Kulić Andrijana, Cvetković Zorica, Libek Vesna
Vojnosanit Pregl. 2016 Sep;73(9):877-80. doi: 10.2298/VSP150525076K.
A bleeding syndrome in the setting of primary hyperfibrinolysis in a prostate cancer patient is only 0.40– 1.65% of cases. The laboratory diagnosis of primary hyperfibrinolysis is based on the increase of biomarkers like D-dimer, fibrinogen split products, plasminogen, and euglobulin lysis test. These tests are not specific for primary hyperfibrinolysis. We reported a rare case of hemorrhagic syndrome caused by primary hyperfibrinolysis as the first clinical symptom of metastatic prostate cancer.
A 64-year-old male was admitted to our hospital with large hematomas in the right pectoral and axillary areas (20 x 7 cm), right hemiabdomen (30 x 30 cm) and the left lumbal area, (25 x 5 cm). The patient had no subjective symptoms nor used any medication. Initial coagulation testing, prothrombin time (PT), and activated partial thromboplastin time (APTT) were within the normal range, while fibrinogen level was extremely low (1.068 g/L) (normal range 2.0–5.0) and the D-dimer assay result was high 1.122 mg/L (normal range < 0.23). The results obtained by rotation thrombelastometry pointed to primary fibrinolysis. Further clinical and laboratory examination indicated progressive malignant prostate disease. First line treatment for the patient was a combined administration of tranexamic acid (3 x 500 mg iv) and transfusion of ten units of cryoprecipitate (400 mL). Next day, fibrinolytic function measurements by rotation thrombelastometry were within the normal ranges. Fibrinogen level was normalized within two days (2.4 g/L). There were no newly developed hematomas.
This case report shows primary hyperfibrinolysis with bleeding symptoms, which is an uncommon paraneoplastic phenomenon within expanded prostate malignancy. Rotation thrombelastometry in this severe complication helped to achieve the prompt and proper diagnosis and treatment.
前列腺癌患者原发性纤溶亢进所致的出血综合征仅占病例的0.40%-1.65%。原发性纤溶亢进的实验室诊断基于D-二聚体、纤维蛋白原降解产物、纤溶酶原和优球蛋白溶解试验等生物标志物的升高。这些检查并非原发性纤溶亢进所特有。我们报告了一例罕见病例，原发性纤溶亢进引起的出血综合征是转移性前列腺癌的首发临床症状。
一名64岁男性因右胸和腋窝区（20×7cm）、右半腹（30×30cm）及左腰区（25×5cm）出现巨大血肿入院。患者无主观症状，未使用任何药物。初始凝血检测、凝血酶原时间（PT）和活化部分凝血活酶时间（APTT）在正常范围内，而纤维蛋白原水平极低（1.068g/L）（正常范围2.0-5.0），D-二聚体检测结果较高，为1.122mg/L（正常范围<0.23）。旋转血栓弹力图检测结果提示原发性纤溶。进一步的临床和实验室检查表明为进展性恶性前列腺疾病。患者的一线治疗是联合应用氨甲环酸（3×500mg静脉注射）和输注十单位冷沉淀（400mL）。第二天，旋转血栓弹力图检测的纤溶功能在正常范围内。纤维蛋白原水平在两天内恢复正常（2.4g/L）。未出现新的血肿。
本病例报告显示了伴有出血症状的原发性纤溶亢进，这是前列腺恶性肿瘤扩展中一种罕见的副肿瘤现象。旋转血栓弹力图在这一严重并发症中有助于实现快速、正确的诊断和治疗。
