維持透析患者の開心術前後にロミプロスチムで治療した特発性血小板減少性紫斑病  [in Japanese] Successful management of primary immune thrombocytopenia with romiplostim during open heart surgery in a hemodialysis patient  [in Japanese]

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Abstract

<p>症例は維持透析中に大動脈弁狭窄症と血小板減少が指摘された66歳の男性。鎖骨下動脈閉塞の既往のためワーファリンによる抗凝固療法も併用していた。紹介時,WBC 5,200/µ<i>l</i>,Hb 13.5 g/d<i>l</i>,Plt 6.8万/µ<i>l</i>。出血傾向は認めなかった。骨髄穿刺では異形成のない巨核球数の増加を認め特発性血小板減少性紫斑病と診断した。大動脈弁狭窄症は手術適応であり術前後の血小板数コントロールが必要と考えられた。少量ロミプロスチム投与を術前2ヶ月前から開始。速やかに血小板数は増加し,術前後の出血・血栓イベントなく大動脈弁置換術を施行した。維持透析患者に対するロミプロスチムの使用報告は少なく,且つ出血リスクの高い術前後のマネージメントには注意を要する。文献的考察と共に報告する。</p>

<p>A 66-year-old male undergoing maintenance hemodialysis presented with mild thrombocytopenia. He also had aortic valve stenosis and required aortic valve replacement. In addition, he required anticoagulation therapy with warfarin because of chronic subclavian artery occlusion. He was eventually diagnosed with immune thrombocytopenic purpura (ITP), although there were no bleeding tendencies. The patient was preoperatively treated with thrombopoietin receptor agonist (romiplostim<sup>®</sup>) because of the risk of bleeding complication during cardiac surgery. The platelet count rapidly increased with low-dose romiplostim, and no thrombotic complication occurred. During surgery, no significant bleeding complications were observed. This report suggests that romiplostim is a useful treatment option for the management of bleeding complication during cardiac surgery in a hemodialysis patient with ITP.</p>

Journal

  • Rinsho Ketsueki

    Rinsho Ketsueki 60(1), 28-32, 2019

    The Japanese Society of Hematology

Codes

  • NII Article ID (NAID)
    130007590727
  • NII NACSIS-CAT ID (NCID)
    AN00252940
  • Text Lang
    JPN
  • ISSN
    0485-1439
  • NDL Article ID
    029493885
  • NDL Call No.
    Z19-295
  • Data Source
    NDL  J-STAGE 
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