Generalized Shwartzman Reaction: Role of the Granulocyte in Intravascular Coagulation and Renal Cortical Necrosis

Abstract

Summary: The protective effect of nitrogen mustard‐induced neutropenia on the development of the GSR was studied. No coagulation defect was found in neutropenic rabbits and simultaneous administration of Thorotrast and endotoxin did not produce intravascular coagulation or renal cortical necrosis. Infusion of neutropenic rabbits with suspensions of viable granulocytes derived from peritoneal exudates reinduced susceptibility to both intravascular coagulation and renal cortical necrosis. It is concluded that the presence of granulocytes is essential for the production of intravascular coagulation by endotoxin.

Studies on Tissue Factor Activity and Production by Leukocytes of Human Umbilical Cord and Adult Origin

“…The investigations of the role of leukocytes in coagulation in recent years have followed the initial demonstrations of changes in the levels of coagulation factors I, VII, VIII, and XI1 after endotoxin administration to rabbits, described in studies on the SSR, in which two spaced doses of endotoxin result in the development of bilateral renal glomerular capillary thrombi and DIC (10,17,30,33). The SSR can be prevented, as can the changes in coagulation factor levels, by rendering the animals neutropenic by nitrogen mustard before endotoxin challenge.…”

“…Evidence of the involvement of leukocytes in blood coagulation has accumulated from several sources; reports have documented the associations between DIC and promyelocytic leukemias (9,13,27), and investigations on the SanarelliShwartzman reaction (SSR) (10,30,33) have shown leukocytes to be essential for the full expression of the reaction.…”

Pathophysiology of Generalized Intravascular Coagulation

“…It has been shown that endotoxin can stimulate granulocytes or monocytes to generate and release tissue thromboplastin-like material [43,83,107,183,216]. The activation of GIC by endotoxin is dependent on the presence of leukocytes [13,41,106,173,247].…”

On the Influence of Normal and Leukemic Human Leukocytes on Blood Coagulation

“…Although a possible role of leukocytes in blood coagulation was pointed out in the last century (Buchanan 1845), this problem has only recently attracted attention [10]. These studies have demonstrated that leukocytes may be a source of thromboplastic and antiheparin activities [4,5,6,9,13,15,18,24,29], although the relationship between these activities and platelet factors 3 and 4 [14] are still not clear. Thromboplastic activity was also demonstrated in erythrocytes [7,8].…”