原発性血小板血症に合併した慢性硬膜下血腫の1手術例—Plateletpheresisを応用して

Chronic Subdural Hematoma Associated with Primary Thrombocythemia; Report of an operated case, using plateletpheresis

I．はじめに

　原発性血小板血症は血小板が一次性に著明に増加し，各種臓器において血栓症状のみならず出血症状を呈するのが特徴である^2）．今回われわれは慢性硬膜下血腫を合併した稀な1例を経験した．血腫除去術の際，出血傾向が懸念されたが，plateletpheresis（血小板除去療法）を行うことによって新たな出血の発現を予防しえたので，若干の文献的考察を加え報告する．

Abstract

Primary thrombocythemia is a chronic proliferative disorder of the bone marrow in which either thrombo-tic or paradoxically hemorrhagic symptoms or both may occur due to the pathological increase in the num-ber of platelets. The mechanism of hemorrhagic diath-esis in this disorder is not fully defined. We presented a rare case of primary thrombocythemia developing chro-nic subdural hematoma which was surgically managed with the use of plateletpheresis. It was believed that platelepheresis was useful in controlling hemorrhagic complications during surgery associated with primary thrombocythemia.

A 62-year-old man was admitted to the hospital forevaluation of motor weakness on the right side. The patient had no episode of head trauma. CT scan de-monstrated the presence of subdural hematoma in the left frontotemporal region with significant ventricular shift and deformity. No definite abnormalities were dis-closed on laboratory examination except for the hemo-gram in which platelet count was extremely elevated and read 109 × 10⁴/mm³. Examination of bone marrow smears disclosed an abnormal increase in megakary-ocytes. Despite the increase in the number of the platelets, other coagulation studies gave normal results. Prior to surgery plateletpheresis was attempted in hopes of reducing the number of peripheral platelets and eventually avoiding the risk of hemorrhagic com-plications during sugery. As a result surgery for aspira-tion of the hematoma was successfully performed. The postoperative course remained uneventful as the patient continuously underwent two courses of plateletpheresis and chemotherapy, The patient was discharged with no neurological deficits and the peripheral platelets re-mained reduced in number at 50 × 10⁴/mm³ two months after discharge.