Platelet and Fibrinogen Kinetics with [75Se]Selenomethionine in Thrombocytopenic States. II

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Abstract
Summary: Simultaneous platelet and fibrinogen kinetics were determined with a cohort label, [75Se]selenomethionine, in 19 thrombocytopenic patients divided into three groups. Group 1 consisted of six patients with idiopathic thrombocytopenic purpura, five were splenectomized and one treated with corticosteroids after the isotope study; Group 2 consisted of four patients with hypersplenism who were splenectomized after the isotope study; and Group 3—nonsplenectomized patients—consisted of two with hepatic cirrhosis, six with either leukaemia or lymphoma and one with paroxysmal nocturnal haemoglobinuria (PNH). A control group, consisting of patients with non‐haernatologic disease and normal coagulation profiles, had a mean platelet survival of 10.5 days and a mean fibrinogen survival of 7.8 days. In both Groups 1 and 2 the mean platelet survivals of 2.4 and 5.2 days respectively were sharply decreased as compared to the controls and also to the mean platelet survival of 11.0 days in Group 3. Mean platelet turnovers in all three groups were either decreased or normal as compared to the control range. Platelet survival curves in Groups 1 and 2 suggested random destruction and in Group 3 a combination of random plus senescent destruction. In Groups 1 and 2 splenectomy or corti‐costeroid therapy resulted in excellent haematologic remissions. In all three groups the mean fibrinogen survivals were within the control range of 6.5–9.5 days. However, one patient, in Group 2 had a substantial decrease in both platelet and fibrinogen survival, probably indicative of low‐grade disseminated intravascular coagulation. A hypercoagulable state was not demonstrated in the patient with PNH. Simultaneous platelet and fibrinogen kinetics are important adjuncts to the study of the pathogenesis, differential diagnosis, therapy, and criteria for splenectomy in thrombocytopenic patients.
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