[A case of suspected pulmonary thrombosis in a patient with reactive thrombocytemia who underwent liver subsegmentectomy].
A 68-year-old man with reactive thrombocytemia (platelet count: 97.2 x 10(4).mm-3) underwent liver subsegmentectomy for hepatocellular carcinoma. Thoracic epidural combined with general anesthesia was carried out for the surgery. Platelet aggregability was monitored during the operation. At the beginning of the operation, platelet aggregability to aggregating factor ADP showed an abnormal pattern without dose dependency. In spite of continuous administration of gabexate mesilate for inhibition of thrombosis, the patient developed hypercapnia with low end tidal CO2 pressure (PETCO2) and hypoxia, suggesting pulmonary embolism. PETCO2 and SPO2 recovered soon after heparin administration. The patient recovered without any neurologic complications. This case demonstrated that hyperaggregability is possible in patients with thrombocytemia and suggests that monitoring of platelet function in patients with thrombocytemia is difficult.
Yoshida
Shin-ichiro
S
Department of Anesthesiology, Sapporo Medical University School of Medicine, Sapporo 060-8543.
Kohro
Shinji
S
Yamakage
Michiaki
M
Nakayama
Masayasu
M
Namiki
Akiyoshi
A
D000368:Aged; D000767:Anesthesia, Epidural; D000768:Anesthesia, General; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000601:surgery; D006498:Hepatectomy; D006801:Humans; D007431:Intraoperative Complications / Q000175:diagnosis / Q000209:etiology*; D008113:Liver Neoplasms / Q000150:complications / Q000601:surgery; D008297:Male; D016343:Monitoring, Intraoperative; D010974:Platelet Aggregation; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000209:etiology*; D013922:Thrombocytosis / Q000097:blood / Q000150:complications*