Wiemer M, Kreuzpaintner G, Lauer B, Kiefel V, Schultheiss H P, Horstkotte D, Strauer B E
Medizinische Kliniken B und D der Universität Düsseldorf.
Dtsch Med Wochenschr. 1995 Sep 15;120(37):1236-40. doi: 10.1055/s-2008-1055470.
In a 66-year-old woman with unstable angina, treated with 20,000 IU heparin daily for 6 days, platelet count fell dramatically from 310,000 to 1000/microliters 8 hours after injection of 90 ml of contrast medium (Iopromide) during coronary angiography. In addition to a marked tendency towards spontaneous bleeding she developed a large haematoma at the site of the arterial puncture, with a fall in haemoglobin to 9 g/dl, and acute renal failure.
Red blood cell and platelet infusions were given, together with cortisone, 1000 mg, and immunoglobulins. Platelet count returned to within normal limits after 8 days. Two haemodialyses initiated polyuria, followed by rapid normalization of kidney function. No antibodies against iopromide, iopamidol, heparin or heparinoids were found. At an emergency coronary balloon angioplasty 3 weeks later iopamidol was injected (45 ml). Again there was a profound fall in platelets to 1000/microliters, associated with acute renal failure. Treatment identical to that after the first episode brought about complete normalization.
The reported reactions were most likely due to immune thrombocytopenia after administration of contrast medium.
一名66岁患有不稳定型心绞痛的女性，每天接受20,000国际单位肝素治疗6天，在冠状动脉造影期间注射90毫升造影剂（碘普罗胺）8小时后，血小板计数从310,000急剧降至1000/微升。除了有明显的自发出血倾向外，她在动脉穿刺部位出现了一个大血肿，血红蛋白降至9克/分升，并出现了急性肾衰竭。
给予红细胞和血小板输注，同时给予1000毫克可的松和免疫球蛋白。8天后血小板计数恢复到正常范围。两次血液透析引发了多尿，随后肾功能迅速恢复正常。未发现针对碘普罗胺、碘帕醇、肝素或类肝素的抗体。3周后进行紧急冠状动脉球囊血管成形术时注射了碘帕醇（45毫升）。血小板再次大幅降至1000/微升，并伴有急性肾衰竭。与首次发作后相同的治疗使各项指标完全恢复正常。
所报告的反应很可能是由于使用造影剂后发生的免疫性血小板减少症。
