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Article
August 28, 1967

Occult Bleeding

JAMA. 1967;201(9):706. doi:10.1001/jama.1967.03130090070027
Abstract

To the Editor:—  Hemostasis in the surgical patient first aroused my interest when as an intern I encountered what was then a nearly hopeless situation, the postoperative bleeding in obstructive jaundice. Subsequently, Bancroft, Stanley-Brown, and I observed a prolonged prothrombin time in severe obstructive jaundice.1 Later (Amer J Physiol, 118:260, 1937), the use of vitamin K and bile salts as a possible prophylaxis for cholemic bleeding was soon substantiated. I have retained my interest in the subject and have read with profit the timely paper (201:123, 1967) by William B. Wilson, MD.Three topics could profitably be added to his presentation: (1) telangiectasia (Rendu-Osler disease) as a basic cause of bleeding, especially of the gastrointestinal tract; (2) aspirin as a common factor in the accentuation of a bleeding tendency; and (3) defective platelet dysfunction as a participant in faulty hemostasis.The majority of patients with telangiectasia rarely

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