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April 26, 1958


Author Affiliations

Spokane, Wash.

From the Department of Medicine, Rockwood Clinic.

JAMA. 1958;166(17):2114-2123. doi:10.1001/jama.1958.02990170012004

A group of 24 patients, all characterized by prolonged bleeding time with normal clotting time, were studied with respect to family history, personal history, bleeding time, prothrombin time, serum prothrombin, and thrombin generation. None showed abnormalities of clot retraction, platelet count, or morphology. No simple rule was found to explain the inheritance of this defect. The most important finding in the individual histories was excessive bleeding after tooth extractions. Classification on the basis of laboratory findings proved to be difficult, but the cases in general fitted von Willebrand's description of the thrombopathic state, and were shown to include variable abnormalities of labile prothrombin accelerator, platelet prothrombin accelerator, and platelet-co-thromboplastin. Adrenal steroids were used in 12 patients. This therapy was nonspecific, required two or three days to exert its characteristic action, but was effective in 10 patients.