抄録
We presented a case of abdominal aortic aneurysm associated with chronic consumption coagulopathy and cerebral hemorrhage.
A 70-year-old man was admitted with a 9-months' history of spontaneous ecchymoses and an episode of cerebral hemorrhage. On physical examination mild mental deterioration, emotional lability, right hemiparesis, petechiae on arms, mild acrocyanosis, weakened pulsation of pedal arteries and a pulsatile abdominal mass were noted. Ultrasonography revealed a large dissecting abdominal aortic aneurysm with multiple intraluminal thrombi. The surface scanning after intravenous injection of 125I-human fibrinogen demonstrated an increased accumulation of the radioactivity over the aneurysm. No maliganant diseases were disclosed by extensive investigations.
Coagulation studies revealed moderate thrombocytopenia, markedly impaired aggregation responses to ADP and collagen, moderately increased levels of plasma β-thromboglobulin and FDP, mild prolongation of prothrombin time and activated partial thromboplastin time, moderately decreased level of fibriongen with markedly shortened survival T1/2, mildly to moderately decreased levels of various coagulation factors, plasminogen, α2-plasmin inhibitor and antithrombin III, and markedly increased levels of plasma factor VIII related antigen and factor VIII related von Willebrand factor activity.
A diagnosis of consumption coagulopathy associated with abdominal aortic aneurysm was made and treated successfully by continuous intravenous infusions of small dose of heparin, with rapid improvement of above coagulation abnormalities except for a markedly high level of plasma factor VIII related antigen.
The pathogenetic mechanisms of consumption coagulopathy and its relationship with cerebral hemorrhage were discussed.
