Lew Wei Han, Chang Chun-Jen, Lin Jiunn-Diann, Cheng Chung-Yi, Chen Yin-Kai, Lee Ting-I
Department of Internal Medicine, Division of Endocrinology and Metabolism, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
J Clin Apher. 2011;26(3):159-61. doi: 10.1002/jca.20282. Epub 2011 Jan 25.
Agranulocytosis is an uncommon but serious complication of Graves' disease under thionamide therapy. In some patients removal of circulating thyroid hormones and thyroid antibodies by plasmapheresis is an effective adjunctive therapeutic option. In perioperative settings, however, plasmapheresis may cause excess bleeding intraoperatively due to coagulation factor depletion unless fresh frozen plasma (FFP) products are used in the replacement fluid mix. Double filtration plasmapheresis (DFPP) in which only a small amount of albumin supplementation is used may be a potential alternative to conventional apheresis interventions where clotting factor depletion is problematic. We report a case of a patient with Graves' disease complicated with intravenous immunoglobulin responsive methimazole-induced agranulocytosis/hemophagocytosis who underwent successful preoperative DFPP treatment in preparation for thyriodectomy. In addition to conventional apheresis using FFP replacement, DFPP may offer an effective adjunct option in the management of hyperthyroid patients needing emergent surgical interventions.
粒细胞缺乏症是硫脲类药物治疗格雷夫斯病时一种罕见但严重的并发症。对于一些患者，通过血浆置换去除循环甲状腺激素和甲状腺抗体是一种有效的辅助治疗选择。然而，在围手术期，除非在置换液混合物中使用新鲜冷冻血浆（FFP）产品，否则血浆置换可能会因凝血因子消耗而导致术中出血过多。仅使用少量白蛋白补充的双重过滤血浆置换（DFPP）可能是传统血液分离干预的一种潜在替代方法，因为传统干预中凝血因子消耗是个问题。我们报告了一例格雷夫斯病合并静脉注射免疫球蛋白反应性甲巯咪唑诱导的粒细胞缺乏症/噬血细胞增多症患者，该患者在准备甲状腺切除术时接受了术前DFPP治疗并取得成功。除了使用FFP替代的传统血液分离术外，DFPP可能为需要紧急手术干预的甲亢患者的管理提供一种有效的辅助选择。
