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Multiple Coagulative Defects in a Patient with the Waterhouse-Friderichsen Syndrome

Ann Intern Med. 1962;56(4):627-632. doi:10.7326/0003-4819-56-4-627
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The pathogenesis of the purpuric manifestations of the Waterhouse-Friderichsen syndrome is unknown. The histologic changes in cutaneous ecchymotic areas have seemed inadequate to explain the occurrence of the bleeding. Information concerning blood clotting mechanisms in this syndrome is limited. Cases have been described in which the blood has been incoagulable (1), clotting and bleeding times have been prolonged (2), or deficiencies of platelets (3-7), proaccelerin, or proconvertin (3) have been present; however, these abnormalities may be exceptional, for they have not been observed in many well-studied cases.

The possibility that severe alterations in the clotting mechanism may sometimes contribute to


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