Akimoto Tetsu, Ito Chiharu, Kotoda Atsushi, Ogura Manabu, Sugase Taro, Sato Ryuta, Kusano Eiji, Nagata Daisuke
Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke, Japan.
Clin Med Insights Case Rep. 2013 Nov 25;6:171-5. doi: 10.4137/CCRep.S13238. eCollection 2013.
An autogenous arteriovenous fistula has been considered to be the optimal form of vascular access for hemodialysis (HD) in the field of nephrology. Nevertheless, the decision regarding the type of access, whether it be an arteriovenous fistula, an arteriovenous graft, or a central venous catheter, must still be individualized. In the present report, we describe the case of a female patient with advanced chronic kidney disease (CKD) associated with a hemostatic disorder. Despite the exhausted peripheral vasculature, she required recurrent platelet transfusions for severe thrombocytopenia due to aplastic anemia. The goal of care for this patient was to optimize the dialysis treatment without increasing the bleeding risk. Various concerns regarding the therapeutic conundrums encountered in the case are also discussed.
自体动静脉内瘘一直被认为是肾脏病领域血液透析（HD）的最佳血管通路形式。然而，关于血管通路类型的决策，无论是动静脉内瘘、动静脉移植物还是中心静脉导管，仍必须因人而异。在本报告中，我们描述了一名患有晚期慢性肾脏病（CKD）并伴有止血障碍的女性患者的病例。尽管外周血管系统已衰竭，但由于再生障碍性贫血导致严重血小板减少，她仍需要反复输注血小板。对该患者的护理目标是在不增加出血风险的情况下优化透析治疗。还讨论了该病例中遇到的各种治疗难题。
