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Lessons learned from a case of abdominal aortic aneurysm accompanied by unstable coagulopathy

Katsuyuki Hoshina1, Makoto Kaneko, Akihiro Hosaka

  • 1Division of Vascular Surgery, Department of Surgery, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.

Case Reports in Vascular Medicine
|August 31, 2012
PubMed

Insights

This case study highlights prolonged thrombocytopenia in a patient with abdominal aortic aneurysms (AAA) and disseminated intravascular coagulation (DIC). Gamma-globulin therapy effectively treated persistent low platelet counts, even after AAA repair.

Area of Science:

  • Vascular Surgery
  • Hematology
  • Critical Care Medicine

Background:

  • Abdominal aortic aneurysms (AAA) can present with coagulopathy, including thrombocytopenia and decreased coagulation factors, meeting criteria for disseminated intravascular coagulation (DIC).
  • Management of the underlying AAA is crucial for resolving DIC.
  • Persistent thrombocytopenia post-AAA treatment can occur despite factor recovery.

Purpose of the Study:

  • To report an unusual case of prolonged thrombocytopenia in a patient with AAA and DIC.
  • To describe the diagnostic and therapeutic challenges encountered.
  • To highlight an effective treatment for refractory thrombocytopenia in this context.

Main Methods:

  • A 70-year-old male patient with AAA and shaggy aorta presented with DIC.
  • Underwent aneurysmectomy with combined preoperative nafamostat mesilate and recombinant human soluble thrombomodulin for DIC control.
  • Postoperatively, persistent thrombocytopenia was investigated, leading to HPA antibody and PA-IgG detection.
  • Treatment with gamma-globulin was administered for suspected immune-mediated thrombocytopenia.

Main Results:

  • Preoperative DIC was effectively controlled with nafamostat mesilate and recombinant human soluble thrombomodulin.
  • Coagulation factors recovered post-surgery, but thrombocytopenia persisted and was refractory to platelet transfusion.
  • Detection of HPA antibody and PA-IgG prompted gamma-globulin administration, leading to rapid improvement in platelet count.
  • A transient recurrence of DIC occurred 2 weeks later, with spontaneous coagulation factor recovery.

Conclusions:

  • Prolonged thrombocytopenia can complicate AAA and DIC management, even after successful aneurysm repair and DIC control.
  • Immune-mediated thrombocytopenia, suggested by HPA antibody and PA-IgG, should be considered in refractory cases.
  • Gamma-globulin therapy can be effective in managing immune-mediated thrombocytopenia associated with AAA and DIC.
  • Spontaneous resolution of DIC recurrence is possible.

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