Haemostasis in Haemophilia in Relation to the Haemostatic Balance in the Normal Organism and the Effect of Pea Nuts

Abstract

SummaryThe problems of haemostasis in haemophiloid patients are considered on the basis of a dynamic equilibrium between fibrin formation and fibrin resolution. It is suggested that the observation by Boudreaux and Frampton of an orally acting haemostatic factor in pea nuts is a result of a delayed fibrin resolution, caused by an antifibrinolytic compound, and not of a restoration of the plasma thromboplastin system (the antihaemophilic factor). This assumption is supported by the results of some preliminary experiments. The haemophiloid disorders represent a deviation in the normal haemostatic balance. For this reason they acquire a broader significance in the study of the physiology and pathology of tissue repair processes than represented by the number of patients carrying these diseases. Some implications concerning the pathogenesis of arteriosclerotic lesions are suggested.

Double-blind experiments on the effect of a peanut extract on the bleeding incidence in 92 haemophiliacs.

“…The antiprotease activity is directed rather against the activation of plasminogen than against formed plasmin. The observation that haemophilic patients may have an increased fibrinolytic activity, as suggested by a short euglobulin lysis time (van Creveld et al, 1961), fits well with the hypothesis of Astrup et al (1961) that an increased fibrinolytic activity which causes no harm in a normal individual could produce bleeding in a patient with an impaired haemostatic balance.…”

“…More recently it was suggested that the peanut factor might enhance the platelet-plug-stabilization process, and that vasoconstriction was merely incidental to the phenomenon of platelet-pluginduced haemastasis (Frampton et al, 1966). Astrup et al (1961) found that peanuts and their extracts, with hexane, saline, barbital buffer, or 2 M potassium thiocyanate, exert a powerful protease-inhibiting effect. These results were later confirmed (Schmutzler, 1961 ;van Creveld and Mochtar, 1961 ;Verstraete et al, 1962).…”

“…After oral adsorption of roasted peanuts a decrease in fibrinolytic activity of euglobulin precipitate (Astrup et al, 1961 ;van Creveld and Mochtar, 1961 ;Moers and den Ottolander, 1961;Brakman et al, 1962) and an increased inhibitory activity against streptokinase activated human blood (Nilsson, 1960) have been ascribed to the passage of the protease inhibitor through the membranes of the intestinal villi.…”