Girolami A, Scarparo P, Candeo N, Sartori R, Scandellari R, Girolami B
University of Padua Medical School, Department of Medical and Surgical Sciences, Padua, Italy.
Acta Haematol. 2009;121(1):42-6. doi: 10.1159/000210063. Epub 2009 Mar 31.
Hemospermia is usually a symptom of urological relevance, however it may have also a medical and hematological significance and has been reported in congenital or acquired bleeding disorders. Because of this symptom's negative psychological impact on the patient, it is likely that the condition is underplayed and therefore underdiagnosed. During the years 1967-2003 we had the opportunity to see 3 patients with hemospermia on a congenital bleeding disorder: a patient with hemophilia A, another with prothrombin deficiency and finally a patient with von Willebrand disease type I. All patients were heterosexual. In all instances the course was benign since it required administration of substitution therapy on only 2 occasions. Rest and abstinence from sexual activity appeared to be helpful. The first patient had other signs and symptoms compatible with the diagnosis of urethritis due to Escherichia coli and he underwent a course of antibiotic therapy. The other 2 cases appeared to be idiopathic since no associated condition was found. Urinary cytology, rectal examination, prostate sonography and prostate-specific antigen were normal in all cases. The rarity of hemospermia in congenital bleeding disorders remains unexplained, although the strong perineal and sphincter muscles may exercise a compressive hemostatic effect which could prevent or reduce bleeding.
血精通常是一种与泌尿外科相关的症状，然而它也可能具有医学和血液学意义，并且在先天性或获得性出血性疾病中已有报道。由于这种症状会对患者产生负面心理影响，该病症很可能被轻视，因此诊断不足。在1967年至2003年期间，我们有机会诊治了3例患有先天性出血性疾病并伴有血精的患者：1例甲型血友病患者，另1例凝血酶原缺乏患者，最后1例为Ⅰ型血管性血友病患者。所有患者均为异性恋。在所有病例中，病程均为良性，因为仅在2次情况下需要进行替代治疗。休息和禁欲似乎有所帮助。首例患者还有其他与大肠杆菌引起的尿道炎诊断相符的体征和症状，他接受了一个疗程的抗生素治疗。另外2例病例似乎是特发性的，因为未发现相关病症。所有病例的尿细胞学检查、直肠检查、前列腺超声检查和前列腺特异性抗原均正常。先天性出血性疾病中血精罕见的原因尚不清楚，尽管强大的会阴和括约肌肌肉可能发挥压迫止血作用，从而预防或减少出血。
