Serial determinations of platelets, leucocytes and coagulation parameters in surgical septicemia

The prognostic and therapeutic information obtained by serial determinations of platelets, leucocytes, Normotest (NT), Thrombotest (TT), fibrinogen concentrations and the ethanol gelation test (EGT) was evaluated in 18 surgical patients with septicemia. Nine of these patients died and autopsy revealed a persistent septic focus in all but one. In this last patient only microscopic changes after an intra-abdominal abscess evacuated 14 days prior to death was found. Consecutive platelet counts provided valuable prognostic and therapeutic information during the course of septicemia. Within two weeks after start of therapy, this parameter had returned towards the normal range in the survivors whereas continuous low platelet counts were observed until death in the patients with a persistent septic focus. The initial degrees of thrombocytopenia did not discriminate between survivors and non-survivors. Serial leucocyte counts did not give information of prognostic or therapeutic value in either group during the observation period. NT- and TT-values were significantly lower in the fatal cases than in the survivors during the first week of septicemia. Moreover, TT seemed to be a better early discriminator between survivors and non-survivors than NT. Neither fibrinogen concentrations nor the EGT provided information of prognostic or therapeutic value in this study.