White thromboembolism in the hamster cheek pouch after trauma, infection and neoplasia.

White thrombosis and embolism were investigated by cinephotomicroscopy in the transillumined cheek pouch of the hamster in an experimental study of factors which may be involved in the febrile hemolytic syndrome in man, characterized by a finding of generalized platelet thrombosis of arterioles, capillaries and veins at autopsy. Endothelial trauma resulting from vascular occlu-sion produced platelet thrombosis and embolism. Dicumarol prevented the formation of platelet thrombosis and embolism after trauma. Heparin produced spontaneous platelet emboli and both heparin and dicumarol resulted in a leukocytic thrombosis. Platelet and leukocytic coatings and embolization were photographed during staphylococcus infection and malignant neoplasia. Sludged blood was not found in trauma, infection or malignant neoplasia. AN EXPERIMENTAL investigation of the production of intravascular agglu-tination and the factors involved is significant because of the frequency of thrombo-embolism, both spontaneous and postoperative, and the practice of administering the antico-agulants heparin and dicumarol as therapeutic agents. In recent years, the intravascular agglu-tination of circulating erythrocytes bound together by a sticky glassy precipitate to form "sludged blood" has been reported by Knisely and co-workers.'-5 These workers 1, 3 described the formation of sludged blood in traumatic areas and proposed that sludged blood may form thrombi in the capillaries, resulting in the production of traumatic shock. Laufman, Mar-tin and Tanturi6 occluded the mesenteric vein in the dog and reported that heparin and di-cumarol caused a diminished adherence of erythrocytes to the vessel wall but did not prevent the formation of sludged blood. The authors concluded that anticoagulants prevent thrombosis by preventing agglutinated erythro-cytes from adhering to the endothelial wail. Laufmian, Martin and Tuell,7 using Knisely's quartz rod apparatus with magnifications of X 25 and X 48, found a clumping of blood elements which they interpreted to be the blood sludge described by Knisely. Odell, Aragon and Pottinger,8 using Knisely's technic for ob-339 serving, at X 48, the blood flow in the con-junctiva of man, found sludged blood in a small group of pathologic cases and in pregnancy. Timonen and Zilliacus9 reported sludged blood in patients with skin allergies. Bloch'0 reported sludged blood of the "soft clump" type in the conjunctivas of 262 patients suffering from poliomyelitis. Except for a single in vitro experiment' in monkey malaria, erythrocyte masses have not been probed or otherwise tested for adhesive-ness. Blood flow examined under the usual binocular magnifications frequently shows that the erythrocytes are arranged in groups simulating the condition referred to as …