Carr D J, Kramer B S, Dragonetti D E
South Med J. 1986 Apr;79(4):476-9. doi: 10.1097/00007611-198604000-00020.
A patient with metastatic gastric adenocarcinoma had progressive microangiopathic red blood cell changes, thrombocytopenia with increased marrow megakaryocytes, bleeding, altered mentation, and seizure. Coagulation parameters were inconsistent with disseminated intravascular coagulation; a clinical diagnosis of thrombotic thrombocytopenic purpura (TTP) was made. Plasmapheresis resulted in improvement on two separate occasions. The diagnosis of tumor-associated TTP should be considered in cancer patients. Plasmapheresis may be more effective than plasma transfusion alone in this syndrome, perhaps via removal of tumor-induced immune complexes from the circulation. Aggressive management of this complication seems justified in cancer patients for whom effective chemotherapy exists.
一名转移性胃腺癌患者出现进行性微血管病性红细胞改变、血小板减少伴骨髓巨核细胞增多、出血、精神状态改变和癫痫发作。凝血参数不符合弥散性血管内凝血；临床诊断为血栓性血小板减少性紫癜（TTP）。血浆置换在两个不同的场合均带来改善。癌症患者应考虑肿瘤相关性TTP的诊断。在该综合征中，血浆置换可能比单纯输血更有效，这可能是通过从循环中清除肿瘤诱导的免疫复合物实现的。对于存在有效化疗方案的癌症患者，积极处理这种并发症似乎是合理的。
