Three cases of disseminated intravascular coagulation

Coagulopathy of disseminated neuroblastoma

We performed coagulation studies in 16 patients with advanced neuroblastoma. Four of these patients had major hemorrhagic or thromboembolic complications. Abnormal coagulation screening tests were seen in all patients with active metastatic disease. We also measured plasma fibrinopeptide A, a sensitive measure of intravascular thrombin generation. Increased concentrations of fibrinopeptide A were found in each patient studied with active metastatic disease. Coagulopathy is a frequent finding in metastatic neuroblastoma and may cause severe morbidity. Laboratory studies suggesting either hyper- or hypocoagulability are frequent findings.

Coagulation defects in hypoxic full-term newborn infants

Blood clotting was examined in 24 consecutive full-term newborn infants with hypoxia and 23 normal control infants. There was evidence of a gross alteration in the clotting process in the hypoxic infants. The degree of disturbance in clotting seemed to be dependent on the severity of the hypoxia, suggesting a causal relationship. The mechanism involved seemed to be intravascular coagulation. The consumption of clotting factors involved led to the appearance of a haemorrhagic diathesis. This effect seemed to be of short duration, suggesting that direct liver damage plays at most a minor part.Though there was no evidence of damage in the infants who survived, it is possible that intravascular coagulation induced by hypoxia, by leading to deposition of fibrin, may cause damage to vital organs. Further studies will be required to examine this possibility.