造血干细胞移植期间子宫出血的处理。
Management of uterine bleeding during hematopoietic stem cell transplantation.
机构信息
Department of Obstetrics and Gynecology, Hospital of University of Pennsylvania, Philadelphia, Pennsylvania, USA.
出版信息
Obstet Gynecol. 2013 Feb;121(2 Pt 2 Suppl 1):424-7. doi: 10.1097/aog.0b013e318270ecd3.
BACKGROUND
Hematopoietic stem cell transplant is an effective treatment strategy for a variety of hematologic disorders, but patients are at risk for dysfunctional coagulation and abnormal bleeding. Gynecologists are often consulted before transplant for management of abnormal uterine bleeding, which may be particularly challenging in this context.
CASE
A premenopausal woman with MonoMAC (a rare adult-onset immunodeficiency syndrome characterized by monocytopenia and Mycobacterium avium complex infections resulting from mutations in GATA2, a crucial gene in early hematopoiesis) presented with pancytopenia, evolving leukemia, and recent strokes, necessitating anticoagulation. During preparation for hematopoietic stem cell transplant, she experienced prolonged menorrhagia requiring transfusions. Surgical therapy was contraindicated, and medical management was successful only when combined with balloon tamponade.
CONCLUSION
Balloon tamponade may be a potentially life-saving adjunct to medical therapy for control of uterine hemorrhage before hematopoietic stem cell transplant.
背景
造血干细胞移植是治疗各种血液系统疾病的有效策略，但患者存在凝血功能障碍和异常出血的风险。在移植前，妇科医生经常被咨询异常子宫出血的处理，在这种情况下，这可能特别具有挑战性。
病例
一位患有单倍体巨噬细胞激活综合征（一种罕见的成年发病免疫缺陷综合征，其特征为单核细胞减少症和分枝杆菌感染，由早期造血过程中的关键基因 GATA2 突变引起）的绝经前妇女出现全血细胞减少症、进行性白血病和近期中风，需要抗凝治疗。在准备造血干细胞移植期间，她经历了长时间的月经过多，需要输血。手术治疗被禁止，仅当与球囊填塞联合使用时，药物治疗才成功。
结论
球囊填塞可能是造血干细胞移植前控制子宫出血的一种潜在的救命药物治疗辅助手段。
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