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- W3008685078 abstract "血栓性微小血管症（thrombotic microangiopathy: TMA）は血小板減少・臓器障害・溶血性貧血を呈する比較的稀な病態であり，血栓性血小板減少性紫斑病（thrombotic thrombocytopenic purpura: TTP），志賀毒素産生大腸菌による溶血性尿毒症症候群（Shiga toxin-producing Escherichia coli-hemolytic uremic syndrome: STEC-HUS），非典型溶血性尿毒症症候群（atypical HUS: aHUS），二次性TMAに分類される．類似の症状をきたす病態としては播種性血管内凝固（disseminated intravascular coagulation: DIC）の頻度が高く，TMAもDICも早期治療が予後を左右するため，これらの早期鑑別が問題になることがある．血小板減少・臓器障害・溶血性貧血の診療においてはTMAを疑うことが大切であり，そのために最も重要な点は溶血性貧血に気付くことである．溶血性貧血に気付くことが出来れば，ADAMTS13活性など確定診断に必要な検査を提出し，その結果を得るまでにTMAおよびDICの早期鑑別診断を進める．PLASMIC score，腸炎症状，原因疾患，家族歴・既往歴，溶血所見・凝固異常の程度などを指標に可能性の高い疾患を選び出して早期治療を開始しつつ，確定診断が得られるまでは常に他のTMAやDICの可能性も念頭に置いて，治療経過の中で繰り返し判断することが重要である．" @default.
- W3008685078 created "2020-03-06" @default.
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- W3008685078 date "2020-01-01" @default.
- W3008685078 modified "2023-09-25" @default.
- W3008685078 title "Early differential diagnosis between thrombotic microangiopathy (TMA) and disseminated intravascular coagulation (DIC)" @default.
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- W3008685078 doi "https://doi.org/10.2491/jjsth.31.7" @default.
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