Liu Alexander, Saman Harman, Pusalkar Pawan
Acute Admissions Unit, Watford General Hospital, London, UK.
BMJ Case Rep. 2011 Aug 4;2011:bcr0220113812. doi: 10.1136/bcr.02.2011.3812.
Eisenmenger syndrome (ES) causes polycythaemia and thrombocytopenia, thus rendering patients at risk from both thrombosis and haemorrhage. The clinical dilemma lies in how to treat one without precipitating the other. Our case demonstrates this important clinical problem. A 35-year-old lady with ES taking aspirin with clopidogrel for thrombo-prophylaxis presented with massive epistaxis. Blood tests showed polycythaemia, thrombocytopenia and normal clotting studies. A bone marrow biopsy ruled out leukaemia and normal imaging made pulmonary haemorrhage unlikely. Drug induced platelet dysfunction on a background of thrombocytopenia was the most likely cause of her epistaxis. Despite cessation of her dual anti-platelet therapy and multiple nasal packing, heavy epistaxis continued. She was given an infusion of platelets, and once her counts normalised, she was re-started on anti-platelet therapy.
艾森曼格综合征（ES）可导致红细胞增多症和血小板减少症，从而使患者面临血栓形成和出血的风险。临床难题在于如何在不引发另一方的情况下治疗其中一方。我们的病例展示了这个重要的临床问题。一名35岁患有ES的女性为预防血栓服用阿司匹林和氯吡格雷，出现了大量鼻出血。血液检查显示红细胞增多、血小板减少且凝血检查正常。骨髓活检排除了白血病，正常的影像学检查排除了肺出血的可能。血小板减少背景下的药物性血小板功能障碍是她鼻出血最可能的原因。尽管停用了双联抗血小板治疗并进行了多次鼻腔填塞，但严重鼻出血仍持续。她接受了血小板输注，一旦血小板计数恢复正常，就重新开始抗血小板治疗。
