极端的D-二次体升高和血液动力学崩由于骨破裂在一个抗凝血患者
Isa Alshamsan1, Reem Alameri2, Harikrishnan Nair3
1Internal Medicine, Betsi Cadwaladr University Health Board, Rhyl, GBR.
Cureus
|January 1, 2026
概括
极高的D-二聚物水平可能表明严重的非血栓性疾病,而不仅仅是静脉血栓塞栓症 (VTE). 这一案例凸显了骨破裂是抗凝药患者血液动力学崩的关键原因.
科学领域:
- 内部医学 内部医学
- 紧急医疗 紧急医疗
- 血液学 血液学 血液学
背景情况:
- D-二聚体是疑似静脉血栓塞栓症 (VTE) 的常见生物标志物.
- 显著升高的D-二聚合物水平 (>10,000 ng/mL) 可能缺乏特异性,并表明非血栓性疾病.
- 解释极端的D-二次体升高在急性医学中构成了诊断挑战.
研究的目的:
- 在接受抗凝剂治疗的患者中报告骨破裂病例,呈现出严重升高的D-二次体.
- 强调在血液动力学恶化的情况下,考虑出血而不是血栓塞栓症的重要性.
- 要突出与极端的D-二次元升高相关的诊断困难.
主要方法:
- 一个83岁的妇女的病例报告,胸部有多发性疼痛和D-二次数升高.
- 最初的CT肺血管造影以排除肺栓塞.
- 随后的CT腹部和骨盆显示出血和怀疑骨破裂.
- 紧急腹腔切除术用于骨破裂修复.
主要成果:
- 肺栓塞被排除在外,但D-二次体水平显著增加.
- 患者出现低血压和贫血,表明内出血.
- 在手术期间确认了骨破裂,并实现了血液静止.
- 组织学揭示了潜在的血管瘤,导致骨脆弱.
结论:
- 在服用抗凝血药物的患者中,突然的血液动力学恶化可能意味着危及生命的出血,例如骨破裂,而不是VTE.
- 临床医生必须保持广泛的差异诊断,并在初步调查不确时重新评估患者.
- 及时识别罕见但至关重要的崩原因对于患者的生存至关重要.
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