A hematologist has identified the cause of a number of limb loss syndromes, according to study results published recently in the New England Journal of Medicine.
Ted Warkentin, MD, FRCPC, professor of medicine and of pathology and molecular medicine for the Michael G. DeGroote School of Medicine at McMaster University and hematologist for Hamilton Health Sciences, said conditions including gangrene can be the result of microthrombosis, or blood clots in the smallest blood vessels. The clots can be caused by septic shock, some cancers, and side effects of certain blood thinners.
“This is a new idea, but important because these conditions can be devastating. Some of the athletes of the current Parapan Am Games are disabled because of these medical conditions,” Warkentin said in a press release.
Warkentin studied symmetric peripheral gangrene which can lead to loss of extremities including the feet and hands, and sometimes other areas such as nose or ears. Symmetric peripheral gangrene patients have underlying septic shock caused by blood poisoning, but Warkentin determined the cause of the gangrene is “the failure of the liver to produce factors, such as protein C, that protect the small blood vessels,” according to the press release.
Warkentin also researched venous limb gangrene, a rare situation which can cause limb loss through blood clots in the lower limb vein. Warkentin found the syndrome can be caused by side effects of blood thinners. In addition, the patients had critically low levels of protein C.
“By closely examining this group of rare and poorly understood syndromes, we can identify certain unifying themes, and get closer to having a rational approach to treating these conditions,” Warkentin said.
Reference: Warkentin T. N Engl J Med. 2015;doi:10.1056/NEJMra1316259.
Disclosure: Warkentin reports receiving fees for serving on an advisory board from Instrumentation Laboratory, consulting fees from W.L. Gore, lecture fees from Instrumentation Canada and Pfizer Canada, and fees for providing expert testimony in cases regarding thrombocytopenia, coagulopathy or ischemic limb losses.
