血小板凝集阻害剤が有効であった成人溶血性尿毒症性症候群(Hemolytic Uremic Syndrome)の1症例

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A 47 year-old male was admitted to hospital on April 11 with general fatigue, anorexia and ecchymosis of lower extremities. He was well unti 3 months ago when he complained of recurrent upper respiratory infection and diarrhea. In February 1978, proteinuria and renal dysfunction were first realized.
On examination he looked pale and ecchymosis and pitting edema were proved. His blood pressure was 236/126, with retinopathy (stage IIb∼IIIa Keith-Wagener). The Hb was 6.1g/dl with reticulocytosis 44‰, white cell count was 6,140, platelet count was 25,000, and red cell fragmentation remarkably appeared on peripheral blood smear. His bone marrow aspirate revealed erythroid hyperplasia with normal megakaryocyte counts. The BUN 93mg/dl, serum creatinine 9 mg/dl, LDH 2,160U. Coagulation parameters were normal except the presence of FDP. The urinalysis revealed protein, red cell and platelets.
After starting combined treatment of aspirin 1g P. O. and dipyridamole 200mg i. v. d., with peritoneal dialysis, the platelet count increased to 100,000 within a few days. But the platelet count soon decreased to 23,000 after discontinuity of these platelet inhibitors because of gastrointestinal bleeding. Then dipyridamole was given 100mg i. v. d. again, platelet count rapidly increased to 100,000, and red cell fragmentation completely disappeared.
It was concluded that inhibitors of platelet function with dialysis revealed definite benefit for an adult case of hemolytic uremic syndrome.