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April 1967, Vol 113, No. 4 >
Article | April 1967

Hypofibrinogenemia and Thrombocytopenia With Meningococcemia FREE

Daniel J. Wilhelm, MD; Charles Cherubin, MD
[+] Author Affiliations

Received for publication June 28, 1966.

Read before the US Public Health Clinical Society Meeting, Baltimore, May 10, 1966.

Reprint requests to 619 River St, Port Huron, Mich 48060 (Dr. Wilhelm.)


Am J Dis Child. 1967;113(4):494-497. doi:10.1001/archpedi.1967.02090190140020.
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Comments

SEVERE coagulation disorders in the course of meningococcal sepsis have been reported only sporadically, although petechial and purpuric lesions occur in one half of the clinical cases.1 Von Rechenberg2 stated that incoagulable blood does occur in fulminant meningococcemia; and Koller3 described a case in which hypofibrinogenemia, a deficiency in blood-clotting factor V, and thrombocytopenia were demonstrated. There have been occasional other reports of meningococcemia with prolonged bleeding and clotting times, thrombocytopenia, and associated factor V or VIII deficiences.4-7 A case of Waterhouse-Friderichsen syndrome due to pneumococcal septicemia, with incoagulable blood and multiple coagulation factor deficits, including hypofibrinogenemia and a circulating anticoagulant, has been reported by Ratnoff and Nebehay.8 Rodriguez-Erdman has recently suggested the name consumption-coagulopathy to describe similar clinical conditions.9

This is a report of a fatal case of fulminant meningococcemia, accompanied by hypofibrinogenemia, thrombocytopenia, and incoagulable blood. No fibrinolysins or antithrombin substances were

REFERENCES

1 +
Swartz, M.N., and Dodge, P.R.:  Bacterial Meningitis: A Review of Selected Aspects , New Eng J Med 272:725, 1965;.
2 +
Von Rechenberg, H.K.:  Zur Perakuten Meningokokkensepsis , Deutsch Med Wschr 79:1208, 1954;.
3 +
Koller, F.:  Clinical and Genetic Aspects of Coagulopathies: With Special Emphasis on Generalized Intravascular Clotting , Ann Intern Med 62:744-756, 1965;.
4 +
Pratt-Thomas, H.R.; Kelly, W.H.; and Gazes, P.C.:  Fulminating Meningococcemia , Southern Med J 38:229, 1945;.
5 +
Cosgriff, S.W.:  The Waterhouse-Friderichsen Syndrome , Ann Intern Med 21:187-193, 1944;.
6 +
Gordon, W.H., and Shimkin, M.B.:  Fulminant Meningococcemia With Purpura Meningitis and Focal Necrosis of the Pituitary , JAMA 123:147, 1943;.
7 +
Hill, W.R., and Kinney, R.D.:  Cutaneous Lesions in Acute Meningococcemia , JAMA 134:513-518, 1947;.
8 +
Ratnoff, O.D., and Nebehay, W.E.:  Multiple Coagulation Defects in a Patient With Waterhouse-Friderichsen Syndrome , Ann Intern Med 56:627-632, 1962;.
9 +
Rodriguez-Erdman, F.:  Bleeding Due to Increased Intravascular Coagulation: Hemorrhagic Syndromes Caused by Consumption of Blood Clotting Factors (Consumption-Coagulopathies) , New Eng J Med 273:1370, 1965;.
10 +
Rosenberg, A.:  Plasma Fibrinogen Determination , Clin Chem 2:331, 1956;.
11 +
MacFarlane, R.E., and Biggs, R.:  Fibrinolysis: Its Mechanisms and Significance , Blood 3:1167-1187, 1948;.
12 +
Tagnon, H.J., et al:  The Occurrance of Fibrinolysis in Shock, With Observations on Prothrombin Time and Plasma Fibrinogen During Hemorrhagic Shock , Amer J Med Sci 211:88-96, 1946;.
13 +
Lincoln, A.F.; Moorman, A.J.; and Schultz, R.L.:  Fibrinolysis Following Thoracic Surgery , Surg Gynec Obstet 195:541, 544, 1958;.
14 +
Weiner, A.E.; Reid, D.E.; and Roby, C.C.:  Incoagulable Blood in Severe Premature Separation of Placenta , Amer J Obstet Gynec 66:475-499, 1953;.
15 +
Weiner, A.E., et al:  Coagulation Defects With Intrauterine Death From Rh Isosensitization , Amer J Obstet Gynec 60:1015-1022, 1950;.
16 +
Ratnoff, O.D., and Vosburgh, G.J.:  Clotting Defect in Amniotic Fluid Embolism , New Eng J Med 247:970-973, 1952;.
17 +
Josey, W.W., and Szeillies, G.:  Hypofibrinogenemia and Presumptive Shwartzman Reaction in Septic Abortion , JAMA 184:502-504, 1963;.
18 +
Conley, C.L.; Ratnoff, O.D.; and Hartmann. R.C.:  Studies in Afibrinogenemia: I. Afibrinogenemia in Patient With Septic Abortion, Acute Yellow Atrophy of the Liver and Bacteremia Due to E Coli , Bull Hopkins Hosp 88:402-413, 1959;.
19 +
Rapaport, S.I., and Chapman, C.G.:  Coexistant Hypercoagulability and Acute Hypofibrinogenemia in Patient With Prostatic Carcinoma , Amer J Med 27:144-153, 1959;.
20 +
Ratnoff, O.D.:  Studies on Proteolytic Enzyme in Human Plasma: Fetal Hemorrhagic State Associated With Excessive Proteolytic Activity in Patient Undergoing Surgery for Carcinoma of Head of Pancreas , J Clin Invest 31:521-528, 1952;.
21 +
Fountain, J.R., and Holman, R.L.:  Acquired Fibrinogen Deficiency Associated With Carcinoma of the Bronchus , Ann Intern Med 52:459, 1960;.
22 +
Bjorkman, S.E.:  Three Cases of Polycythemia With Fibrinogenopenia , Acta Med Scand 129:472-477, 1948;.
23 +
Nilsson, I.M.; Shanse, B.; and Gydell, K.:  Fibrinolysis in Boecks Sarcoid , Acta Med Scand 159:463-470, 1957;.
24 +
Bowman, H.S.:  Acquired Fibrinogenopenia , Amer J Med 24:967-973, 1958;.
25 +
Cooperberg, A.A., and Neiman, E.M.:  Fibrinogenopenia and Fibrinolysis in Acute Myelogenous Leukemia , Ann Intern Med 42:706-711, 1955;.
26 +
Kwaan, H.C.; McFadzean, A.; and Cook, J.:  Plasma Fibrinolytic Activity in Cirrhosis of Liver , Lancet 1:132-136, 1956;.
27 +
Little, J.R.:  Purpura Fulminas Treated Successfully With Anticoagulation , JAMA 169:36, 1959;.
28 +
Trigg, J.W.:  Hypofibrinogenemia in Rocky Mountain Spotted Fever , New Eng J Med 270:1042-1044, 1964;.
29 +
Hardaway, R.M., and Johnson, M.C.:  Clotting Mechanism in Endotoxin Shock , Arch Intern Med 112:775-782, 1963;.
30 +
Levin, J., and Cluff, L.B.:  Endotoxemia and Adrenal Hemorrhage , J Exper Med 121:247, 1965;.

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References

1 +
Swartz, M.N., and Dodge, P.R.:  Bacterial Meningitis: A Review of Selected Aspects , New Eng J Med 272:725, 1965;.
2 +
Von Rechenberg, H.K.:  Zur Perakuten Meningokokkensepsis , Deutsch Med Wschr 79:1208, 1954;.
3 +
Koller, F.:  Clinical and Genetic Aspects of Coagulopathies: With Special Emphasis on Generalized Intravascular Clotting , Ann Intern Med 62:744-756, 1965;.
4 +
Pratt-Thomas, H.R.; Kelly, W.H.; and Gazes, P.C.:  Fulminating Meningococcemia , Southern Med J 38:229, 1945;.
5 +
Cosgriff, S.W.:  The Waterhouse-Friderichsen Syndrome , Ann Intern Med 21:187-193, 1944;.
6 +
Gordon, W.H., and Shimkin, M.B.:  Fulminant Meningococcemia With Purpura Meningitis and Focal Necrosis of the Pituitary , JAMA 123:147, 1943;.
7 +
Hill, W.R., and Kinney, R.D.:  Cutaneous Lesions in Acute Meningococcemia , JAMA 134:513-518, 1947;.
8 +
Ratnoff, O.D., and Nebehay, W.E.:  Multiple Coagulation Defects in a Patient With Waterhouse-Friderichsen Syndrome , Ann Intern Med 56:627-632, 1962;.
9 +
Rodriguez-Erdman, F.:  Bleeding Due to Increased Intravascular Coagulation: Hemorrhagic Syndromes Caused by Consumption of Blood Clotting Factors (Consumption-Coagulopathies) , New Eng J Med 273:1370, 1965;.
10 +
Rosenberg, A.:  Plasma Fibrinogen Determination , Clin Chem 2:331, 1956;.
11 +
MacFarlane, R.E., and Biggs, R.:  Fibrinolysis: Its Mechanisms and Significance , Blood 3:1167-1187, 1948;.
12 +
Tagnon, H.J., et al:  The Occurrance of Fibrinolysis in Shock, With Observations on Prothrombin Time and Plasma Fibrinogen During Hemorrhagic Shock , Amer J Med Sci 211:88-96, 1946;.
13 +
Lincoln, A.F.; Moorman, A.J.; and Schultz, R.L.:  Fibrinolysis Following Thoracic Surgery , Surg Gynec Obstet 195:541, 544, 1958;.
14 +
Weiner, A.E.; Reid, D.E.; and Roby, C.C.:  Incoagulable Blood in Severe Premature Separation of Placenta , Amer J Obstet Gynec 66:475-499, 1953;.
15 +
Weiner, A.E., et al:  Coagulation Defects With Intrauterine Death From Rh Isosensitization , Amer J Obstet Gynec 60:1015-1022, 1950;.
16 +
Ratnoff, O.D., and Vosburgh, G.J.:  Clotting Defect in Amniotic Fluid Embolism , New Eng J Med 247:970-973, 1952;.
17 +
Josey, W.W., and Szeillies, G.:  Hypofibrinogenemia and Presumptive Shwartzman Reaction in Septic Abortion , JAMA 184:502-504, 1963;.
18 +
Conley, C.L.; Ratnoff, O.D.; and Hartmann. R.C.:  Studies in Afibrinogenemia: I. Afibrinogenemia in Patient With Septic Abortion, Acute Yellow Atrophy of the Liver and Bacteremia Due to E Coli , Bull Hopkins Hosp 88:402-413, 1959;.
19 +
Rapaport, S.I., and Chapman, C.G.:  Coexistant Hypercoagulability and Acute Hypofibrinogenemia in Patient With Prostatic Carcinoma , Amer J Med 27:144-153, 1959;.
20 +
Ratnoff, O.D.:  Studies on Proteolytic Enzyme in Human Plasma: Fetal Hemorrhagic State Associated With Excessive Proteolytic Activity in Patient Undergoing Surgery for Carcinoma of Head of Pancreas , J Clin Invest 31:521-528, 1952;.
21 +
Fountain, J.R., and Holman, R.L.:  Acquired Fibrinogen Deficiency Associated With Carcinoma of the Bronchus , Ann Intern Med 52:459, 1960;.
22 +
Bjorkman, S.E.:  Three Cases of Polycythemia With Fibrinogenopenia , Acta Med Scand 129:472-477, 1948;.
23 +
Nilsson, I.M.; Shanse, B.; and Gydell, K.:  Fibrinolysis in Boecks Sarcoid , Acta Med Scand 159:463-470, 1957;.
24 +
Bowman, H.S.:  Acquired Fibrinogenopenia , Amer J Med 24:967-973, 1958;.
25 +
Cooperberg, A.A., and Neiman, E.M.:  Fibrinogenopenia and Fibrinolysis in Acute Myelogenous Leukemia , Ann Intern Med 42:706-711, 1955;.
26 +
Kwaan, H.C.; McFadzean, A.; and Cook, J.:  Plasma Fibrinolytic Activity in Cirrhosis of Liver , Lancet 1:132-136, 1956;.
27 +
Little, J.R.:  Purpura Fulminas Treated Successfully With Anticoagulation , JAMA 169:36, 1959;.
28 +
Trigg, J.W.:  Hypofibrinogenemia in Rocky Mountain Spotted Fever , New Eng J Med 270:1042-1044, 1964;.
29 +
Hardaway, R.M., and Johnson, M.C.:  Clotting Mechanism in Endotoxin Shock , Arch Intern Med 112:775-782, 1963;.
30 +
Levin, J., and Cluff, L.B.:  Endotoxemia and Adrenal Hemorrhage , J Exper Med 121:247, 1965;.

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