Respir Case Rep. 2016; 5(2): 93-96 | DOI: 10.5505/respircase.2016.37790

Pulmoner Emboli ve Ýmmün Trombositopeni Birlikteliði; Nadir Bir Olgu

Jülide Çeldir Emre¹, Tuðba Önalan², Nur Soyer³, Sami Deniz⁴, Mustafa Hikmet Özhan^5
1Turgutlu Devlet Hastanesi Göðüs Hastalýklarý Kliniði, Manisa
²Karþýyaka Devlet Hastanesi Göðüs Hastalýklarý Kliniði, Ýzmir
³Ege Üniversitesi Týp Fakültesi, Ýç Hastalýklarý Anabilim Dalý, Hematoloji Bilim Dalý, Ýzmir
⁴Didim Devlet Hastanesi Göðüs Hastalýklarý Kliniði, Aydýn
⁵Ege Üniversitesi Týp Fakültesi, Göðüs Hastalýklarý Anabilim Dalý, Ýzmir

Ýmmün Trombositopeni (ITP); anti platelet immünglobulin üretimi ile iliþkili trombositopeni ve mukokutanöz kanamalarla karakterize otoimmün bir bozuk-luktur. Otuzdört yaþýnda bayan hastanýn üç kez spontan kanamalý abortus öyküsü mevcuttu. Sol bacakta derin ven trombozu saptanan hastanýn toraks bilgisayarlý tomografisinde (BT) her iki ana pulmoner arter ve segmental dallarda pulmoner emboliyle uyumlu dolum defektleri saptandý. Trombositopenisi olan olguya (13.000/mm3) düþük molekül aðýrlýklý heparin (DMAH) baþlanamadý. Olgunun periferik yaymasý ve kemik iliði aspirasyonu ITP ile uyumlu saptandý. Trombofili panelinde MTHFR ve Faktör V mutasyonu saptandý ve ömür boyu antikoagulan planlandý. Ýzlemde trombosit sayýlarý yeniden düþen hastaya hematoloji tarafýndan splenektomi planlandý. Genel cerrahi kliniðin-de yatarken nefes darlýðý olmasý nedeniyle çekilen toraks BT' de her iki ana pulmoner arterde akut pulmoner tromboemboliyle uyumlu dolum defekti saptandý. Olgumuzda tekrarlayan pulmoner embolilerin olmasý ve dirençli ITP bulunmasý nedeniyle tedavide yaþanan güçlükler tartýþýlmaktadýr.

Anahtar Kelimeler: Ýmmün Trombositopeni, Pulmoner emboli, Faktör V Leiden Mutasyonu

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Coinciding of Pulmonary Embolism and Immune Thrombocytopenia; A Rare Case

Jülide Çeldir Emre¹, Tuðba Önalan², Nur Soyer³, Sami Deniz⁴, Mustafa Hikmet Özhan^5
1Department of Chest Diseases, Turgutlu State Hospital, Manisa, Turkey
²Department of Chest Diseases, Karþýyaka State Hospital, Ýzmir, Turkey
³Department of Internal Medicine, Division of Hematology, Ege University School of Medicine Ýzmir, Turkey
⁴Department of Chest Diseases, Didim State Hospital, Aydýn, Turkey
⁵Department of Chest Diseases, Ege University School of Medicine, Ýzmir, Turkey

Immune thrombocytopenia (ITP) is an autoimmune disease which is related to antiplatelet immuno-globulin production, characterized by thrombocytopenia and, mucocutaneous bleeding. A 34-year-old woman had spontaneous abortion three times. Having been detected deep venous thrombosis, thoracic computer tomography (CT) showed a mas-sive pulmonary embolism (PE) involving bilateral pulmonary arteries and segmental branches. The patient with thrombocytopenia (13,000 mm3) was unable to be given low molecular weight heparin (LMWH). The patient’s peripheral smear and bone marrow aspiration findings were compatible with ITP. Once MTHFR and Factor V mutation for thrombophilia were detected, anticoagulant treat-ment was planned life-long. As the platelet level decreased again, splenectomy was offered by a hematologist. While the patient was hospitalized in general surgery clinic for dyspnea, thoracic CT revealed acute embolism of the bilateral main pulmonary arteries. Our case is discussed due to difficulties in the treatment of recurrent pulmonary embolism and refractory ITP.

Keywords: Immune thrombocytopenia, pulmonary embolism, Factor V Leiden Mutation

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