Disseminated intravascular coagulation in an ambulatory young woman
Disseminated intravascular coagulation in an ambulatory young woman
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DOI：
10.1016/j.lab.2005.05.006
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发表时间：
2005-09-01
期刊：
影响因子：
--
通讯作者：
Horne, MK
中科院分区：
文献类型：
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作者：
Aue, G;Carroll, N;Horne, MK
我们报告一位有10年反复静脉血栓病史的年轻女性，其临床表现为弥漫性血管内凝血(DIC)。在排除了DIC的已知原因后，我们检查了她临床上静止性溃疡性结肠炎可能是潜在刺激的可能性。我们记录了这位患者败血症范围的内毒素血症，当时她处于无热状态，C反应蛋白水平正常。在体外，HER血清上调了培养的内皮细胞中的组织因子。我们推测，她已经对内毒素从发炎的结肠渗出的全身影响产生了耐受性，但内毒素刺激了她的内皮和/或单核细胞产生组织因子，使她高度高凝。她的血栓前状态可能是因为她的凝血酶原G20210A杂合子和她的血浆凝血时间显示出对激活蛋白C的抵抗而加剧的。
We are reporting the case of an ambulatory young woman with a 10-year history of recurrent venous thrombosis who presented to us with diffuse intravascular coagulation (DIC). After excluding the recognized causes of DIC, we examined the possibility that her clinically quiescent ulcerative colitis might be the underlying stimulus. We documented sepsis-range endotoxemia in this patient at a time when she was afebrile and had a normal C-reactive protein level. In vitro her serum upregulated tissue factor in cultured endothelial cells. We postulate that she had become tolerant to the systemic effects of endotoxin leaking from her inflamed colon but that the endotoxin stimulated her endothelium and/or monocytes to produce tissue factor that made her intensely hypercoagulable. Her prothrombotic state may have been compounded by the fact that she was heterozygous for prothrombin G20210A and that her plasma clotting time demonstrated resistance to activated protein C.