Thrombocytopenia and Bleeding Complications in Severe Cases of Meningococcal Infection Treated with Heparin, Dextran 70 and Chlorpromazine

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Abstract
32 consecutive patients with meningococcal meningitis and septicemia were divided into a high-risk group (10 cases) and a low-risk group (22 cases) according to a prognostic score. Two sulphonamideresistant strains were isolated, which are the first ones reported from Sweden. Heparin was given to 8 high-risk patients and 7 low-risk patients. Shock therapy included dextran 70, chlorpromazine and high doses of dexamethasone. The fatality rate was 50% in the high-risk group and 0% in the low-risk group compared with 63% and 1.4% in corresponding groups of an earlier series, treated differently. There was evidence of disseminated intravascular coagulation (DIC) in 9 of the 10 high-risk patients. Thrombocytopenia was the most constant coagulation defect. It was most pronounced during the second to the fourth day after admission and was not affected by heparin treatment, and thus may have had other causes than DIC. Five patients had unusual and severe bleeding complications and are described in detail. Heparin has probably contributed to the bleedings in at least 2 cases. Dextran 70, chlorpromazine and acetylsalicylic acid may have impaired the hemostatic function. The beneficial effect of heparin in meningococcal septicemia is not significantly proved. When used, heparin should be given continuously in low dosage with frequent laboratory checks, especially if renal insufficiency is present Acetylsalicylic acid, dextran, chlorpromazine and other drugs that impair platelet function, should be given with care if thrombocytopenia is pronounced, especially if combined with heparin.