Shiroshita Kohei, Okayama Mikio, Soma Hiroki, Sato Yuki, Hayashi Hiroyoshi, Shiozawa Yuka, Okamoto Shinichiro, Sadahira Ken
Division of Hematology, Kawasaki Municipal Kawasaki Hospital, 12-1 Shinkawa-dori, Kawasaki-city, Kanagawa, 210-0013, Japan.
Division of General Internal Medicine, Kawasaki Municipal Kawasaki Hospital, 12-1 Shinkawa-dori, Kawasaki-city, Kanagawa, 210-0013, Japan.
Clin Hematol Int. 2023 Jun;5(2-3):165-169. doi: 10.1007/s44228-023-00043-9. Epub 2023 Apr 24.
Pulmonary embolism and deep venous thrombosis (PE/DVT) are well-known lethal complications in autoimmune hemolytic anemia (AIHA). However, the impact of their treatment is unclear. Here, we describe three elderly Japanese patients with AIHA who developed PE/DVT early after glucocorticoid administration. All patients presented with active hemolysis and high D-dimer levels upon admission. Thromboembolism was confirmed within 2 weeks after starting glucocorticoid, suggesting that both active hemolysis and glucocorticoid administration synergistically contributed to the development of PE/DVT. Clinicians should consider that such synergism may increase the risk of thromboembolism in patients with AIHA, and prophylactic anticoagulation is worth considering in patients after starting glucocorticoid.
肺栓塞和深静脉血栓形成（PE/DVT）是自身免疫性溶血性贫血（AIHA）中众所周知的致命并发症。然而，其治疗效果尚不清楚。在此，我们描述了3例日本老年AIHA患者，他们在使用糖皮质激素后早期发生了PE/DVT。所有患者入院时均表现为活动性溶血和高D-二聚体水平。在开始使用糖皮质激素后2周内确诊为血栓栓塞，提示活动性溶血和糖皮质激素的使用协同促成了PE/DVT的发生。临床医生应考虑到这种协同作用可能会增加AIHA患者血栓栓塞的风险，并且在开始使用糖皮质激素后的患者中值得考虑预防性抗凝治疗。
