血漿析離療法引起之凝血異常：一例報告

Plasmapheresis－related Coagulopathy；Report of A Case

血漿析離術相關之出血併發症，在文獻中發生率極低。新光醫院神經科報告一例重症肌無力感患在接受連續5天，每次一個血漿容積過濾量的雙重過濾血漿析離療法後，出現凝血異常現象，引起原先中心靜脈穿刺處大量出血，緊急凝血機能試驗發現凝血酵素原時間(prothrombin time)>60秒，活化部份凝血激素時間(activated partial thromboplastin time)>120秒，纖維蛋白原<70 mg/Dl，遂接受6單位新鮮冷凍血漿輸注及持續患部加壓止血而緩解。文中討論引起此現象之可能成因及因應之道。我們建議如病人在短時間連續數次之密集血漿析離療法時，必須嚴密監控凝血機能以避免出血之危險性。

Plasmapheresis-related bleeding is rare. We report a patient with myasthenia gravis who experienced hemorrhage from the puncture site used to insert a central vein catheter, after only five aessions of double filtration plasmapheresis. Hematologic survey showed markedly prolonged prothrombin time ( >60 sec.) and activated partial thromboplastin time ( > 120 sec.) and an extremely low level of serum fibrinogen ( < 70 mg/dL), but a normal thrombocyte count. Under the diagnosis of plasmapheresis-related coagulopathy, 6 units of fresh frozen plasma was transfused to stop the bleeding. No further hemorrhagic complications were noted. We suggest coagulation function should be monitored when multiple aphereses are performed over a short period to minimize the risk of hemorrhage.