Summary and conclusions
Evidence has been presented to show that oral administration of a fat soluble vitamin and bile salts will increase the concentration of prothrombin and thereby reduce the clotting time of the blood, as measured by both direct and indirect methods. It appears that the vitamin alone will not accomplish this result if bile is excluded from the intestine, while bile or bile salts have some definite effect, presumably because these substances facilitate absorption of the vitamin which is already present in the intestinal tract. The question naturally arises as to why bile alone cannot be used in the preoperative and postoperative treatment. The first reason is, of course, that the prothrombin time may continue to rise postoperatively, even when bile is flowing freely into the intestine. As Warner, Brinkhous and Smith (23) have shown, the administration of Vitamin K greatly accelerates the restoration of prothrombin in such cases. The second is the inadequate food intake which is common to most jaundiced patients and which may of itself lead to depletion of the amount of Vitamin K in the digestive tract. The third factor has to do with the ability of the liver itself to convert the protective material into prothrombin. There is considerable clinical evidence to show that in the presence of injury of the liver larger amounts of Vitamin K are required to achieve the desired effect. Presumably, the chemical laws governing mass action are operative in this connection. A good deal of future experience will be needed before a definite statement as to the indications for and the limitations of this treatment can be established, but for the present it may be said that it offers considerable hope for the ultimate control of the hemorrhagic diathesis in jaundiced persons.
Similar content being viewed by others
References
Aggeler, P.M. and Lucia, S. P.: Study of Some Variables Affecting the Prothrombin Time.Proc. Soc. Exper. Biol. and Med., 38:11–16, Feb., 1938.
Almquist, H. J.: Anti-hemorrhagic Vitamin.Poultry Sc., 16:166–172, May. 1937.
Almquist. H. J.: Further Studies on the Anti-hemorrhagic Vitamin.Jour. Biol. Chem., 120:635–640, Sept., 1937.
Boland, E. W.: Pathologic Data in Cases of Jaundice and Fatal Hemorrhage.Proc. Staff Meet. Mayo Clinic, 13:70–72, Feb. 2 1938.
Bollman, J. L.: Personal communication to the authors.
Butt, H. R., Snell, A. M. and Osterberg, A. E.: The Use of Vitamin K and Bile in Treatment of the Hemorrhagic Diathesis in Cases of Jaundice.Proc. Staff Meet. Mayo Clinic, 13:74–77, Feb. 2, 1938.
Dam, H.: Haemorrhages in Chicks Reared on Artificial Diets: New Deficiency Disease.Nature, 133:909–910, June 16, 1934.
Dam, H.: The Anti-haemorrhagic Vitamin of the Chick: Occurrence and Chemical Nature.Nature, 135:652–653, April 27, 1935.
Dam, Henrik and Glavind, Johannes: Vitamin K in Human Pathology.Lancet, 1:720–721, March 26, 1938.
Dann, Flementine P.: Personal communication to the authors.
Greaves, J. D. and Schmidt, C. L. A.: Nature of the Factor Concerned in Loss of Blood Coagulability of Bile Fistula Rats.Proc. Soc. Exper. Biol. and Med., 37:43–45, Oct., 1937.
Hawkins, W. B. and Brinkhous, K. M.: Prothrombin Deficiency the Cause of Bleeding in Bile Fistula Dogs.Jour, Exper. Med. 63:795–801, June 1, 1936.
Judd. E. S. and Wangensteen, O. H.: Unpublished data.
Magath, T. B.: Coagulation of Blood with Special Reference to Prothrombin.Proc. Staff Meet. Mayo Clinic, 13:67–69, Feb. 2, 1938.
Nygaard. K. K.: Coagulability of Blood Plasma: a Method of Determining Hemorrhagic Tendency of Jaundiced Patients.Proc. Staff Meet. Mayo Clinic. 7:691–696, Nov. SO, 1932.
Osterberg, A. E.: Vitamin K: Its Distribution and Chemical Properties: Methods of Preparation and Assay.Proc. Staff Meet. Mayo Clinic. 13:72–74, Feb. 2, 1938.
Patek, A. J., {jrJr.} and Taylor, F. H. L.: Hemophilia. II. Some Properties of a Substance Obtained from Normal Human Plasma Effective in Accelerating the Coagulation of Hemophilic Blood.Jour. Clin. Investigation, 16:113–124, Jan., 1937.
Quick, A. J., Stanley-Brown. Margaret and Bancroft, F. W.: A Study of the Coagulation Defect in Hemophilia and in Jaundice.Am. Jour. Med. Sc., 190:501–511, Oct., 1935.
Roderick, L. M.: The Pathology of Sweet Clover Disease in Cattle.Jour. Am. Vet. Med. Assn., 74:314–326, Feb., 1929.
Smith, H. P., Warner, E. D. and Brinkhous, K. M.: Prothrombin Deficiency and the Bleeding Tendency in Liver Injury (Chloroform intoxication).Jour. Exper. Med., 66:801–811, Dec, 1937.
Snell, A.M.: Clinical and Experimental Conditions Associated with a Deficiency of Prothrombin.Proc. Staff Meet. Mayo Clinic, 13:65–67, Feb. 2, 1938.
Warner, E. D., Brinkhous, K. M. and Smith, H. P.: A Quantitative Study on Blood Clotting: Prothrombin Fluctuations Under Experimental Conditions.Am. Jour. Physiol., 114:667–675, Feb., 1936.
Warner, E. D., Brinkhous, K. M. and Smith, H. P.: Bleeding Tendency of Obstructive Jaundice: Prothrombin Deficiency and Dietary Factors.Proc. Soc. Exper. Biol. and Med., 37:628–630, Jan.. 1938.
Author information
Authors and Affiliations
Additional information
Read before the meeting of the American Gastro-Enterological Association, Atlantic City, New Jersey, May 2-3, 1938.
Rights and permissions
About this article
Cite this article
Snell, A.M., Butt, H.R. & OSterberg, A.E. Treatment of the hemorrhagic tendency in jaundice; with special reference to vitamin k. American Journal of Digestive Diseases 5, 590–596 (1938). https://doi.org/10.1007/BF02996480
Issue Date:
DOI: https://doi.org/10.1007/BF02996480