Surface as a Quantitative Factor in Prothrombin Utilization1

Abstract

The accelerating effect of foreign surfaces on coagulation of whole blood has been recognized for many years. In 1863, Lister (1) was aware of the great influence exerted upon the blood by exposure for a very short time to a foreign solid . . . ," and concluded, "The real cause of the coagulation of the blood, when shed from the body, is the influence exerted upon it by ordinary matter. . . ." Since the original observations of Lister, many subsequent investigators have studied this phenomenon (2-15).In the experiments to be described, the rate of prothrombin utilization was employed as a measure of the effect of foreign surface on the blood coagulation mechanism. Blood and plasma from normal human subjects and from patients with hemophilia and thrombocytopenia were exposed to differing glass surface areas, and prothrombin utilization was measured. METHODSMethods of obtaining and handling blood: Approximately 60 ml. of blood were drawn from the antecubital vein of human subjects using sterile, non-silicone treated 18 gauge needles and silicone 4 treated syringes lubricated with silicone oil.5 In order to expose this blood to various areas of foreign surface, 2.0 ml. portions of the blood were measured in duplicate directly from the syringe into 13 x 100 mm. test tubes which had been prepared in different ways. Some tubes were silicone-treated, others were plain glass (i.e., chemically clean, dry, "Pyrex"

Studies on the Clot-Promoting Activity of Glass

“…The observations that the residual high level of serum prothrombin remaining after clotting of PF plasma was decreased when the plasma was treated with glass before recalcification are in agreement with those of Dick, Jackson, and Conley (8). However, as in the present experiments (Table VII) it was shown that after contact with a large area of glass prothrombin may be partly removed from plasma, we hesitate to attribute the decrease in serum prothrombin after contact with glass, to enhanced prothrombin utilization.…”

“…Conley and his associates (5)(6)(7)(8) have reported that contact with glass markedly shortens the clotting time of silicone prepared "platelet free" plasma and increases its prothrombin utilization. They concluded that glass activates "plasma thromboplastin," a constituent residing in the globulin fraction.…”

Nature of a Platelet-Agglutinating Factor in Serum of Patients With Idiopathic Thrombocytopenic Purpura*

“…When thrombocytopenic blood coagulates, relatively large amounts of prothrombin persist (26,27). Significant amounts may remain in the serum of normal blood, depending upon the manner in which the blood is handled (14). If serum containing prothrombin is mixed with thromboplastic materials or with platelets, additional thrombin is generated (28).…”

“…Residual prothrombin in serum was estimated by the method of Quick and Favre-Gilly (13) as modified by Dick, Jackson, and Conley (14). Platelets were counted by the method of Brecher and Cronkite (15).…”

Hemorrhagic Diathesis in Patients With Cyanotic Congenital Heart Disease: Preoperative Management*

“…Cases [7][8][9][10][11][12][13][14][15] Effects of multiple preoperative phlebotomies in nine other cases are summarized in TABLE 2. Three of these patients ( # 10, #13, and Single Phlebotomy Ten patients were subjected to a single phlebotomy prior to surgery.…”