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本文报导血浆交换成功地治疗1例特发性(自身免疫)血小板减少性紫瘢(以下简称 ITP)并发威胁生命的腹腔内出血的青年男性患者,效果显著。患者入院时双下有紫瘢,血小板计数为4,000,给予大剂量强地松(每日达200毫克),但血小板仍低于25,000,因有消化道及颅内出血倾向,故于住院第13日行脾切除手术。术后血小板数仅短暂增加,术后第1天 Hb 急剧下降,诊断为腹腔内出血。术后10天内逐渐增加强地松剂量,并加用长春新碱治疗,反复输入红细胞与血小板,但腹腔内出血仍未好转。拟再次剖腹探查。入院第24日给患者交换血浆5,875毫升,此后 Hb 未再下降,腹围缩小。换血浆后第1天血小板由15,000升至80000,但5天后又有下降,住院第29天第二次交换血浆4,835毫升,血小板计数上升为120,000,此后稳定在50,000左右,住院34天出院,血小板渐上升接近正常水平。数月后患者情况良好。没有明显的出血。作者应用免疫组织化学法测定抗血小板抗体,在血浆中抗体活性以“反应指数”来表示,测定结
This article reports the successful results of plasma exchange in the treatment of 1 young male patient with idiopathic (autoimmune) thrombocytopenic purpura (hereinafter referred to as ITP) with life-threatening intra-abdominal hemorrhage. Patients admitted to hospital with double under the purple scar, platelet count 4,000, giving large doses of prednisone (200 mg daily), but still less than 25,000 platelets, due to digestive tract and intracranial hemorrhage, it was hospitalized on the 13th Splenectomy surgery. Postoperative platelet count increased only briefly, Hb sharp decline on the first postoperative day, the diagnosis of intra-abdominal hemorrhage. 10 days after the gradual increase in prednisone dose, and add vincristine treatment, repeated input of red blood cells and platelets, but intraperitoneal bleeding has not improved. To be another laparotomy exploration. On the 24th day of admission, 5,875 milliliters of plasma were exchanged for the patient, after which Hb did not decrease any more and the abdominal circumference was reduced. Platelets changed from 15,000 to 80,000 on day 1 after plasma exchange, but dropped again after 5 days. On the 29th day of hospitalization, 4,835 ml of plasma were exchanged for the second time. The platelet count increased to 120,000 and then stabilized at around 50,000. The patients were discharged on hospital for 34 days and platelets Gradually rise close to normal levels. After several months the patient was in good condition. No obvious bleeding. The authors apply immunohistochemistry to determine anti-platelet antibodies, antibody activity in plasma as “reaction index” to indicate that the junction