Changes in the Blood Coagulation System Associated with Septicemia

Abstract

Detailed coagulation analyses in 36 pediatric cases of septicemia revealed 22 gram-negative and eight gram-positive infections, two Rocky Mountain spotted fevers, and four with no etiologic agent isolated. Various changes in the clotting mechanism were encountered irrespective of the infectious agent but apparently related to blood pressure. The most frequent single abnormality was thrombocytopenia in 61 per cent of all cases. Multiple coagulation changes, regularly noted in patients with hypotension or shock, were interpreted as being secondary to diffuse intravascular coagulation. Similar changes were not seen in cases with normal blood pressures. The most reliable laboratory guides seemed to be a reduced platelet count, low factor V levels in plasma and fibrinolytic split products in serum. Heparin was given in all patients with hypotension suspected of having the defect. Most patients with septicemia and low blood pressure apparently have the defect.