Draaijers Lonneke, Hassing Robert-Jan, Kooistra Menno, van Kessel Kok, Hovens Marcel
Internal Medicine, Rijnstate Hospital Arnhem, The Netherlands.
Internal Medicine, Infectious Diseases, Rijnstate Hospital Arnhem, The Netherlands.
Eur J Case Rep Intern Med. 2018 Dec 27;5(12):0001002. doi: 10.12890/2018_0001002. eCollection 2018.
Haemostatic abnormalities frequently occur during sepsis and are most often attributed to disseminated intravascular coagulation (DIC). We report the case of a patient with severe coagulopathy acquired during fulminant sepsis. DIC was not present. This coagulopathy was most likely caused by exotoxins forming inhibitory complexes with coagulation factor Xa.
To our knowledge, this is the first report describing inhibition of coagulation by in vivo and so will hopefully broaden our knowledge of sepsis, exotoxins and coagulation disorders during sepsis.While disseminated intravascular coagulation (DIC) is the most frequent severe coagulopathy diagnosed during sepsis, inhibition of coagulation by SSL10 may be an underdiagnosed cause during sepsis.As DIC and inhibition of coagulation by SSL10 should be treated differently, we emphasize the importance of considering inhibition of blood coagulation by when an acquired coagulopathy is found during severe sepsis.
止血异常在脓毒症期间经常发生，且最常归因于弥散性血管内凝血（DIC）。我们报告一例在暴发性脓毒症期间获得性严重凝血病患者的病例。该患者不存在DIC。这种凝血病很可能是由外毒素与凝血因子Xa形成抑制性复合物所致。
据我们所知，这是第一份描述体内凝血抑制的报告，有望拓宽我们对脓毒症、外毒素及脓毒症期间凝血障碍的认识。虽然弥散性血管内凝血（DIC）是脓毒症期间诊断出的最常见严重凝血病，但SSL10介导的凝血抑制可能是脓毒症期间一个未被充分诊断的病因。由于DIC和SSL10介导的凝血抑制的治疗方法不同，我们强调在严重脓毒症期间发现获得性凝血病时考虑凝血抑制的重要性。
