Oliveira A S, Miranda M P, Duarte P C, Sarmento J N
Serviço de Medicina I, Hospital Universitário de Santa Maria, Lisboa.
Acta Med Port. 1993 Oct;6(10):461-5.
The authors report the case of a 60-year-old white man with a previous history of pulmonary tuberculosis, smoking habits, hypertension, intermittent claudication and erythromelalgia, admitted to our ward with an ischemic cerebral event. Initial laboratory evaluation documented thrombocytosis (platelet-950000/mm3) and discrete anemia. Additional studies confirmed the diagnosis of essential thrombocythemia, meeting all the criteria proposed by the Polycythemia Vera Study Group in 1986, after exclusion of the possible causes of reactive thrombocytosis. Therapy was initiated with alpha-2b interferon (3 MU/m2 subcutaneously three times a week) and aspirin. Platelet count control was obtained and the patient remained asymptomatic. Nine months later cutaneous toxicity obliged the discontinuance of alpha-interferon. Due to a continuous increase of platelet count, hydroxyurea was introduced. The patient is asymptomatic, with platelet counts < 500000/mm3, without toxicity manifestations, two years after diagnosis. The contribution of cardiovascular risk factors versus thrombocythemia in the pathogenesis of the ischemic cerebral event and the benefit of platelet count control are discussed.
作者报告了一例60岁白人男性病例，该患者既往有肺结核病史、吸烟习惯、高血压、间歇性跛行和红斑性肢痛症，因缺血性脑事件入住我们病房。初始实验室评估显示血小板增多（血小板计数为950000/mm³）和轻度贫血。进一步检查在排除反应性血小板增多的可能原因后，确诊为原发性血小板增多症，符合1986年真性红细胞增多症研究组提出的所有标准。治疗开始时使用α-2b干扰素（3 MU/m²，皮下注射，每周三次）和阿司匹林。血小板计数得到控制，患者仍无症状。九个月后，皮肤毒性迫使停用α干扰素。由于血小板计数持续升高，开始使用羟基脲。诊断两年后，患者无症状，血小板计数<500000/mm³，无毒性表现。本文讨论了心血管危险因素与血小板增多症在缺血性脑事件发病机制中的作用以及控制血小板计数的益处。
