Penner M, Hartenauer U, Schmitz-Huebner U
Anasth Intensivther Notfallmed. 1986 Aug;21(4):187-92.
In addition to the typical manifestations of thrombotic-thrombocytopenic purpura like thrombocytopenia, haemolysis, fever, coma and renal failure, signs of a beginning DIC could be seen in a patient after abdominal surgery. Haemostatic, cardiovascular and respiratory data are presented. Pulmonary angiography by using a Swan-Ganz-catheter revealed multiple filling defects reversible with therapy. Treatment with fresh whole blood aggravated thrombocytopenia. Daily infusions of fresh frozen plasma combined with heparinisation and antithrombin III because of DIC, induced haematologic remission. Renal failure and cerebral symptoms could not be influenced. Diagnosis, monitoring and therapy are discussed.
除了血栓性血小板减少性紫癜的典型表现，如血小板减少、溶血、发热、昏迷和肾衰竭外，腹部手术后的患者还可出现弥散性血管内凝血（DIC）初期的体征。文中呈现了止血、心血管和呼吸方面的数据。使用 Swan-Ganz 导管进行的肺血管造影显示有多个充盈缺损，经治疗可逆转。输注新鲜全血使血小板减少加重。由于 DIC，每日输注新鲜冷冻血浆并联合肝素化及抗凝血酶 III 治疗后，血液学症状得到缓解。肾衰竭和脑部症状未得到改善。文中讨论了诊断、监测及治疗。
