Traivaree Chanchai, Lumkul Rachata, Torcharus Kitti, Krutuecho Triroj, Sriphaisal Thip
Division of Pediatric Hematology/Oncology, Department of Pediatrics, Phramongkutklao College of Medicine, Bangkok, Thailand.
J Med Assoc Thai. 2012 May;95 Suppl 5:S181-5.
Kasabach-Merrit phenomenon (KMP) is a rare disorder of pediatric hematological malignancies which is previously referred to Kasabach-Merrit syndrome (KMS). The disorder is characterized by prominent vascular mass resulting from abnormal proliferation of blood vessels, consumption coagulopathy and thrombocytopenia. The diagnosis is based upon three basic findings as above. The authors describe a 6-month-old girl with a huge ecchymotic mass at left buttock who is found to have thrombocytopenia and consumption coagulopathy. The clinical and imaging studies strongly suggested the diagnosis of KMP. Vincristine was administered after a trial of corticosteroids was failed to show clinical and laboratory improvement. After 2 weeks, the patient showed that the platelet count and fibrinogen level become to be normal without blood transfusion and gradually decreased in tumor size without any surgical procedure in 4 weeks and disappeared in 5 months without any complications. In the present report, the authors present the findings from successfully specific treatment with vincristine alone and supportive treatment for life-threatening hemorrhage with platelet concentrate and cryoprecipitate should be the best management in our situation.
卡萨巴赫-梅里特现象(KMP)是一种罕见的小儿血液系统恶性疾病,以前称为卡萨巴赫-梅里特综合征(KMS)。该疾病的特征是血管异常增殖导致明显的血管肿块、消耗性凝血病和血小板减少。诊断基于上述三个基本发现。作者描述了一名6个月大的女孩,其左臀部有巨大的瘀斑肿块,发现有血小板减少和消耗性凝血病。临床和影像学研究强烈提示KMP的诊断。在试用皮质类固醇未能显示临床和实验室改善后,给予长春新碱。2周后,患者显示血小板计数和纤维蛋白原水平在未输血的情况下恢复正常,肿瘤大小在4周内未经任何手术程序逐渐减小,5个月内消失且无任何并发症。在本报告中,作者展示了单独使用长春新碱成功进行特异性治疗的结果,对于危及生命的出血,使用血小板浓缩物和冷沉淀进行支持治疗应该是我们这种情况下的最佳管理方法。