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GIANT HAEMANGIOMA WITH A DISORDER OF COAGULATION

The mechanism of the coagulation disorder in an infant with a large haemangioma of the right arm has been studied. The disorder was characterised by thrombocytopenia, prolonged bleeding time and the occurrence of fibrinolytic split products in the blood. The levels of various coagulation factors were normal. The mechanism of the disorder was further investigated by injection of 51Cr labelled platelets, which disappeared very rapidly from the circulation owing to the uptake by the haemangioma. Injection of 125I labelled fibrinogen revealed a considerable increase in disappearance rate, which, however, was not as high as for 51Cr labelled platelets. Treatment with heparin in this case appeared inadvisable because the thrombocytopenia was found to be due mainly to mechanical destruction in the haemangioma while intravascular coagulation played only a subordinate role. On the other hand, the fibrinolytic activity in the tumour vessels was found to be high, which together with the occurrence of fibrinolytic split products in the blood was considered to indicate treatment with inhibitors of fibrinolysis (EACA). During this treatment the angioma decreased in size. It would therefore appear advisable to investigate the mechanisms of the coagulation disorders in these patients before deciding upon treatment.