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January 1946

PURPURIC MANIFESTATIONS OF HEATSTROKEStudies of Prothrombin and Platelets in Twelve Cases

Arch Intern Med (Chic). 1946;77(1):27-36. doi:10.1001/archinte.1946.00210360032003

THE appearance of purpuric manifestations in heatstroke has been recorded by several authors.1 According to Wakefield and Hall,2 Andnal gave the first accurate account of the major postmortem features in 1838—namely, petechiae, liquid blood and venous engorgement. In 1892 Osier3 wrote: "The venous engorgement is extreme, particularly in the cerebrum. The blood is usually fluid; the lungs are intensely congested. Parenchymatous changes occur in the liver and spleen."

In a review of available literature concerning heatstroke we have not found an adequate explanation of this hemorrhagic phenomenon. However Wilson and Doan4 reported decreases in prothrombin and platelets in patients subjected to artificially induced fever. They concluded that the decrease in prothrombin was secondary to hepatic damage and that the degree of thrombopenia depended on the extent of megakaryocytic damage.

The purpose of this report is to record the results of repeated determinations of prothrombin time and