Nephrology and Dialysis Clinic, Université Libre de Brussels, Centre Hospitalier Universitaire Brugmann, Brussels, Belgium.
Clin Ther. 2009 Nov;31(11):2559-64. doi: 10.1016/j.clinthera.2009.11.006.
Management of essential thrombocythemia (ET) in high-risk patients is difficult because high platelet numbers can lead to vascular occlusive events and bleeding. Therapeutic interventions in ET are limited to hydroxyurea and anagrelide; however, in Europe, anagrelide is contraindicated in patients with chronic renal disease.
The aim of this case report was to describe the use of anagrelide in a patient with ET and renal impairment.
A 73-year-old white female patient with severe renal impairment who was diagnosed with ET was receiving treatment with hydroxyurea 1 g/d since 2001. At this time she was also receiving aspirin 80 mg/d; calcium carbonate 1 g/d; pravastatin 40 mg/d; folic acid 5 mg/d; furosemide 40 mg/d; cetirizine 10 mg/d; erythropoietin 10,000 U once monthly; a vitamin B complex, 1 tablet a day; and iron tablets 105 mg/d. In February 2007, because her white blood cell count fell to 2.1 x 10(9)/L, myelodepression was suspected and hydroxyurea was stopped. This led to enhanced platelet levels and the introduction of anagrelide at an initial dose of 0.5 mg/d that was steadily increased to 2.5 mg/d. All other treatments were continued with some dosage adjustments. Sodium bicarbonate 1 g/d and vitamin D were added to her regimen. After 18 months of anagrelide treatment, a sudden but moderate fall of platelets to 142 x 10(3)/microL with severe anemia (hemoglobin, 6.5 g/dL) was observed. The patient had anemia since 2004, but the condition worsened due to bleeding related to an ulcer at the cecal valve. The patient refused blood and platelet transfusions and surgical intervention for religious reasons. Because of hemodynamic instability, she was admitted to the intensive care unit in December 2008 and died 24 hours after admission.
We report a case of ET and chronic renal failure treated with anagrelide and low-dose aspirin in a patient who did not receive transfusion and surgical intervention due to religious reasons, and had a fatal outcome.
由于血小板数量高可导致血管阻塞性事件和出血，高危患者的原发性血小板增多症（ET）的治疗较为困难。ET 的治疗干预措施仅限于羟基脲和安纳格雷尔；然而，在欧洲，安纳格雷尔禁忌用于慢性肾病患者。
本病例报告的目的是描述安纳格雷尔在伴有肾功能损害的 ET 患者中的应用。
一名 73 岁的白人女性患者，患有严重肾功能损害，自 2001 年以来一直接受羟基脲 1 g/d 治疗，当时还接受阿司匹林 80 mg/d；碳酸钙 1 g/d；普伐他汀 40 mg/d；叶酸 5 mg/d；呋塞米 40 mg/d；西替利嗪 10 mg/d；促红细胞生成素 10,000 U 每月一次；复合维生素 1 片/天；和铁剂 105 mg/d。2007 年 2 月，由于白细胞计数降至 2.1 x 10(9)/L，怀疑骨髓抑制并停止使用羟基脲。这导致血小板水平升高，并开始使用安纳格雷尔初始剂量 0.5 mg/d，逐渐增加至 2.5 mg/d。继续使用所有其他治疗方法，并进行一些剂量调整。在她的治疗方案中添加了 1 g/d 碳酸氢钠和维生素 D。安纳格雷尔治疗 18 个月后，血小板突然降至 142 x 10(3)/µL，同时出现严重贫血（血红蛋白 6.5 g/dL）。患者自 2004 年以来一直患有贫血，但由于回盲瓣溃疡出血，病情恶化。由于宗教原因，患者拒绝输血和血小板输注以及手术干预。由于血流动力学不稳定，患者于 2008 年 12 月入住重症监护病房，并在入院后 24 小时死亡。
我们报告了一例 ET 和慢性肾衰竭患者，用安纳格雷尔和低剂量阿司匹林治疗，由于宗教原因，患者未接受输血和手术干预，导致致命结局。
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