Assuntos
Ácidos Borônicos/uso terapêutico , Mieloma Múltiplo/tratamento farmacológico , Mieloma Múltiplo/patologia , Pirazinas/uso terapêutico , Idoso , Antineoplásicos/uso terapêutico , Bortezomib , Fator V/metabolismo , Feminino , Hemostasia , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Agregação Plaquetária/efeitos dos fármacos , Proteína C/metabolismo , Recidiva , Resultado do TratamentoRESUMO
We have described a patient with colon cancer and liver metastases who developed heparin-induced thrombocytopenia and skin necrosis. We believe that the skin necrosis caused by the heparin/platelet factor 4 antibody was exacerbated by the acquired protein C and protein S deficiency. After the heparin was discontinued and infection treated, the skin necrosis and thrombocytopenia resolved. This case illustrates the fact that, in patients with heparin-induced skin necrosis, a search must be undertaken for an underlying pro-thrombotic state, which may precipitate the microthrombosis responsible for skin necrosis. We could not find any previous case reports of heparin-induced skin necrosis associated with isolated protein C deficiency, or combined protein C and protein S deficiency.
Assuntos
Anticoagulantes/efeitos adversos , Heparina/efeitos adversos , Pele/patologia , Trombocitopenia/induzido quimicamente , Trombose/prevenção & controle , Adulto , Neoplasias do Colo/cirurgia , Feminino , Humanos , Necrose , Pele/efeitos dos fármacosRESUMO
Thalidomide is being increasingly used in hematology and oncology. Its use is associated with neuropathy, sedation, edema, fatigue, constipation, and deep venous thrombosis. Cytopenias are unusual, but there are case reports. However, there are no reports of isolated thrombocytopenia. We describe here a case of prolonged isolated thrombocytopenia most likely caused by thalidomide. The patient's in platelet count decreased promptly after an increase in the dose and improved after discontinuation of the drug. The relevant literature is reviewed.