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一名原发性抗磷脂综合征患者使用炔诺酮后出现出血和血栓形成：病例报告

Bleeding and thrombosis in a patient with primary antiphospholipid syndrome using norethisterone: a case report.

作者信息

Al Abdulhai Sawsan Abdullah, El-Ali Mahmoud Wahid, El-Dahshan Mohsen El-Sherbiny

机构信息

Department of Rheumatology, Dammam Medical Complex, Dammam, Saudi Arabia.

Department of Hematology, Dammam Medical Complex, Dammam, Saudi Arabia.

出版信息

J Med Case Rep. 2015 Apr 22;9:87. doi: 10.1186/s13256-015-0554-3.

DOI:10.1186/s13256-015-0554-3
PMID:25895835
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4424544/
Abstract

INTRODUCTION

Antiphospholipid syndrome is known to be associated with the occurrence of venous and/or arterial thrombosis. There are several factors that might trigger the risk of thrombosis in antiphospholipid syndrome, including drugs, however bleeding is rare. Only a few cases of antiphospholipid syndrome have reported simultaneous bleeding and thrombosis, and only a few of these cases have reported thrombosis induced by norethisterone when used by patients with an underlying risk factor for thromboembolism.

CASE PRESENTATION

We report the case of a 35-year-old Saudi woman diagnosed with antiphospholipid syndrome with a history of several spontaneous miscarriages and two previous lower limb deep vein thromboses. She had used norethisterone to postpone her menstruation and presented to our institution with severe menorrhagia. During admission, she developed thrombocytopenia, and at the same time she was found to have extensive inferior vena cava and bilateral common iliac thrombosis.

CONCLUSIONS

This case report is of interest to rheumatologists, hematologists and radiologists because we have found that the presence of bleeding and thrombocytopenia do not preclude the concomitant occurrence of thrombotic complications of antiphospholipid syndrome. Norethisterone is normally safe to take, but it is not suitable for patients with an increased risk of deep vein thrombosis. Also, the simultaneous management of thrombosis and heavy vaginal bleeding is a challenge for clinicians since there are no evidence-based guidelines regarding the management of these patients.

摘要

引言

已知抗磷脂综合征与静脉和/或动脉血栓形成有关。有多种因素可能引发抗磷脂综合征的血栓形成风险，包括药物，但出血情况罕见。仅有少数抗磷脂综合征病例报告了同时出现出血和血栓形成的情况，其中只有少数病例报告了有血栓栓塞潜在危险因素的患者使用炔诺酮后引发血栓形成。

病例介绍

我们报告了一名35岁沙特女性的病例，该患者被诊断为抗磷脂综合征，有多次自然流产史以及两次既往下肢深静脉血栓形成病史。她曾使用炔诺酮推迟月经，因严重月经过多前来我院就诊。住院期间，她出现了血小板减少症，同时被发现存在广泛的下腔静脉及双侧髂总静脉血栓形成。

结论

本病例报告对风湿病学家、血液学家和放射科医生具有参考价值，因为我们发现出血和血小板减少的存在并不排除抗磷脂综合征血栓形成并发症的同时发生。炔诺酮通常服用安全，但不适合深静脉血栓形成风险增加的患者。此外，对于临床医生而言，同时处理血栓形成和严重阴道出血是一项挑战，因为目前尚无针对这些患者管理的循证指南。

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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f9a8/4424544/48f906fe5f74/13256_2015_554_Fig10_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f9a8/4424544/5f0ccfb9eac9/13256_2015_554_Fig1_HTML.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f9a8/4424544/d0a66d8b5cb3/13256_2015_554_Fig5_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f9a8/4424544/f72c678d38c3/13256_2015_554_Fig6_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f9a8/4424544/c15305c7b940/13256_2015_554_Fig7_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f9a8/4424544/05fac3e63e0a/13256_2015_554_Fig8_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f9a8/4424544/a4b05c785200/13256_2015_554_Fig9_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f9a8/4424544/48f906fe5f74/13256_2015_554_Fig10_HTML.jpg

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