以SVT为首发表现免疫性血小板减少症患者的治疗选择及临床意义

The Treatment Options and Clinical Significance of Immune Thrombocytopenia Patients with Splanchnic Vein Thrombosis as the Initial Manifestation

目的:探讨免疫性血小板减少症(ITP)患者伴发内脏静脉血栓(SVT)的成因、治疗选择及转归。方法:采集一例26岁以SVT为首发表现的ITP男性患者的临床诊断、治疗及转归资料,结合文献探讨其可能的成因及治疗选择。结果:患者多次血常规提示,血小板(37-38)×10^(9)/L,嗜酸粒细胞(EOS) 46.9%-50%。B超和CT检查均提示,肝门静脉及其分支、脾静脉血栓形成,诊断为ITP伴SVT。经积极病因治疗及减低剂量低分子肝素(LMWH)抗凝,患者已痊愈。结论:ITP伴发较大范围SVT实属罕见,治疗难度大。临床上需关注一过性高EOS可能引起的血栓风险,应积极治疗本病,平衡抗凝和出血风险。

Objective:To investigate the causes,treatment options and outcomes of immune thrombocytopenia(ITP) patients with splanchnic venous thrombosis(SVT).Methods:The clinical diagnosis,treatment and outcomes data of one 26-year-old male ITP patient with SVT as initial manifestation were collected.The possible causes and treatment options of the patients were discussed through literatures review.Results:The result of blood routine tests of the patient showed that Plt(17-38)×10^(9)/L and eosinophils(EOS) 46.9%-50.0%.B-ultrasound and CT findings suggested thromboses of splenic vein,hepatic portal vein and its branches were formed,the patient was diagnosed as ITP with SVT.After active etiological treatment and reduced dose of low molecular weight heparin(LMWH) for anticoagulation,the patient recovered.Conclusion:ITP combined with large scale of SVT is rare,and it is difficult to cure.It should be pay more attention to the possible thrombosis risk triggered by a transiently increased EOS in the blood stream.Promptly etiological treatment and the balance between anticoagulant therapy and bleeding risks should be taken in clinical practice.