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Uni, Masahiro ; Yoshimi, Akihide ; Maki, Hiroaki ; Maeda, Daichi ; Nakazaki, Kumi ; Nakamura, Fumihiko ; Fukayama, Masashi ; Kurokawa, Mineo ; 前田, 大地
概要:
金沢大学医薬保健研究域医学系<br />We report here a 47-year-old male with the diagnosis of high-grade B-cell lymphoma and hemophagocyto
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sis accompanying disseminated intravascular coagulation (DIC). Lymphoma-associated hemophagocytic syndrome (LAHS) is a life-threatening disorder, and LAHS secondary to B-cell lymphoma is relatively rare compared to that secondary to T- or NK/T-cell lymphoma in Western countries. T- or NK/T-cell LAHS is sometimes combined with DIC, which makes patients' outcomes even worse, but few reports of B-cell LAHS accompanying DIC has been published so far. We successfully treated a patient with this condition with recombinant thrombomodulin (rTM), a novel agent for DIC. We believe that rTM is a therapeutic option in cases with B-cell LAHS accompanying DIC.
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朝倉, 英策
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二上, 文夫 ; 永川, 宅和 ; 北川, 裕久 ; 萓原, 正都 ; 太田, 哲生 ; 上野, 桂一 ; 三輪, 晃一
概要:
過去10年間の消化器外科領域における5, 000ml以上の術中大量出血症例64例を対象に, 10, 000ml未満の出血群46例(出血量6, 800±1, 393ml)とそれ以上の超出血群18例(同16, 936±9, 153ml)に分け種
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々の因子を比較検討した.ともに悪性腫瘍が9割を占めた.輸血量はほぼ出血量に相当しており約半分を新鮮凍結血漿が占めた.輸血後肝炎疑いを1例に認めた.2群間で大きく異なるのは平均出血速度で, 術中の血圧およびヘモグロビン値低下度の差に反映していた.術後は頻脈傾向, 著明な血小板減少, 肝機能障害が共通してみられ, 特に超出血群では肝・腎不全に近い状態に陥る傾向がみられたが, いずれも1週で回復した.出血量の多寡が肝機能障害の程度を左右した.術後合併症としてDICが注目された.濃厚血小板投与例のすべてがDICを回避しえており, 大量出血時には積極的な血小板輸血の必要性が示唆された. Sixty-four patients with intraoperative massive bleeding of more than 5, 000 ml in gastroenterological surgery over the past 10 years were evaluated. These patients were divided into two groups according to the volume of intraoperative blood loss:a bleeding group(5, 000〜10, 000 ml, n=46)and an ultrableeding group(more than 10, 000 ml, n=18). About 90 per cent of all patients in both groups had malignant diseases. The total transfusion volume almost corresponded to blood loss and half of it was composed of fresh frozen plasma. Only one patient was suspected of having post-transfusion hepatitis. A significant difference between the two groups was seen in the average speed of bleeding and was reflected in a difference in the drop in blood pressure and hemoglobin level. Although after the operation, a tendency of tachycardia, marked thrombocytopenia and liver dysfunction was seen in both groups, and a tendency of hepato-renal failure was observed particularly in the ultrableeding group, the patients recovered within a week. Grades of liver dysfunction were affected by the volume of blood loss. DIC was noticed among postoperative complications. All patients who received platelet transfusion were saved from DIC. This funding suggests that active platelet transfusion is necessary in intraoperative massive bleeding.
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