Stahl R L, Javid J P, Lackner H
Am J Med. 1984 May;76(5):772-8. doi: 10.1016/0002-9343(84)90985-9.
Six patients are described in whom disseminated intravascular coagulation of uncertain cause was found to be due to occult pulmonary embolism. The peripheral blood smear showed thrombocytopenia in all patients and schistocytes in four. Coagulation studies revealed increased levels of fibrinogen/fibrin degradation products (six of six patients), positive results for fibrin monomer (five patients), prolonged thrombin times (four patients), hypofibrinogenemia (three patients), prolonged prothrombin times (two patients), and decreased plasma coagulation factors (two patients). Pulmonary embolism was confirmed by lung scanning or pulmonary angiography. Institution of full-dose heparin therapy was associated with hemostatic and clinical improvement in all patients. The association of disseminated intravascular coagulation with occult pulmonary embolism merits recognition since full-dose heparinization is required for successful therapy.
本文描述了6例患者，他们被发现原因不明的弥散性血管内凝血是由隐匿性肺栓塞所致。所有患者的外周血涂片均显示血小板减少，4例出现裂红细胞。凝血研究显示，纤维蛋白原/纤维蛋白降解产物水平升高（6例患者均如此），纤维蛋白单体检测呈阳性（5例患者），凝血酶时间延长（4例患者），纤维蛋白原血症（3例患者），凝血酶原时间延长（2例患者），血浆凝血因子减少（2例患者）。肺扫描或肺血管造影证实存在肺栓塞。所有患者在开始全剂量肝素治疗后均出现止血及临床症状改善。弥散性血管内凝血与隐匿性肺栓塞之间的关联值得重视，因为成功治疗需要全剂量肝素化。
