Muto Jun, Kishimoto Hiroshi, Kaizuka Yasuo, Kinjo Mitsuru, Higashi Hidefumi, Kishihara Fumiaki
Department of Surgery, Steel Memorial Yawata Hospital, Kitakyushu, Japan
Department of Nephrology, Steel Memorial Yawata Hospital, Kitakyushu, Japan.
In Vivo. 2017 May-Jun;31(3):439-441. doi: 10.21873/invivo.11080.
Thrombotic microangiopathy (TMA) represents a spectrum of serious disorders characterized by occlusive microvascular thrombosis, thrombocytopenia and end-organ damage. TMA is associated with a broad range of conditions and is also a well-described complication of both cancer and its treatment.
A 77-year-old Japanese woman underwent S-1 and cisplatin chemotherapy for treatment of advanced gastric cancer with multiple lymph node and liver metastases. She was found with severe anemia and thrombocytopenia during the third course of chemotherapy. She was diagnosed with TMA based on thrombocytopenia, schistocytosis, hemolytic anemia and renal dysfunction. She underwent treatment with plasmapheresis; however, her response to treatment was poor and died on day 16 of hospitalization. The autopsy performed revealed microthrombi in the glomeruli and tubulonecrosis in the kidneys.
This is the first case report of TMA in association with the use of S-1 and cisplatin. Therapists have to take account of TMA when using S-1 and cisplatin treatment.
血栓性微血管病（TMA）是一系列以微血管闭塞性血栓形成、血小板减少和终末器官损伤为特征的严重疾病。TMA与多种情况相关，也是癌症及其治疗中一种常见的并发症。
一名77岁的日本女性因治疗伴有多发淋巴结和肝转移的晚期胃癌接受了S-1和顺铂化疗。在化疗第三个疗程期间，她出现了严重贫血和血小板减少。基于血小板减少、裂体细胞症、溶血性贫血和肾功能不全，她被诊断为TMA。她接受了血浆置换治疗；然而，她对治疗反应不佳，于住院第16天死亡。尸检显示肾小球有微血栓形成，肾脏有肾小管坏死。
这是首例与使用S-1和顺铂相关的TMA病例报告。治疗师在使用S-1和顺铂治疗时必须考虑到TMA。
