title: Lessons learned from a case of abdominal aortic aneurysm accompanied by unstable coagulopathy.
abstract: Preoperative examination for abdominal aortic aneurysms (AAAs) occasionally reveals an abnormal decrease in coagulation factors and thrombocytopenia, fulfilling the criteria for disseminated intravascular coagulation (DIC). Treatment of the underlying disorder is indispensable for alleviating DIC. We report an uncommon case of a patient with AAA and DIC who showed prolonged thrombocytopenia despite successful treatment of AAA and temporary recovery of coagulation factors. A 70-year-old man presented with AAA and shaggy aorta accompanied by DIC and underwent aneurysmectomy. Combined preoperative use of nafamostat mesilate and recombinant human soluble thrombomodulin was effective in controlling DIC. Although recovery of coagulation factors was observed after surgery, the thrombocytopenia continued throughout the postoperative course and was refractory to platelet transfusion. Because HPA antibody and PA-IgG were present, a trial administration of γ-globulin was performed; this resulted in rapid improvement of thrombocytopenia. Although DIC recurred again 2 weeks thereafter, coagulation factors subsequently recovered without any medication.
authors.affiliation: Division of Vascular Surgery, Department of Surgery, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
authors.forename: Katsuyuki
authors.initials: K
authors.lastname: Hoshina
authors.forename: Makoto
authors.initials: M
authors.lastname: Kaneko
authors.forename: Akihiro
authors.initials: A
authors.lastname: Hosaka
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Okamoto
authors.forename: Kunihiro
authors.initials: K
authors.lastname: Shigematsu
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Miyata