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A decrease in intra-platelet 5-hydroxytryptamine (5-HT) may be a possible marker for primary thrombocytosis and there are several different methods for the measurement of platelet 5-HT content (e.g. fluorimetry, high-performance liquid chromatography and radioimmunoassay). The present study has shown that, in laboratories with radioprotected areas, radioimmunoassay of 5-HT is a simple method which correlates well with a standard fluorimetric technique and yields satisfactory results in patients with thrombocytosis.

A patient with combined factor VII and factor VIII deficiency is discussed. The propositus is a 21-year-old male who presented a mild bleeding tendency. The patient appears to be a hemophilia and at the same time heterozygote for factor VII deficiency. This conclusion is based on the fact that heterozygosis for factor VII deficiency was present in the father and in other relatives of the paternal side. On the contrary, no factor VII deficiency was present in the maternal side of the family. However, the maternal grandfather was known to have been a bleeder and the propositus' mother, his sister and his aunt had low-normal factor VIII levels and were probably hemophilia A carriers. This type of combined factor VII and factor VIII deficiency appears to be due to the casual association of two independently segregating defects.

Heparin was found to inhibit the interaction between human factor VIII and platelets. This was noted in two different systems, namely, platelet aggregation induced by neuraminidase-treated human cryoprecipitate and platelet aggregation induced by ristocetin-human factor VIII complex. Heparin appeared to have an inhibitory effect on the above systems similar to that reported on bovine factor VIII-induced platelet aggregation.

Platelet aggregation in citrated and heparinized plasma by ionophore A 23187 and Ristocetin was studied in normal subjects and in patients with von Willebrand's disease and congenital afibrinogenemia. Aggregation by ionophore was normal in all groups both in citrated and heparinized plasma. Aggregation by Ristocetin in citrated plasma was normal in congenital afibrinogenemia, in normal subjects and in types II and III of von Willebrand's disease. It was absent in classical von Willebrand's disease, type I. In heparinized plasma it was absent in all groups, except in some patients with von Willebrand's disease, type III. It is concluded that ionophore A 23187 behaves in a different way than Ristocetin and has no diagnostic implications.

Three venoms obtained from three vipers, namely Echis carinatus, Notechis scutatus scutatus and Oxyuranus scutellatus, have been used as thromboplastin in a one-stage assay of coumarin-induced prothrombin. Regardless of the venom used, prothrombin resulted to be low in coumarin-treated patients. The mean values obtained were 27.2, 33.6, and 24.2%, respectively. These values were comparable to those obtained by means of the classical one-stage method (24.8%). A good correlation was observed among the different methods. However, the levels observed using the Notechis scutatus scutatus venom method were slightly higher as compared to those obtained by means of the other viper venoms and by means of the classical one-stage method. The three viper venoms used seem unable to activate coumarin-induced prothrombin. The levels obtained were in fact, in each instance, definitely lower than those observed immunologically. Methods which employ these viper venoms may be used in the evaluation of prothrombin in coumarin-treated patients.

2 members of a family, a child and his father, showed a combined morphological abnormality of leukocytes and platelets. The abnormality consisted of the presence of pseudodrumsticks in the neutrophils and of large platelets. One or more than one pseudodrumstick was present in about 40% of neutrophils. Leukocyte count, differential count and enzymatic stains were normal. Large platelets constituted about 25% of the platelet population. 1 patient also had mild thrombocytopenia which appeared to be unrelated to the basic defect since it appeared after a parotitis infection. Platelet function was normal but for a moderate prolongation of the bleeding time in the patient who had mild thrombocytopenia. No chromosomal abnormality was present in the propositi. The condition seems different from other leukocyte and platelet abnormalities so far described.

Factor I (fibrinogen) and factor VIII were shown, by an indirect immunofluorescence technique, to be present in human washed platelets. In the case of fibrinogen, the immunofluorescent pattern had a ‘clod distribution’ up to a 1:128 dilution of the antiserum. Factor VIII showed a ‘speckled’ pattern up to the 1:64 dilution. Cross-absorption studies confirmed the presence of such factors. Factor II, VII, IX, X and XIII, however, were not found in washed platelets. A diffuse fluorescence was noted using normal rabbit sera, but this was due to a cross-reaction, since it disappeared using a 1:32 diluted sera.

We studied platelet survival in 14 cardiac patients before heart valve replacement using 75Se-methionine ‘cohort label’. The temporal variation of plasma and platelet activity was plotted by a continuous curve by means of a computerized interaction of the single points. Then we computed the plasmatic radioactivity fraction used daily for thrombo-poiesis and made a subtraction of this aliquot from the experimental activity in the catabolic phase of the slope. Platelet life span obtained after this ‘correction’ is comparable with the values of random label using 51Cr.

Factor VIII von Willebrand may be detected by a Ristocetin-dependent platelet agglutination reaction. The authors have measured plasma levels of Factor VIII-related Ristocetin cofactor (VIIIR:RCoF) using formalin-fixed platelets tested by an aggregometric method or by a new, commercially available glass slide test. Plasmas were obtained from patients with von Willebrand's disease and Cushing's syndrome, and from normal controls. Von Willebrand factor (vWf) levels varied between 0-500% of the normal. A good correlation (r = 0.95) was found comparing the results obtained by the two methods over the entire range. If all patients were considered, a satisfactory correlation was obtained between VIIIR:RCoF and VIII-related antigen (VIIIR:Ag), both by the aggregometric method (r = 0.79) and by the glass slide method (r = 0.88). On the contrary, if values below 25% of the normal are taken into account, only a mild correlation was found between VIIIR: RCoF (aggregometric method) and VIIIR:Ag and no correlation between VIIIR:RCoF (glass slide method) and VIIIR:Ag. No correlation, regardless of the method used, was found between VIIIR:RCoF and VIIIR:Ag for values above 120%.

Summary13 male New Zealand rabbits were injected with two different doses (25 μg/Kg and 100 μg/Kg) of human platelet factor 4 antigen (PF4). The disappearance of the protein was extremely fast with an half-life for the fast component of 1.07 ± 0.16 and 1.76 ± 0.11 min respectively. The half-life for the slow component, detectable only with the highest dosage, was 18.8 min.The administration of 2500 I.U. of heparin 30 min after PF4 administration induced a partial release of the injected protein and its clearance from plasma was slow, with half-life of 23.3 ± 5.9 min and 30.9 ± 2.19 min respectively.

We performed a retrospective study on 21 patients, aged 70 years or more, affected by polycythemia vera (PV) or essential thrombocythemia (ET). As controls, we evaluated 10 younger ET patients. The results indicate that in older ET subjects there was a lower incidence of hemorrhagic and thrombotic complications than in younger patients and PV patients. However, platelet number and platelet function tests were similar in all the patients studied. We suppose that an increase in hematocrit as seen in PV is much more dangerous as compared to an isolated increase in platelet count, and that thrombocytosis alone in old age can be an isolated expression of a natural involution of blood marrow similar to myelofibrosis.

Any discussion of arterial hypertension in the elderly must essentially turn on the vexed question of the indications and limitations imposed on its treatment. We can perhaps oversimplify the matter by saying that there are two approaches towards antihypertensive management in the aged: intervention, and abstention wherever possible. Let me say straightaway that I am to be found in the second camp for both clinical and physiopathological reasons. From the clinical standpoint, long experience with patients of this type has convinced me that treatment — by which I mean management imbued with a certain degree of “aggressiveness” — is often accompanied by side-effects that greatly cloud the quality of life, while its influence on the quantity of life is, to say the least, debatable. In physiopathological terms, too, there do not seem to be sure premisses for a rationally effective and useful intervention. The question may thus seem somewhat categorical, and certainly in opposition to the normal run of things (at any rate to non-geriatricians). I shall therefore try to explain the steps that led me to this conclusion. I must say that I came to the approach of abstention wherever possible through a long evolution (or involution, according to one’s point of view) starting from the taken-for-granted equation: “hypertension increases the vascular risk, therefore correction of hypertension decreases such risk.”

A "new" antithrombin III (AT III) abnormality is described in five members of the same family. None of the affected members showed thrombotic manifestations and no consanguinity was present in the family. The main laboratory features were: normal routine clotting tests, slightly decreased AT III activities in all assays carried out in the presence of heparin. In the absence of heparin, antithrombin III activities were instead within normal limitis. Progressive AT III activity and AT III antigen were also normal. Crossed immunoelectrophoresis in the absence of heparin showed a normal pattern both in plasma and serum. In the presence of heparin, the propositi's plasma showed a major, less anodal, abnormal peak and a smaller normal peak. Three peaks were present in the propositi's serum as compared with the two normal ones. This AT III abnormality is different from AT III Padua previously described by us and we propose the toponym of Antithrombin Padua-2 to define this condition.

Platelet aggregation to common inductors and to Ristocetin, Thrombo-fax and Ionophore is normal in congenital factor X deficiency and in factor X Friuli coagulation disorder. Washed normal platelets resuspended in the patient’s plasma and in adsorbed normal plasma showed a normal aggregation. On the contrary, normal platelets resuspended in normal serum failed to aggregate. These studies indicate that factor X plays no role in normal platelet aggregation.

Porcine mucosal heparin was chemically depolymerized. The depolymerization was stopped at different steps to obtain two low molecular weight (LMW) heparins with a molecular weight of 10 000 and 6000, respectively. The LMW heparins were tested in vitro for anti-clotting activities and for platelet serotonin release in different systems in comparison with normal heparins, dermatan and heparan sulphate. After addition of various amounts of heparin preparations to washed platelets, no significant release was observed for all tested heparins. On the contrary, different heparins showed an inhibition of serotonin-release induced by collagen in platelet rich plasma, whereas the ADP-induced release was increased. The effect on the platelet release appears related to the molecular weight. In fact, it is significant only for normal heparins whereas it is not for LMW heparins. A good relation was observed, also, between anti-activated factor X activity/antiglobal clotting activity (Xa/APTT) ratio of different heparins and the effect on platelet release.

Factor VIII: C activity decay was studied in lyophilized concentrates (Kryobulin, Immuno) stored at room temperature and in reconstituted preparations frozen and stored at −20°C. A slow, pratically identical, decay of Factor VIII: C was found in lyophilized concentrates kept at room temperature, in reconstituted lyophilized concentrates frozen and stored at −20°C and in lyophilized concentrate kept at +4°C.

The hypothesis that thrombocytopenia in liver cirrhosis (LC) could be due to platelet activation was investigated. 18 patients with thrombocytopenia and LC have been studied. Circulating beta-thromboglobulin (beta TG) was normal, but appeared elevated when referred to platelet count. However, this may not accurately reflect alpha-granule release because of reduced liver cell function. Intraplatelet beta TG, on the contrary, should not be affected by liver cell function. It was markedly depressed, thus truly suggesting the existence of an exhausted state caused by platelet activation. Thromboxane B2 production was slightly increased. This could be due to a compensatory mechanism, or simply to platelet size, which was slightly increased, too. Anti-platelet therapy failed to improve thrombocytopenia. A platelet activation state seems therefore to be present in LC, but seems not to be the only cause of thrombocytopenia. Platelet factor 4 approximated zero, regardless of platelet count and therapy. This confirms that elevated values of such a protein represent only a laboratory artifact, due to platelet activation in vitro.

Bartter’s syndrome is characterized by hypokalemia, hyperreninemia, hyperaldosteronism without hypertension, and juxtaglomerular cell hyperplasia.1 Recent studies have demonstrated an increase of the urinary excretion of prostaglandins (PGs) PGE2, PGF2α 2–4 and 6-keto PGF1α 5,6 in cases of Bartter’s syndrome.

Porcine mucosal Heparin (mean molecular weight= 15.000 Dalton) has been chemically depolymerized in presence of peroxides and N-sulphate groups have been re-introduced by reaction with sulpho- trioxides of amines. The depolymerization has been stopped at different times and the products are essayed for Anti-Xa, APTT and their ratio. A rise in the ratio Anti-Xa/APTT has been observed.In order to check for an activity on the platelet aggregation, two sets of experiments have been carried out: in a first model, the 5-hydroxytrip- tamine (5-HT) release has been measured after addition of different quantities of products to washed platelets. One commercil Heparin gave a significant rise in 5-HT release whereas a normal porcine mucosal Heparin did not show any modification in basal values, nor significant modifications have been observed for low molecular weight heparins (10.000 to 7.000 D). Heparansulphate (HS) and Dermatansulphate (DS) show a slight anti-aggregating activity in this test.In a second model, the percentage inhibition in collagen induced platelet release has been measured in a platelet rich plasma (PRP). All the tested heparins show a very significant inhibition, whereas HS and DS have no inhibiting activity in this test.

Platelet aggregation by various inductors was studied in citrated and heparinized plasma of the following groups of subjects: Normal, hemophilia A, combined factor V and factor VIII deficiency, v. Willeprand's disease and congenital afibrinognemia. The results may be summarized as follows: A-platelet aggregation in citrated plasm 1) platelet aggregation by common inductors ADP, adrenalin and collagen was normal in all groups of subjects but for the patients with congential afibrinogenemia in whom adrenalin induced aggregation was absent or markedly refuced whereas ADP and collagen gave slightly reduced or near normal aggregation curves. 2) platelet aggregation by ristocetin was normal in all groups of subjects but for v. Willebrand's disease in which it was absent. B-platelet aggregation in heparized plasma. 1) platelet aggregation by common inductors resulted to be normal in all groups of subjects except in congenital afibrinogenemia. In this latter case the pattern was still mildly defective but here was an increased aggregation as compared to citrated plasma. These findings have been interpretemmon inductors. 2) platelet aggregation by ristocetin resulted to be absent in all groups of subjects investigated. The possible mechanism of action of the inhibitory effect exercised py heparin with regard to restocetin is discussed.

Two unrelated patients with Bernard-Soulier syndrome and their relatives were studied. The patients demonstrated severe bleeding diathesis, the relatives were asymptomatic. The propositi showed the characteristic abnormalities of the syndrome: thrombocytopenia, a percentage of giant platelets higher than 65%, prolonged bleeding time and defective platelet aggregation to ristocetin and bovine plasma. On the contrary, in the heterozygotes, the typical abnormalities were not fully evident. We introduce a simple ELISA method for the precise definition of both homozygous and heterozygous states for the syndrome by the quantitation of platelet glycoprotein (GP) Ib. Specific binding of monoclonal antibodies anti-platelet GPIb was performed both by direct binding of radioiodinated antibody and by ELISA. Comparable results were obtained. In fact, we demonstrated near absence of GPIb in the 2 propositi and about half the amount in the heterozygotes studied compared to normal platelets.

The aim of the study was to investigate the relevance of beta-thromboglobulin (beta tg) measurement in patients with thrombocytosis. We have, therefore, studied the level of plasma and platelet beta tg in 74 patients with high platelet count in addition to the evaluation of platelet aggregation and platelet serotonin (5-HT) content. The determinations of platelet serotonin content and aggregation are confirmed to be useful in the differentiation between primary and secondary forms of thrombocytosis. The mean plasma level of beta tg in patients with myeloproliferative disease was significantly raised, but the amount observed in subjects with secondary thrombocytosis is increased too. Considering the amount of beta tg in relation to whole blood platelet count (beta tg ratio), no difference was observed between all patients and controls. The beta tg ratio allowed the identification of a group of patients with an increased ratio and a decreased beta tg platelet content who showed the highest occurrence of thrombosis (66%).

Plasmatic β -thromboglobulin (BTG) has been assayed in 5 patients with May-Hegglin anomaly. All patients showed a normal BTG plasmatic level. The plasma BTG/number of platelets ratio resulted to be elevated but this was due to the low platelet count typical of the disease. The platelet content in BTG was studied in only 2 patients and was found to be four times the normal value; however, the circulating BTG platelet mass in these patients resulted to be within normal limits.

Levels of beta-thromboglobulin and platelet factor 4 in 46 patients with transient ischemic attacks and the influence of treatment with dipyridamole or aspirin plus dipyridamole were evaluated. Patients not receiving therapy showed levels of beta-thromboglobulin significantly higher than controls. However, patients taking only dipyridamole showed values of beta-thromboglobulin significantly lower than untreated patients or those taking aspirin plus dipyridamole. No significant difference was observed with regard to platelet factor 4 between the patients.

SummaryThirteen women and 2 men affected by Cushing’s syndrome were investigated. The following parameters were used: plasma and urinary cortisol levels, factor VIII assay (antigen, activity and von Willebrand factor) together with other coagulative assays.Samples were taken before surgery or before medical and/or radiation therapy and every 30–50 days after treatment and continued for 11 months. Cortisol and factor VIII were increased before treatment and decreased slowly after treatment to become normal in 3–4 months. Other clotting tests did not show significant changes. It seems that high plasma cortisol levels may stimulate the production of factor VIII. Patients with Cushing’s syndrome often exhibit thromboembolic complications after surgery. It is likely that the clotting abnormalities responsible for such complications is the increased factor VIII activities level.

The effect of Sulphinpyrazone on the anticoagulant response to Warfarin was evaluated by a double-blind study in 11 patients with prosthetic heart valves. Six patients received Warfarin and Sulphinpyrazone and 5 Warfarin and placebo. Sulphinpyrazone potentiated the anticoagulant effect of Warfarin. Patients receiving Sulphinpyrazone needed about half the amount of Warfarin as compared to the control group. There were four bleeding episodes in the Sulphinpyrazone group and one episode in the control group. It was difficult to regulate the dose of Warfarin in patients also receiving Sulphinpyrazone.

Sixteen patients with chronic idiopathic thrombocytopenic purpura underwent splenectomy after failure of steroid therapy. The average time of follow-up was 69 months. Immediately after splenectomy, complete response (platelets above 150 x 10(9)/l) was obtained by 68% of patients while 25% had partial response (platelets from 50 to 150 x 10(9)/l) and only in 1 patient splenectomy failed. During the long-term follow-up, 2 patients relapsed 9 and 20 years, respectively, after splenectomy (20% of non-responders). Partial recurrence of thrombocytopenia (partial response) was observed in 33% of the patients. The persistent complete response rate was then 47%. The young patient age appears to be the only positive predictive factor both for short-term and long-term response to splenectomy. The platelet recovery rate and postsplenectomy thrombocytosis are also early features of lasting response. Positive serum and platelet-associated immunoglobulins became negative after splenectomy, but there is no correlation with clinical response.