Sugawara A, Ebina K, Ohi H, Sawataishi J, Fukuda M
Department of Neurosurgery, Nakadoori Hospital.
No Shinkei Geka. 1991 Sep;19(9):851-5.
Primary thrombocythemia is a chronic proliferative disorder of the bone marrow in which either thrombotic or paradoxically hemorrhagic symptoms or both may occur due to the pathological increase in the number of platelets. The mechanism of hemorrhagic diathesis in this disorder is not fully defined. We presented a rare case of primary thrombocythemia developing chronic subdural hematoma which was surgically managed with the use of plateletpheresis. It was believed that plateletpheresis was useful in controlling hemorrhagic complications during surgery associated with primary thrombocythemia. A 62-year-old man was admitted to the hospital for evaluation of motor weakness on the right side. The patient had no episode of head trauma. CT scan demonstrated the presence of subdural hematoma in the left frontotemporal region with significant ventricular shift and deformity. No definite abnormalities were disclosed on laboratory examination except for the hemogram in which platelet count was extremely elevated and read 109 x 10(4)/mm3. Examination of bone marrow smears disclosed an abnormal increase in megakaryocytes. Despite the increase in the number of the platelets, other coagulation studies gave normal results. Prior to surgery plateletpheresis was attempted in hopes of reducing the number of peripheral platelets and eventually avoiding the risk of hemorrhagic complications during surgery. As a result surgery for aspiration of the hematoma was successfully performed. The postoperative course remained uneventful as the patient continuously underwent two courses of plateletpheresis and chemotherapy. The patient was discharged with no neurological deficits and the peripheral platelets remained reduced in number at 50 x 10(4)/mm3 two months after discharge.
原发性血小板增多症是一种骨髓慢性增殖性疾病，由于血小板数量病理性增加，可能出现血栓形成或反常出血症状，或两者皆有。这种疾病出血素质的机制尚未完全明确。我们报告了一例罕见的原发性血小板增多症并发慢性硬膜下血肿的病例，该病例通过血小板单采术进行手术治疗。据信血小板单采术有助于控制与原发性血小板增多症相关的手术中的出血并发症。一名62岁男性因右侧肢体运动无力入院评估。患者无头部外伤史。CT扫描显示左额颞部存在硬膜下血肿，伴有明显的脑室移位和变形。实验室检查除血常规显示血小板计数极度升高至109×10⁴/mm³外，未发现明确异常。骨髓涂片检查显示巨核细胞异常增多。尽管血小板数量增加，但其他凝血检查结果正常。术前尝试进行血小板单采术，希望减少外周血小板数量，最终避免手术中出血并发症的风险。结果，血肿抽吸手术成功进行。术后过程顺利，患者持续接受了两个疗程的血小板单采术和化疗。患者出院时无神经功能缺损，出院两个月后外周血小板数量降至50×10⁴/mm³。
