Disseminated intravascular clotting in kwashiorkor.

Abstract

Hassanein, E. A., and Tankovsky, I. (1975). Archives of Disease in Childhood, 50, 308. Disseminated intravascular clotting in kwashiorkor. The role of disseminated intravascular clotting (DIC) in the pathogenesis of the bleeding diathesis kwashiorkor was investigated in 22 patients. According to the severity of the clinical and haematological findings, two grades of DIC were observed. A severe grade of DIC was shown in 6 cases (5 fatal) presenting with thrombocytopenia, hypofibrinogenaemia, and multiple coagulation defects, and with abnormally prolonged partial thromboplastin, prothrombin, and thrombin times. A second group of 16 patients (7 fatal) showed a less severe grade of DIC manifested by thrombocytopenia, low fibrinogen level, and a clotting factor defect shown by prolonged prothrombin and thrombin times.Multiple coagulation defects including factors II, VII, IX, and X have been reported in kwashiorkor (Dorantes et al., 1964). Deficiency of factor V, additionally, together with thrombocytopenia in one instance, was observed in cases of severe kwashiorkor complicated by infections, particularly gastroenteritis (Hassanein and Tankovsky, 1973). Disseminated intravascular clotting (DIC) has been reported in gastroenteritis (Lufti, 1971). The possibility of DIC being of importance in severe cases of kwashiorkor is the subject of this study. Material and methodsTwenty-two patients, 10 male and 12 female, suffering from severe kwashiorkor, bleeding diathesis, and thrombocytopenia were investigated. Their ages ranged from 9 months to 3 years. They were selected out of 132 cases of kwashiorkor admitted during the period of study. Dehydration of moderate or severe degree was present in the majority of cases and appropriate fluid and electrolyte replacement given. Other measures included antibiotics based on stools and urine culture, milk feeding often by gavage, multivitamin supplements; fresh blood transfusions were given to the majority of patients when there was bleeding and severe anaemia. Haematological investigations including partial thromboplastin, prothrombin, and thrombin times, and fibrinogen level were carried out as described by Dacie and Lewis (1968). Serum fibrin degradation products (FDPs) were estimated in 10 patients using the rapid slide screening test (Diagnostic Reagents Limited, Thame, Oxon, England). The normal value for serum Received 6 September 1974. FDPs was 8 ,ug/ml. Standard statistical methods were used and mean values were tested with Student's 't' test. The difference of the means was considered to be significant if P <0 05.

Nutrient-sensing nuclear receptors PPARα and FXR control liver energy balance

“…Two other important secretory defects have been observed in chronic undernutrition. First, undernourished children have decreased plasma concentrations of coagulation factors with elevated prothrombin time (75)(76)(77)(78)(79)(80)(81)(82)(83). This coagulopathy often manifests as bruising but in rare cases can result in severe gastrointestinal hemorrhage (75,81).…”

“…First, undernourished children have decreased plasma concentrations of coagulation factors with elevated prothrombin time (75)(76)(77)(78)(79)(80)(81)(82)(83). This coagulopathy often manifests as bruising but in rare cases can result in severe gastrointestinal hemorrhage (75,81). Although the vitamin K-dependent factors II, VII, IX, and X are often decreased, many cases of coagulopathy in severe undernutrition are associated with decreased vitamin K-independent coagulation factors (80, 82) (71,73) or are refractory to intravenous vitamin K therapy (75).…”

Chronic Intravascular Coagulation and Fibrinolysis (ICF) Syndromes (DIC)

“…DIC, or at least hypercoagulability, has been suggested in glaucoma [64] and denied [114]. It has been observed in heavy smokers [112], intensely treated hemophiliacs [102], kwashiorkor [101], diabetes mellitus [72], and hyperlipidemia, types II and IV [38].…”