BLEEDING IN A PATIENT TAKING LORENZOS OIL - EVIDENCE FOR A VASCULAR DEFECT

We describe a man with adrenoleukodystrophy receiving Lorenzo's oil (g lycerol trioleate and glycerol trierucate) who developed purpura, pete chiae, and bleeding. Bleeding time was markedly increased (>20 min), a lthough he had only borderline thrombocytopenia (120 x 10(9)/1) and co nventional platelet aggregation studies were normal (except for a bord erline response to low concentration collagen), as were results using a new technique employing immobilised von Willebrand factor. Together these results suggest that bleeding in this man resulted from a defect in vascular wall function or in the interaction of platelets with the endothelium.