Saguna Carmen, Berbec Nicoleta Mariana, Platon Marian, Marcoci Alexandra, Jercan Andreea, Colita Andrei, Gherghe Mihai Emanuel, Nedelea Dana-Georgiana, Cergan Romica, Scheau Cristian, Dragosloveanu Serban
Hematology Clinic, Coltea Clinical Hospital, 030171 Bucharest, Romania.
Department of Hematology, The "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania.
Life (Basel). 2024 Sep 6;14(9):1124. doi: 10.3390/life14091124.
We present the case of a 66 year-old male patient who developed severe postoperative thrombocytopenia after revision total hip arthroplasty. The patient underwent surgery in a dedicated orthopedics hospital and was initially managed in the intensive care unit. Upon the development of thrombocytopenia, he was referred to a dedicated hematology clinic for investigation and advanced management. A thorough diagnostic algorithm was employed in order to rule out the main causes of thrombocytopenia. By exclusion, we diagnosed the patient as suffering from a rare and severe form of postoperative thrombocytopenia through an immune mechanism. Although postoperative thrombocytopenia is relatively frequent but transitory and no treatment is required, this condition was refractory to corticosteroids and substitution therapy; however, it quickly responded to treatment with thrombopoietin receptor agonists. The patient recovered and was successfully discharged with normal platelet values. While rare occurrences, alternative causes of thrombocytopenia such as infection, drug-induced, or immune should be considered in patients developing postoperative thrombocytopenia.
我们报告了一例66岁男性患者，该患者在翻修全髋关节置换术后出现严重的术后血小板减少症。患者在一家专门的骨科医院接受手术，最初在重症监护病房接受治疗。血小板减少症出现后，他被转诊至一家专门的血液科门诊进行检查和进一步治疗。采用了全面的诊断方法以排除血小板减少症的主要病因。通过排除法，我们诊断该患者患有一种罕见且严重的免疫机制介导的术后血小板减少症。虽然术后血小板减少症相对常见但为暂时性且无需治疗，但该病例对皮质类固醇和替代疗法无效；然而，它对血小板生成素受体激动剂治疗反应迅速。患者康复，血小板值恢复正常后成功出院。虽然发生率较低，但在发生术后血小板减少症的患者中，应考虑血小板减少症的其他病因，如感染、药物诱导或免疫性病因。
