, S., Corrigan, J. J. and Cathey, M. H. (1970). The coagulation mechanism in acute bacterial infection. Br. J. Haematol., 18, 643PubMedCrossRefGoogle Scholar
  82. 82.
    Beller, F. K. (1969). The role of endotoxin in disseminated intravascular coagulation. Thromb. Diath. Haemorrh., 36 (Supp!.), 125Google Scholar
  83. 83.
    Garner, R. and Evenson, S. A. (1974). Endotoxin-induced intravascular coagulation and shock in dogs: the role of factor VII. Br. J. Haematol., 27, 655PubMedCrossRefGoogle Scholar
  84. 84.
    Rivers, R. P. A., Hathaway, W. E. and Westen, W. L. (1975). The endotoxin induced coagulant activity of human monocytes. Br. J. Haematol., 30, 311PubMedCrossRefGoogle Scholar
  85. 85.
    Prydz, H., Lyberg, T., Deteix, P. and Allison, A. C. (1979). In vitrostimulation of tissue thromboplastin (factor III) activity in human monocytes by immune complexes and lectins. Thromb. Res., 15, 465PubMedCrossRefGoogle Scholar
  86. 86.
    Coe, N. P. and Salzmann, E. W. (1976). Thrombosis and intravascular coagulation. Surg. Clin. N. Am., 56, 875PubMedGoogle Scholar
  87. 87.
    Hawiger, J., Hawiger, A., Steckley, S., Timmons, S. and Cheng, C. (1977). Membrane changes in human platelets induced by lipopolysaccharide endotoxin. Br. J. Haematol., 35, 285PubMedCrossRefGoogle Scholar
  88. 88.
    Nagayama, M., Zucker, M. B. and Beller, F. K. (1971). Effects of a variety of endotoxins on human and rabbit platelet function. Thromb. Diath. Haemorrh., 26, 467Google Scholar
  89. 89.
    Mason, J. W., Kleeberg, U., Dolan, P. and Colman, R. W. (1970). Plasma kallikrein and Hageman factor in gram-negative bacteraemia. Ann. Intern. Med., 73, 545Google Scholar
  90. 90.
    Hergt. K. (1972). Blood levels of thrombocytes in burned patients. Observations on their behaviour in relation to the clinical condition of the patient. J. Trauma, 12, 599PubMedCrossRefGoogle Scholar
  91. 91.
    Curreri, P. W., Wilterdink, M. E. and Baxter, C. R. (1975). Coagulation dynamics following thermal injury. Effect of heparin and protamine sulphate. Ann. Surg., 181, 161PubMedCrossRefGoogle Scholar
  92. 92.
    Blaisdell, F. W. (1973). Respiratory insufficiency syndrome. Clinical and pathological definition. J. Trauma, 13, 195PubMedCrossRefGoogle Scholar
  93. 93.
    McManus, W. F., Eurenius, K. and Pruitt, B. A. (1973). Disseminated intravascular coagulation in burned patients. J. Trauma, 13, 416PubMedCrossRefGoogle Scholar
  94. 94.
    Halleraker, B. (1972). Microcirculatory thrombosis as a cause of death in thermal burns. Acta Chir. Scand., 138, 731PubMedGoogle Scholar
  95. 95.
    Zuckerman, L., Caprini, J. A., Lipp, V. and Vagher, J. P. (1978). Disseminated intravascular multiple systems activation (DIMSA) following thermal injury. J. Trauma, 18, 432PubMedCrossRefGoogle Scholar
  96. 96.
    Simon, T. L., Curreri, P. W. and Harker, L. A. (1977). Kinetic characterization of hemostasis in thermal injury. J. Lab. Clin. Med., 89, 702PubMedGoogle Scholar
  97. 97.
    Lim, R. C., Olcott, C., Robinson, A. F. and Blaisdell, F. W. (1973). Platelet responses and coagulation changes following massive blood replacement. J. Trauma, 13, 577CrossRefGoogle Scholar
  98. 98.
    Wilson, R. F., Mammen, E. and Walt, A. J. (1971). Eight years of experience with massive transfusion. J. Trauma, 11, 275PubMedCrossRefGoogle Scholar
  99. 99.
    Harker, H. and Rakman, S. (1980). Haemostatic disorders during massive transfusion. Bibl. Haematol., 46, 179Google Scholar
  100. 100.
    Sheldon, G. F., Lim, R. C. and Blaisdell, F. W. (1975). The use of fresh warm blood in the treatment of critically injured patients. J. Trauma, 15, 670PubMedCrossRefGoogle Scholar
  101. 101.
    Ellison, N., Beatty, C. P., Blake, D. R., Wurzel, H. A. and Mac Vaugh, H. (1971). Heparin rebound. Studies in patients and volunteers. J. Thorac. Cardiovasc. Surg., 67, 723Google Scholar
  102. 102.
    Kaul, T. K., Crow, M. J., Rajak, S. M., Deverall, P. B. and Watson, D. A. (1979). Heparin administration during extracorporeal circulation. J. Thorac. Cardiovasc. Surg., 78, 95PubMedGoogle Scholar
  103. 103.
    Babka, R., Colby, C., EI-Etr, A. and Piforre, R. (1977). Monitoring of intraoperative heparinization and blood loss following cardiopulmonary bypass surgery. J. Thorac. Cardiovasc. Surg., 73, 780PubMedGoogle Scholar
  104. 104.
    Entress, A., Estafanous, F. G. and Hoffman, G. C. (1979). Prolonged heparin activity during hypothermic cardiopulmonary bypass. Anesthesiology, 51 (Supp!.), 99CrossRefGoogle Scholar
  105. 105.
    Ellison, N., Ominsky, A. J. and Wollman, H. (1971). Is protamine a clinically important anticoagulant. A negative answer. Anesthesiology, 35, 621PubMedCrossRefGoogle Scholar
  106. 106.
    Bachmann, F., McKenna, R., Cole, E. R. and Najafi, H. (1975). The hemostatic mechanism after open-heart surgery. J. Thorac. Cardiovasc. Surg., 70, 76PubMedGoogle Scholar
  107. 107.
    McKenna, R., Bachmann, F., Whittaker, B., Gilson J. R. and Weinberg, M. (1975). The hemostatic mechanism after open-heart surgery. II. Frequency of abnormal platelet functions during and after extracorpeal circulation. J. Thorac. Cardiovasc. Surg., 70, 298PubMedGoogle Scholar
  108. 108.
    Kalter, R. D., Saul, C. M., Wetstein, L., Soriano, C. and Reiss, R. F. (1979). Cardiopulmonary bypass. Associated hemostatic abnormalities. J. Thorac. Cardiovasc. Surg., 77, 427PubMedGoogle Scholar
  109. 109.
    Gralnick, H. R. and Fischer, R. D. (1971). The hemostatic response to openheart operations. J. Thorac. Cardiovasc. Surg., 61, 909PubMedGoogle Scholar
  110. 110.
    Bick, R. L. (1976). Alterations in hemostasis associated with cardiopulmonary by pass. Pathophysiology, prevention, diagnosis and management. Semin. Thromb. Haemostas., 3, 59Google Scholar
  111. 111.
    Bentall, H. H. and Allwork, S. P. (19681 Fibrinolysis and bleeding in openheart surgery. Lancet, 1, 4Google Scholar
  112. 112.
    Rodvien, R. and Salzman, E. W. (1978). Thrombotic and hemorrhagic problems in surgery. Thromb. Haemostas., 39, 254Google Scholar
  113. 113.
    Laufer, N., Merin, G., Grover, B., Pessachowicz, B. and Borman, J. B. (1975). The influence of cardiopulmonary bypass on the size of human platelets. J. Thorac. Cardiovasc. Surg., 70, 727PubMedGoogle Scholar
  114. 114.
    Hallowell, P., Bland, J. H. L., Buckley, M. J. and Lowenstein, E. (1972). Transfusion of fresh autologous blood in open-heart surgery. J. Thorac. Cardiovasc. Surg., 64, 941Google Scholar
  115. 115.
    Oschner, J. L., Mills, N. L., Leonard, G. L. and Lawson, N. (1973). Fresh autologous blood transfusions with extracorporeal circulation. Ann. Surg., 177, 811CrossRefGoogle Scholar
  116. 116.
    PHam, M. B., McGoon, D. C. and Tarhan, S. (1975). Failure of transfusion of autologous whole blood to reduce banked blood requirements in open-heart surgical patients. J. Thorac. Cardiovasc. Surg., 70, 338Google Scholar
  117. 117.
    BO G. (1977). What is the significance of 'blood sludge' today - cause or effect of disease. Vox Sang., 32, 251Google Scholar
  118. 118.
    Ansell, J., Slepchuk, N., Kumar, R., Lopez, A., Southard, L. and Deykin, D. (1980). Heparin induced thrombocytopenia. A prospective study. Thromb. Haemostas., 43, 6Google Scholar
  119. 119.
    Towne, J. 8., Bernkard, V. M., Hussey, C. and Garancis, J. C. (1979). White clot syndrome. Peripheral vascular complications of herapin therapy. Arch. Surg., 114, 372Google Scholar
  120. 120.
    Powers, P. J., Cuthbert, D. and Hirsh, J. (1979). Thrombocytopenia found uncommonly during heparin therapy. 1. Am. Med. Assoc., 241, 2396CrossRefGoogle Scholar
  121. 121.
    Bell, W. R., Tomasulo, P. A., Alving, B. M. and Duffy, T. P. (1976). Thrombocytopenia occurring during the administration of heparin. A pro-spective study in 52 patients. Ann. Intern. Med., 85, 155PubMedGoogle Scholar
  122. 122.
    Babcock, R. B., Dumper, C. W. and Scharfman, W. B. (1976). Heparininduced thrombocytopenia. N. Engl. J. Med., 295, 237PubMedCrossRefGoogle Scholar
  123. 123.
    Bygdeman, S. and Elisson, R. (1967). Effect of dextrans on platelet adhesiveness and aggregation. Scand. J. Clin. Lab. Invest., 20, 17PubMedCrossRefGoogle Scholar
  124. 124.
    Nilsson, I. M. and Eiken, O. (1964). Further studies on the effect of dextran of various molecular weights on the coagulation mechanism. Thromb. Diath. Haemorrh., 11, 38Google Scholar
  125. 125.
    Aberg, M., Hedner, U. and Bergentz, S. (1979). Effect of dextran on factor VIII (antihemophilic factor) and platelet function. Ann. Surg., 189, 243PubMedCrossRefGoogle Scholar
  126. 126.
    Brodman, R. F., Sarg, M., Veith, F. J. and Spaet, T. (1977). Dextran-40 inducedcoagulopathy confused with von Willebrand disease. Arch. Surg., 112, 321PubMedGoogle Scholar
  127. 127.
    Bergentz, S. E., Eiken, O. and Nilsson, I. M. (1961). The effect of dextran of various molecular weights on the coagulation in dogs. Thromb. Diath. Haemorrh., 6, 15Google Scholar
  128. 128.
    Rudowski, W. J. (1980). Evaluation of modern plasma expanders and blood substitutes. Br. J. Hosp. Med., 23, 389PubMedGoogle Scholar
  129. 129.
    Trafford, J. A. P., Jones, R. H., Evans, R., Sharp, P., Sharpstone, P. and Cook, J. (1977). Haemoperfusion with R-004 amberlite resin for treating acute poisoning. Br. Med. J., 2, 1453PubMedCrossRefGoogle Scholar
  130. 130.
    Vane, J. R. (1979). Prostacyclin and the control of platelet function. Thromb. Haemostas., 42, 16Google Scholar
  131. 131.
    Multicentric Trial, (1977). Prevention of fatal postoperative pulmonary embolism by low doses of heparin. Lancet, 1, 567Google Scholar
  132. 132.
    Blaisdell, F. W. (1978). Prevention of deep vein thrombosis. Surgery, 83, 243PubMedGoogle Scholar
  133. 133.
    Goodman, T. L., Todd, M. E. and Goldsmith, E. I. (1976). Laboratory observations and clinical implications of monitoring the effect of heparin by bioassay. Surg. Gynecol. Obstet., 142, 678Google Scholar
  134. 134.
    Simon, T. L., Hyers, T. M., Gaston, J. P. and Harker, L. A. (1978). Heparin pharmacokinetics: increased requirements in pulmonary embolism. Br. J. Haematol., 39, 111CrossRefGoogle Scholar

Copyright information

© MTP Press Limited 1982

Authors and Affiliations

  • Barbara Bain

There are no affiliations available

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