Abnormalities of platelet aggregation and coagulation have been reported in insulin dependent diabetes mellitus (IDDM), although there is controversy concerning their relationship to microangiopathy. We have studied platelet function and haemostasis in 55 patients with IDDM, 23 without, 14 with mild (background retinopathy) and 18 with severe (proliferative retinopathy, or background retinopathy plus proteinuria) complications. Studies were done on 2 occasions 8 weeks apart and the results compared with 28 control subjects. There was evidence of increased in vivo platelet aggregation in the diabetic group v controls shown by raised values of beta-thromboglobulin (61 +/- 42, mean +/- SD, v 18 +/- 14 micrograms/ml, p less than 0.001), platelet factor 4 (62 +/- 76 v 14 +/- 11 micrograms/ml, p less than 0.01), and platelet micro-aggregates (20 +/- 16 v 12 +/- 11%, p less than 0.01). There was no significant difference in fibrinogen and fibrinopeptide A levels, nor in 'in vitro' tests of platelet aggregation between the groups. Dilute whole blood clot lysis time was increased in the diabetic group v controls (6.4 +/- 2.6 v 4.8 +/- 0.5 hours, respectively, p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Chicken-pox is a highly contagious and therefore relatively common viral infection in children. In this age group peripheral gangrene is a particularly rare condition. A recent case is described here. CASE REPORT A 6-year-old white boy was admitted primarily for social reasons to the infectious disease unit of Hither Green Hospital eight days after developing the typical rash of chicken-pox. He had a rash compatible with eight-day chicken-pox involving the trunk and limbs. No other appreciable abnormalities were noted, except that he was mentally retarded. There were no signs of secondary infection.Two days after admission a slight blue discoloration of the left hand was noticed (see Fig.), and in the next three hours the entire left hand and lower third of the ulnar side of the forearm became cyanosed. The area was tender and Digital gangrene in a 6-year-old boy swollen, though the skin was warn and did not blanch on pressure and the peripheral pulses were palpable. The right hand and foot showed similar changes but to a lesser degree. He remained unconcerned and apyrexial. Over the next 18 hours the right hand and foot gradually resumed a normal appearance, but the left upper extremity remained grossly swollen, despite elevation. The changes persisted and the tips of all four fingers became gangrenous three days later. Secondary infection with Staphylococcus aureus occurred as a result of persistent interference with the dressings by the patient but was controlled with penicillin.At that time he had a white cell count of 15,000 mm.,3 with an essentially normal differential. Serum protein electrophoresis showed an increase in the a2 fraction and the immunoglobulin IgM level was 25 mg./100 ml. The A.S.O titre was 320 Todd units and six weeks later was 160 Todd units/100 ml. All other routine investigations including coagulation studies and a search for agglutinins were negative. Subsequent plethysm3graphic measurements on the affected hand showed normal blood flow.A month later he was transferred to the Evelina Hospital for surgical assessment. The finger-tips were dry, black, and necrotic. The gangrenous areas became well demarcated and six weeks after onset were trimmed. Despite mummification, histology demonstrated the digital arteries in a transverse section of the largest specimens. These were distended by what appeared to be organized thrombus, .and the internal elastic lamina and media appeared well preserved and showed no evidence of arteritis. The fingertips healed satisfactorily and further progress was uneventful. COMMENTThe mode of onset and distribution of the lesions corresponded to the description by Lewis and Pickering (1934) of "bilateral gangrene of the digits in the young and with infection." Their review of the literature on peripheral gangrene included many cases with associated generalized infections, but none with chicken-pox. Jepson-(1956) tabulated disease processes described in conjunction with symmetrical digital gangrene and considered separately those without apparent cause. He thoug...

No abstract

No abstract

Abnormalities of haemostasis have been implicated in the development of both large and small vessel disease in diabetes. Platelet behaviour and coagulation factors were studied in 28 non-diabetic control subjects and 81 Type 1 diabetic patients with different degrees of albuminuria. Twenty-four (30%) patients had macro- or micro-albuminuria. These patients had elevated levels of beta-thromboglobulin compared with normo-albuminuric patients and control subjects (macro-albuminuric 113 (range 60-314), micro-albuminuric 88 (50-220), normo-albuminuric 55 (13-273), control 52 (18-210) micrograms l-1, p less than 0.001). Similar results were found for platelet factor 4 (macro-albuminuric 57 (9-350), micro-albuminuric 78 (12-205), normo-albuminuric 10 (2-135), control 9 (3-95) micrograms l-1, p less than 0.001). There were decreased beta-thromboglobulin:platelet factor 4 ratios in the albuminuric patients compared with control subjects and normo-albuminuric patients (p less than 0.001). There is abnormal platelet activity in Type 1 diabetic patients with elevated albumin excretion rates.