| 摘要 |
An 11-year-old girl with chronic idiopathic thrombocytopenic prupura (ITP) was presented with and intracerebral hemorrhage (ICH) complication. Her first episode of ICH was in 1993; she recovered after acrive medical treatment. Her second episode of ICH occurred 3 years later after being afflicted with pneumonia. On admission, her Hb was 9.3 gm/dl and platelet count 8,000/c mm. She received IV immunoglobin, steroid therapy and platelet transfusion. Severe upper gastrointestinal bleeding later occurred and her Hb dropped to 6.8 gm/dl. Headaches and vomiting developed suddenly 4 days after her admission. A CT scan of the head showed a hemorrhage in the right occipital lobe. Her condition progressively deteriorated and she became comatose because of an enlargement in the ICH. Despite a low platelet count (30,000/c mm) and a prolonged bleeding time (8 minutes), she underwent an emergency splenectomy with a continuous platelet transfusion and monitoring of her platelet count. Her platelet count increased to 44,000/c mm after the splenectomy and a transfusion of 24 units of platelet concentrate. We decided to perform a craniotomy to remove the ICH. At the beginning of the hematoma removal, we noticed a substance oozing from the raw surface and the corticotomy site. This oozing was very difficult to control, all we could do was to pack the areas that were oozing with Gel-foam. One hour after the splenectomy, her platelet count increased to 54,000/c mm. With an additional 12 units transfusion of the platelet concentrate the oozing decreaed. We then recommenced removal of the residual hematoma. At this time oozing was minimal, hemostasis was easily achieved, and the residual hematoma was successfully removed. Three hours later, her platelets increased to 317,000/c mm. She regained consciousness soon after the craniotomy and recovered well without any obvious negative side effects. Here, one should note, the importance of comprehensive medical treatment guided by platelet count monitoring indicates and optimal coagulation status suitable for craniotomy after splenectomy. |
