先天性第VII因子欠損症の巨大卵巣嚢腫切除術における止血管理  [in Japanese] Homostatic Management with Prothrombin Complex Concentrate in a Patient with Factor VII Deficiency Undergoing Resection of a Large Ovarian Cyst  [in Japanese]

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Abstract

先天性第VII因子欠損症 (血漿第VII因子活性 (FVII: C) <0.01U/m<i>l</i>) に合併した巨大右卵巣嚢腫切除術の止血管理を経験した. 症例は24歳の女性で, 繰り返す股関節内出血や過多月経に対し, プロトロンビン複合体製剤で止血管理されていた. 術中, 術後の止血管理には, 1バイアル中にFVII: Cを1,755単位 (U) 含有するプロプレックス<sup>®</sup>STの反復投与による補充療法を行った. 本症例のプロプレックス<sup>®</sup>ST試験投与後の血中FVII: C半減期は5.6時間, 生体内回収率は152%であった. 手術直前から術後48時間までは8時間毎に2バイアルを, 以後は8時間毎に1バイアルを投与した. 2バイアル投与10分後の血漿FVII: Cは1.62U/m<i>l</i>で, 反復投与中の8時間後の平均FVII: Cは0.16U/m<i>l</i>, 1バイアル投与8時間後の平均FVII: Cは0.08U/m<i>l</i>であった. 補充療法開始96時間後からは漸次投与間隔を延長し, 計6日間で投与を中止した. 治療経過中, 患者に異常出血や血栓傾向は認めず, 第15病日に軽快退院した.

A 24-year-old Japanese woman with congenital factor VII deficiency (factor VII less than 0.01U/m<i>l</i>) developed a large cyst in the right ovary. She had a history of recurrent joint bleeding and menorrhagia that had been treated with prothrombin complex concentrate (PCC, Proplex<sup>®</sup> ST). She underwent right adnectomy successfully with repeated replacement therapy using Proplex<sup>®</sup> ST (1, 755 U of FVII: C per vial). Pharmacokinetics study of Proplex<sup>®</sup> ST revealed that the biological half-life and <i>in vivo</i> recovery of FVII: C were 5.6h and 152%, respectively. Two vials of Proplex<sup>®</sup> ST were given prior to surgery and every 8 hours until 48 hours after surgery, yielding a peak plasma FVII: C level of approximately 1.62U/m<i>l</i> and a trough level of 0.16U/m<i>l</i>. Subsequently, one vial was given every 8 hrs until 16 hours after surgery, resulting in a peak level of 1.07U/m<i>l</i> and a trough level of 0.08U/m<i>l</i>. The administration interval of PCC was prolonged thereafter and the replacement therapy was terminated on the 6th postoperative day. No abnormal bleeding or thrombotic events occurred during the perioperative course.

Journal

  • Japanese Journal of Thrombosis and Hemostasis

    Japanese Journal of Thrombosis and Hemostasis 11(2), 193-200, 2000-04-01

    The Japanese Society on Thrombosis and Hemostasis

References:  32

Codes

  • NII Article ID (NAID)
    10008601265
  • NII NACSIS-CAT ID (NCID)
    AN10353762
  • Text Lang
    JPN
  • Article Type
    NOT
  • ISSN
    09157441
  • Data Source
    CJP  J-STAGE 
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