Liu WB, Ma JX, Tong HX. Successful treatment in one myelodysplastic syndrome patient with primary thrombocytopenia and secondary deep vein thrombosis: A case report . World J Clin Cases 2022; 10(14): 4640-4647 [PMID: 35663076 DOI: 10.12998/wjcc.v10.i14.4640]
Corresponding Author of This Article
Hong-Xuan Tong, PhD, Associate Professor, Institute of Basic Theory for Chinese Medicine, China Academy of Chinese Medical Sciences, No.16 Nanxiao Street, Dongcheng District, Beijing, 100700, China. thongxuan1@163.com
Research Domain of This Article
Hematology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. May 16, 2022; 10(14): 4640-4647 Published online May 16, 2022. doi: 10.12998/wjcc.v10.i14.4640
Successful treatment in one myelodysplastic syndrome patient with primary thrombocytopenia and secondary deep vein thrombosis: A case report
Wen-Bin Liu, Jian-Xiong Ma, Hong-Xuan Tong
Wen-Bin Liu, Department of Hematology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310006, Zhejiang Province, China
Jian-Xiong Ma, The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou 320000, Zhejiang Province, China
Hong-Xuan Tong, Institute of Basic Theory for Chinese Medicine, China Academy of Chinese Medical Sciences, Beijing 100700, China
Author contributions: Tong HX and Liu WB were involved in the medical treatment, designed the study, and wrote the article; Ma JX contributed to drafting and modifying the manuscript; all authors read and approved the final manuscript.
Supported bythe Zhejiang Province Administration of Traditional Chinese Medicine, No. 2017ZB034 and No. 2020ZB096; the Zhejiang University of Traditional Chinese Medicine School-Level Fund, No. 2019ZG06; and the National Nonprofit Institute Research Grant for Institute of Basic Theory for Chinese Medicine, CACMS, No. YZ-202142.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hong-Xuan Tong, PhD, Associate Professor, Institute of Basic Theory for Chinese Medicine, China Academy of Chinese Medical Sciences, No.16 Nanxiao Street, Dongcheng District, Beijing, 100700, China. thongxuan1@163.com
Received: November 16, 2021 Peer-review started: November 16, 2021 First decision: December 27, 2021 Revised: January 9, 2022 Accepted: April 3, 2022 Article in press: April 3, 2022 Published online: May 16, 2022 Processing time: 178 Days and 0 Hours
Abstract
BACKGROUND
The contradictory process of coagulation and anticoagulation maintains normal physiological function, and platelets (PLTs) play a key role in hemostasis and bleeding. When severe thrombocytopenia and deep vein thrombosis (DVT) occur simultaneously, the physician will be confronted with a great challenge, especially when interventional thrombectomy fails.
CASE SUMMARY
We describe a 52-year-old woman who suffered from myelodysplastic syndrome with severe thrombocytopenia and protein S deficiency with right lower extremity DVT. In this patient, the treatment of DVT was associated with numerous contradictions due to severe thrombocytopenia, especially when interventional thrombectomy was not successful. Fortunately, fondaparinux sodium effectively alleviated the thrombus status of the patient and gradually decreased the D-dimer level. In addition, no increase in bleeding was noted. The application of eltrombopag stimulated the maturation and differentiation of megakaryocytes and increased the peripheral blood PLT count. The clinical symptoms of DVT in the right lower extremities in this patient significantly improved. The patient resumed daily life activities, and the treatment effects were independent of PLT transfusion.
CONCLUSION
This is a contradictory and complex case, and fondaparinux sodium and eltrombopag may represent a good choice for the treatment of DVT in patients with severe thrombocytopenia.
Core Tip: One 52-year-old Chinese female suffered from myelodysplastic syndrome of multilineage dysplasia with severe thrombocytopenia and thrombophilia with deep vein thrombosis. In the basic treatment for underlying diseases, the treatment of thrombosis is full of contradictions because of the low platelets, especially in the situation that the curative effect of surgical thrombectomy was not obvious. Pleasantly, Fondaparinux sodium effectively alleviated the thrombus status, and the D-dimer gradually decreased. In addition, there was not any unexpected bleeding. This patient’s circumference of right lower limb recovered and restored the movement basically finally.
