Oral submucous fibrosis--a chronic disseminated intravascular coagulation syndrome with local coagulopathy.

Oral submucous fibrosis-a chronic disseminated intravascular coagulation syndrome with local coagulopathy EDITOR,-We have read the leading article in Gut with great interest. (Gut 1992; 33: 4-6). We were, however, disappointed as the work on oral submucous fibrosis published in Indian journals' and the American Journal of Clinical Patholog/ has not been covered by the authors. After working for about 15 years on oral submucous fibrosis, we cannot agree with the views expressed by the authors. According to Jayanthi et al, oral submucous fibrosis has been attributed to local irritation caused by tobacco and chillies used in cooking and that the progression of the disease can be halted by stopping tobacco, pan, etc but it does not seem to be that simple or straightforward. We have seen young female patients who were not exposed to such irritants and they still developed the disease. We have seen that oral submucous fibrosis is a chronic disseminated intravascular coagula-tion syndrome but it is well compensated for in most patients. We have shown that there is a thrombin like substance identified as fibrin producing factor in the saliva of patients suffering from oral submucous fibrosis.2 This is in contrast with the findings in normal saliva. In normal saliva fibrinolytic substances have been shown. Nitta et al' have found considerable amounts of proactivator and plaminogen in mixed, parotid, and submaxillary sublingual saliva. Several centres in India have confirmed the presence of fibrin producing factor in oral submucous fibrosis (personal communication). In 1984, using a haemagglutination inhibition technique (Wellcome Kit HA-14) we showed that fibrinogen/fibrin degradation products-which we prefer to call molecules immunologically similar to fibrinogen (MISFI)-were detected both in the plasma and sera of the patients with oral submucous fibrosis.2 These MISFI were like fibrin monomers, because paracoagulation tests were positive and cryofibrinogen was present. In addition to the discovery of MISFI we have done global or first line clotting time tests in oral submucous fibrosis (unpublished data). These screening tests-activated partial throm-boplastin time, prothrombin time, and throm-bin time-yield interesting information. The clotting times of oral submucous fibrosis are either prolonged or normal or even shortened. When working on oral submucous fibrosis plasma, it is important to appreciate that there is a strong tendency for the formation of cryofibrinogen so that tests should be performed on fresh plasma and sera. When the plasma is stored at-20°C, cryofibrinogen can develop in a matter of two to six …