Although bleeding states associated with the presence of a circulating fibrinolytic enzyme are not rare, it appears worth while to report 2 cases in which treatment was associated with control of the lytic agent and adequate control of bleeding.
Report of Cases
Case 1.—
A 40-year-old white farmer had been observed at the Mayo Clinic for 5 years because of chronic lymphocytic leukemia; this had been asymptomatic without treatment until 1 year ago, when he had noted the onset of increasing fatigability, loss of 25 lb., easy bruising and bilateral fullness in the flanks. After he had slammed his finger in a car door 5 days prior to his last visit, intractable subungual hemorrhage developed and persisted despite removal of the nail and use of absorbable gelatin sponge (Gelfoam) dressings.Examination at the clinic disclosed numerous petechiae over the arms and trunk, ecchymoses over the trochanters, and crusted blood in