104 



Scientific Proceedings (74). 



59 («23) 



The effect of sodium citrate on blood coagulation in hemophilia. 

 By Reuben Ottenberg. 



[From the Pathological Department of Mt. Sinai Hospital.] 



The question of the effect on blood coagulation of the injection 

 of sodium citrate into the circulation was raised immediately 

 after the introduction of the citrate method of obtaining blood 

 for transfusion. 



Weil found that in cases with normal coagulation, the coagu- 

 lation time immediately after citrate transfusions was slightly 

 shortened instead of lengthened. As the question is one of 

 particular importance in the hemorrhagic diseases and as there 

 have been no observations recorded on the ultimate effect of 

 citrate administration on the coagulation of blood, I wish to 

 present some experiments in a case of hemophilia, whose prolonged 

 coagulation time made it particularly suitable for this study. 



The patient, an adult male, had nearly bled to death at least 

 six times and presented all the typical features of the disease 

 excepting the family history. The blood count showed nothing 

 abnormal and the blood platelets were within the normal range or 

 slightly above it (490,000 per cu. mm. counted in metaphosphate 

 solution in a counting chamber). The coagulation time of his 

 blood obtained at various intervals within the preceding three 

 years had always been between one and two and a half hours. 



The method of determining the coagulation time consisted in 

 obtaining approximately three cubic centimeters of blood with a 

 hollow needle direct from an arm vein. The blood was received 

 into a clean five cubic centimeter test tube and observed 

 at regular intervals, being kept at approximately body tempera- 

 ture. Complete coagulation was recorded when it was possible 

 to turn the tube up-side down without the blood flowing. Begin- 

 ging or partial coagulation was noted by the retarded flow of the 

 blood when the tube was slanted. This method is far preferable 

 to all the methods which involve the taking of drops of blood from 

 the finger or ear as these methods, due to the admixture of fluids 



