Ticlopidine相關之血栓性血小板減少性紫斑症：一例報告

Ticlopidine-associated Thrombotic Thrombocytopenic Purpura: Report of A Case

血栓性血小板減少性紫斑症是一種罕見但有致命性Ticlopidine使用併發症。我們報告一例77歲男性病人因預防腦中風服用Ticlopidine四周後出現血栓性血小板減少性紫斑症。發病時極低之血小板數目（5000/uL）對血漿交換療法反應良好，在連續5天血漿交換療法後，血小板數目已恢復正常。溶血性貧血及痙攣在血漿交換療法後亦改善。需血液透析之急性腎衰竭則於血漿交換療法後三週內獲得控制。唯因住院中合併大範圍腦栓塞，以致病程拖長，出院時呈植物人狀態。

Thrombotic thrombocytopenic purpura (TTP) is a rare but lethal complication of ticlopidine treatment. We report a case of TTP in a 77-year-old male patient receiving ticlopidine for four weeks due to stroke prevention. The extremely low platelet count (5000/uL) responded favorably to plasma exchange (PE) and returned to normal state after 5 daily exchanges. Hemolytic anemia and seizure stabilized after PE-treatment. Acute renal failure necessitating hemodialysis had been controlled 3 weeks after start of PE. Unfortunately, massive cerebral infarcts complicated his clinical course and resulted in vegetative state at discharge.