Abstract
We report a 55-year-old woman who manifested both symptomatic bleeding and thrombosis, and was diagnosed as ITP associated with the antiphospholipid syndrome (APS). She has a history of cerebral infarction at the age of 51. At the age of 53, she developed a bleeding tendency and her platelet count was found to be decreased. A diagnosis of ITP associated with APS was made based on the laboratory data showing the presence of lupus anticoagulant (LA). She was administered corticosteroid, and her bleed-ing tendency disappeared in accordance with an increase in the platelet counts. Two years later, however, she suffered from a lumbar compression fracture due to an adverse effect of corticosteroid, and severe bleeding started again. For this clinical episode, splenectomy was performed. To prevent postoperative thrombosis, heparin was given immediately after surgery, but pulmonary infarction developed on postoperative day 7. Since a risk of postoperative thrombosis is thought to be increased in patients with ITP associated with APS, it seems to be legitimate to measure the anticardiolipin antibody and LA prior to splenectomy. Although an early administration of heparin after splenectomy is necessary, administration of heparin together with other drugs such as antiplatelet drugs is expected to be more efficient, since heparin administration alone may be insufficient for the prevention of postoperative thrombsosis as observed in this patient.
