抄録
This is to report results of coagulation study in a rare case of disseminated intravascular coagulation complicated in dissecting aortic aneurysm. A 64 year-old Japanese male, known case of dissecting aneurysm since May, 1976, was admitted in Octorber, 1978 for subcutaneous hemorrhage. On physical examination multiple purpura on both arms and a pulsating mass in the abdomen were noted. Aortogram showed a picture of dissecting thoracic and abdominal aortic aneurysm. Coagulation studies on admission revealed a platelet count of 9.8×104/cmm, prothrombin time of 11.7 seconds (control 10.1 seconds), activated partial thromboplastin time of 56.1 seconds (control 40.3 seconds), plasma fibrinogen level of 125 mg/dl, FDP of 40 μg/ml and antithrombin III of 27.3 mg/dl. Activities of plasmin and antiplasmin in the plasma were decreased. Platelet aggregation by adrenaline, ADP and collagen was normal. 51Cr-labelled platelet survival T1/2 was 2.0 days and 125I-fibrinogen, 1.5 days. A diagnosis of DIC associated with dissecting aneurysm was made and continuous intravenous heparin infusion 12,000 U/day was started. Resultingly the abnormalities in coagulation studies, 51Cr-platelet and 125I-fibrinogen survival apparently improved. Activities of coagulation factors V, VIII and IX, which were decreased before the heparin therapy, recovered to levels more than twice as much as those were on admission. The patient underwent aneurysmectomy and a Dacron graft was implanted. But he expired on the ninth post operative day.
On the basis of the clinical data as well as histological findings from surgical and autopsy material, abnormal activation of intrinsic factors by the histological change of the aorta was considered to be responsible for the cause of disseminated intravascular coagulation.
