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A Case of Increased Platelet Anti-Heparin Factor in a Patient With Raynaud's Phenomena and Gangrene, Treated By Aspirin

Identifieur interne : 000D97 ( Istex/Corpus ); précédent : 000D96; suivant : 000D98

A Case of Increased Platelet Anti-Heparin Factor in a Patient With Raynaud's Phenomena and Gangrene, Treated By Aspirin

Auteurs : D. E. Fitzgerald ; W. J. H. Butterfield

Source :

Vascular Diseases [ 0003-3197 ] ; 1969-06.

RBID : ISTEX:1C227CBFD218FC84EECA084DDEA98B7951BC6100

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https://api.istex.fr/document/1C227CBFD218FC84EECA084DDEA98B7951BC6100/fulltext/pdf

DOI: 10.1177/000331976902000601

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<meta-value>317 A Case of Increased Platelet Anti-Heparin Factor in a Patient With Raynaud's Phenomena and Gangrene, Treated By Aspirin SAGE Publications, Inc.1969DOI: 10.1177/000331976902000601 D.E.Fitzgerald Department of Medicine, Guy's Hospital Medical School, London S. E. 1, England W.J.H.Butterfield Department of Medicine, Guy's Hospital Medical School, London S. E. 1, England ANGIOLOGY The _fournal of Vascular Diseases Official Journal of the American College of Angiology and the International College of Angiology Published under the auspices of THE ANGIOLOGY RESEARCH FOUNDATION, INC. Raynaud's disease is usually classified clinically as primary and secondary. The phenomena is usually called primary when no underlying cause can be found for the condition and secondary when the response is associated with some known condition such as a collagen disease. 1, 2 The patient in this report presented with severe Raynaud's phenomena, complicated by gangrene of one digit and spasmodic pain in the hand and other fingers. Investigations for any of the usual underlying causes were negative, but it would appear that in this case abnormalities of the platelets and clotting mechanism contributed to the gangrene. CASE HISTORY Mr. S. A., 49 years old, was admitted from the casualty department complaining of pain in the right middle finger. He has exhibited Raynaud's phenomenon for 24 years, which developed following extensive war wounds involving the right leg, left arm and left side of the neck. Prior to admission in October 1967, the patient had intermittent attacks of pain in the right middle finger for 4/52 increasing in frequency, which became severe enough in the previous three days to prevent sleep. The pain started in the distal phalanx and radiated into the palm of the hand and then into the other fingers of the hand. On admission, the pain was continuous, the tip of the right middle finger was blue, cold and numb to the level of the distal crease. Previous diseases. 1937, sandfly fever during military service in India; 1939, injury to both legs without fracture, when run over by a lorry; 1943, hit by three antitank shells, wounding the right leg, left arm and left side of the neck. Personal history. Married with three children; employed as a chauffeur for many years; smokes 30 cigarets per day; drinks alcohol occasionally. 318 Farnily history. Mother died at 79; father died at 63 of bronchitis. Sibs 4: one brother died of silicosis. Body functions. Normal. Physical examination. The patient was of military appearance and bearing, but thin and drawn and in considerable pain. He had vomited recently: oral temperature was 99° F. The right hand was warm and sweating, the terminal phalanx of the middle finger was cooler than the other fingers by 6° F. There was blue discoloration of this area and some tenderness, particularly on attempts to raise the nail which appeared to have stopped growing and was lifting from the nail bed. Cardiovascular system. Pulse 92/min. and regular; B.P. 160/86 mm Hg. The heart was normal. All peripheral pulses were present except the left ulnar. There was a systolic bruit over the right and left subclavian arteries. Respiratory system. No appreciable disease. Reticuloendothelial system. Bilateral axillary lymphadenopathy. Alimentary system. Mouth, edentulous; abdomen, liver enlarged 2 fingers; on rectal examination, the prostate was slightly enlarged. Nervous system. No appreciable disease. INVESTIGATIONS X-ray. Chest normal, no cervical rib present. Plain x-ray of the hand showed normal appearances on the right except for some soft tissue narrowing of the tip of the middle right finger. Opacities overlying the left hand due to foreign bodies. Hematology. Hemoglobin 14.8 gm/100 ml; hematocrit 48 per cent; mean corpuscular hemoglobin concentration, 30.5 per cent; white blood cells, 6780; neutrophils, 6780; lymphocytes, 3390; monocytes, 907; eosinophils, 226; erythrocyte sedimentation rate, 10 mm in first hour. Group 0 positive. Latex nucleoprotein test, negative. No cold agglutinins demonstrated. Chemistry. Plasma sodium, 130 Eq per l; potassium, 4.5 Eq per l; chloride, 108 Eq per 1; bicarbonate, 20 Eq per 1; blood urea, 30 mg/100 ml; plasma cholesterol, 105 mg/100 mg; total protein, 6.4 gm/100 ml; total albumin, 3.8 gm/100 ml; total globulin, 2.6 gm/100 ml; electrophoretic pattern, no appreciable disease; glucose tolerance test, normal. Autoantibodies. Antinuclear factor, negative; antibodies against: thyroid, stomach, muscle and adrenal, negative; antibodies against nonspecific organ, negative. Bacteriology. A specimen from the nail area exhibited Staphylococcus aureus, resistant to penicillin. Plethysmograph blood flows. See table 1. Treatment. Intraarterial injection of Priscol 25 mg, no effect. Intravenous heparin 10,000 units q.i.d., no relief. Infusion of Rheomacrodex: no improvement was observed after 12 hr. With hyperbaric oxygen, the patient experienced relief of pain for 1 hr. of exposure to high pressure oxygen. There 319 TABLE 1 Plethysmograph blood flows I , I was also a marked reduction in the degree of cyanosis of the digit involved. However, the patient would not agree to further treatment in the hyperbaric chamber. Further medications. Warfarin, 25 mg; pethidine, 50 mg; Priscol, 50 mg 320 t.i.d.; Stemetil, 12.5 mg q.i.d.; ampicillin, 250 mg q.i.d.; Sodium Amytal, 200 mg Nocte; Sparine, 50 mg q.i.d.; brandy, 1 oz q.i.d. No improvement was observed. Four days after admission the right middle finger was amputated through the middle phalanx. The patient was discharged from hospital 12 days later with the skin edges well opposed but black at the amputation site. Histology report on the amputated right middle phalanx. Gross: The distal phalanx of the finger with the head of the middle phalanx. The nail is atrophic and the horny layer of the skin around its distal end is peeling off. The sections of a proximal cuff preparation and also of an anterior-posterior block through the nail bed were examined (fig. 1A) . Microscopic: The digital arteries proximally are unequal. The larger shows long-standing fibrous occlusion, and the smaller is severely stenosed by fibroelastic intimal thickening. In the finger pulp virtually every artery is stenosed or occluded by predominantly fibrous intimal thickening. There is no evidence of any older organic arterial disease that might have caused this. At several points the appearances suggest a process, sometimes multiepisodic, intimal thickening (i.e., the appearances are not those of embolism) (fig. 1B). PROGRESS The patient attended the outpatient department a month later. At this time his chief complaint was loss of libido. The site of amputation was healing satisfactorily. His medication was now confined to warfarin and Valium 2.5 mg t.d.s. Laboratory investigations at this time. Hematology: hemoglobin, 15 g/100 ml; hematocrit, 45 per cent; mean corpuscular hemoglobin concentration, 34.5 per cent; white blood cells, 6,900; neutrophils, 7,370; monocytes, 476; lymphocytes, 4,046; platelets, 275,000; erythrocyte sedimentation rate, 3 mm in first hour. ~Vestergren. No cold agglutinins demonstrated. Chemistry: cryoglobulins not detected; electrophoresis of serum protein, normal pattern. The patient was seen again in the outpatient department 2 months and 3 months later. The amputation site was now healed but the area was tender. On both of these occasions there was little change in his condition. He continued to have ischemic pains in his right hand and it was therefore decided to readmit him. The patient was admitted to hospital for a right sided axillary sympathectomy. On discharge from hospital in March 1968, the right hand was warmer with no sweating. The patient was next seen at the outpatient department 2 months after the operation. He gave a history of a nose bleed some weeks before and his anticoagulant therapy had been withdrawn by his general practitioner. Following this the episodes of Raynaud's phenomenon became more frequent and more severe. Both hands showed a deterioration. There was paronychia on the index fingers of both hands. The patient was admitted for a left sided axillary sympathectomy. 321 FIG. 1. A. Longitudinal histologic section of the amputated finger after removal of the nail (see text). B. Transverse section of the amputated finger showing occluded and partly occluded vessels (see text). Laboratory findings on this admission. Hematology: hemoglobin, 14.8 per cent; hematocrit, 48 per cent; mean corpuscular hemoglobin concentration, 31 per cent; erythrocyte sedimentation rate, 8 mm; neutrophils, 7526; lymphocytes, 2438; monocytes, 530; eosinophils, 106. Cold agglutinins: at 20° C, 322 FIG. 2. A. Appearance of right index finger showing the area of gangrene present for 1 month before commencement of aspirin therapy. B. Appearance of right index finger after 2 weeks of aspirin therapy. C. Appearance of right index finger after 3 weeks of therapy. D. Comparison of the right and left index fingers after 2 months. negative; at 4° C, 1:32; at 37° C, negative. A latex nucleoprotein test, latex rheumatoid test and lupus erythematosus test were negative. Chemistry: plasma cholesterol, 205 mg/100 ml; plasma sodium, 136 mEq per 1; plasma potassium, 4.4 mEq per 1; plasma chloride, 104 mEq per 1; plasma bicarbonate, 19 mEq per 1; blood urea, 26 mEq per 1; serum total protein, 6.6 gm/100 ml; albumin, 4.0 gm/100 ml; globulin, 2.6 gm/100 ml; cryoglobulins, not detected; electrophoresis, normal. After the operation the left hand was warmer. Six weeks later on follow- up, the patient presented with an area of gangrene on the side of the right index finger (fig. 2A ) , which had been present for approximately 1 month. An investigation of platelet activity was carried out at this time by sampling blood from the brachial artery and antecubital vein. The circulation in the arm was occluded by a cuff inflated to 200 mm Hg for 8 min., and a second arterial and venous sample obtained. The technique of this test has been reported elsewhere.3 The samples were investigated for platelet count and platelet adhesiveness (Payling-urright method). It was found that the platelet adhesiveness was the same in both venous blood samples, but that the arterial sample following occlusion showed a 30 per cent increase in platelet adhesiveness. It was also found that the plasma heparin tolerance in the patient was greatly increased.4 4 323 TABLE 2 Plasma heparin tolerance results Dilution in micrograms of heparin per 0.2 ml of plasma, followed by 0.1 ml of thrombin. The heparin tolerance test was repeated a week later and was still approximately twice the control levels. Four tablets of soluble aspirin B.P. were given, and the test was repeated 24 hr. later. The plasma heparin tolerance had now dropped to normal control levels (see table 2) . The recent reports of the influence of aspirin on platelets5-7 and the result of the findings in this patient decided us to administer one soluble aspirin B.P. twice daily as a therapeutic trial. The gangrenous area was dressed with a local application of the enzyme preparation Trypur Novo daily for 1 week. Figure 2 shows the progress of healing while the patient was taking aspirin. After 2 weeks (fig. 2B) the dose was reduced to one tablet daily for a week and then withdrawn (fig. 2C) . The plasma heparin tolerance test was repeated 4 days after withdrawal of aspirin and was found to be within normal control limits. At this time the patient reported fewer attacks of Raynaud's phenomenon. His hands were warm and pain free. His general demeanor was greatly improved and for the first time since his first attendance at the hospital he was anxious to seek employment. COMMENT Recent reports in the literature regarding the action of aspirin on platelets5-7 stimulated the investigation of this aspect of this patient. Further investigations are in progress with other patients subject to Raynaud's phenomenon. It may be that some patients with an increased tendency to platelet aggregation combined with Raynaud's phenomenon are at greater risk of local thrombosis in the digital vessels particularly during periods of reduced blood flow in these vessels. As aspirin seems to block the release of the platelet anti- heparin factor the risk of local thrombosis in the digital vessels during attacks of Raynaud's phenomenon may be reduced. This patient developed an area of digital gangrene, even though sympathectomy had been recently successfully performed. The condition was slowly deteriorating for a month. When treated with aspirin the patient healed in three weeks. ACKNOWLEDGMENTS We wish to thank Dr. P. Barkhan and Fr. A. H. Yussof of the Department of Hematology, Mr. F. Ellis and Mr. J. Bull of the Department of Surgery 324 and ~Irs. J. Keates and NIiss ski, Hodges of the Department of Medicine for their assistance. REFERENCES Hutchinson, J. : M. Press. M. S., 72: 403, 1901. Allen, E.V., Barker, N.W., and Hines, E.A.: Peripheral Vascular Diseases. W. B. Saunders Co., Philadelphia & London, 1962, p. 125. Butterfield, W.J.H., and FitzGerald , D.E.: Angiology, 20: 359, 1969. Yussef, A.H., and Barkhan, P.: Brit. M. J., 1: 746, 1968. MacMillan, D.C. : Lancet, 1151, 1968. Weiss, H.J., and Aledort, M.L.: Lancet, 2: 495, 1967. O'Brien, J.R. : Lancet, 779, 1968.</meta-value>
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         <ref> 
            <citation citation-type="journal" xlink:type="simple"> 
               <name name-style="western"><surname>Hutchinson, J.</surname>
</name>
 : <source>M. Press. M. S.</source>
, <volume>72</volume>
: <fpage>403</fpage>
, <year>1901</year>
.</citation> 
         </ref> 
         <ref> 
            <citation citation-type="book" xlink:type="simple"> 
               <name name-style="western"><surname>Allen, E.V.</surname>
</name>
, <name name-style="western"><surname>Barker, N.W.</surname>
</name>
, and <name name-style="western"><surname>Hines, E.A.</surname>
</name>
: <source>Peripheral Vascular Diseases</source>
. <publisher-name>W. B. Saunders Co.</publisher-name>
, <publisher-loc>Philadelphia</publisher-loc>
 & <publisher-loc>London</publisher-loc>
, <year>1962</year>
, p. <fpage>125</fpage>
.</citation> 
         </ref> 
         <ref> 
            <citation citation-type="journal" xlink:type="simple"> 
               <name name-style="western"><surname>Butterfield, W.J.H.</surname>
</name>
, and <name name-style="western"><surname>FitzGerald , D.E.</surname>
</name>
: <source>Angiology,</source> 
               <volume>20</volume>
: <fpage>359</fpage>
, <year>1969</year>
.</citation> 
         </ref> 
         <ref> 
            <citation citation-type="journal" xlink:type="simple"> 
               <name name-style="western"><surname>Yussef, A.H.</surname>
</name>
, and <name name-style="western"><surname>Barkhan, P.</surname>
</name>
: <source>Brit. M. J.</source>
, <volume>1</volume>
: <fpage>746</fpage>
, <year>1968</year>
.</citation> 
         </ref> 
         <ref> 
            <citation citation-type="journal" xlink:type="simple"> 
               <name name-style="western"><surname>MacMillan, D.C.</surname>
</name>
 : <source>Lancet</source>
, <volume>1151</volume>
, <year>1968</year>
.</citation> 
         </ref> 
         <ref> 
            <citation citation-type="journal" xlink:type="simple"> 
               <name name-style="western"><surname>Weiss, H.J.</surname>
</name>
, and <name name-style="western"><surname>Aledort, M.L.</surname>
</name>
: <source>Lancet,</source> 
               <volume>2</volume>
: <fpage>495</fpage>
, <year>1967</year>
.</citation> 
         </ref> 
         <ref> 
            <citation citation-type="journal" xlink:type="simple"> 
               <name name-style="western"><surname>O'Brien, J.R.</surname>
</name>
 : <source>Lancet</source>
, <volume>779</volume>
, <year>1968</year>
.</citation> 
         </ref> 
      </ref-list>
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A Case of Increased Platelet Anti-Heparin Factor in a Patient With Raynaud's Phenomena and Gangrene, Treated By Aspirin

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