PDF(Pubmed)
Abstract：
BACKGROUND: In the 1990s, transjugular intrahepatic portosystemic shunts (TIPS) were performed using bare metal stents, and stent-induced hemolysis was a complication noted in 10% of patients. This was due to the mechanical stress created by turbulent flow from the uncovered interstices. Polytetrafluoroethylene (PTFE) stents came into regular use in the early 2000s becoming the standard equipment for TIPS placements, which are predominately covered. Due to this, stent-induced hemolysis has become a rare phenomenon.
METHODS: We describe a case of TIPS-induced hemolysis in a 53-years-old Caucasian female patient without cirrhosis. The patient had a history of heterozygous factor 5 Leiden mutation and abnormal lupus anticoagulant profile with development of a portal vein thrombus. She had undergone previous TIPS placement complicated by a TIPS thrombosis 3 years after initial placement requiring venoplasty and extension of the stent. Within one month, the patient developed hemolytic anemia with extensive evaluation that did not yield an alternative cause. Due to temporal association and clinical symptoms, the hemolytic anemia was attributed to the recent TIPS revision.
CONCLUSIONS: This particular case of TIPS-induced hemolysis in a patient who does not have cirrhosis has not been previously described in the literature. Our case highlights that TIPS-induced hemolysis should be considered in anyone who could have potential underlying red blood cell dysfunction, not just those with cirrhosis. Further, the case demonstrates an important point that mild hemolysis (i.e., not requiring blood transfusion) can likely be managed conservatively, without stent removal.
METHODS: We describe a case of TIPS-induced hemolysis in a 53-years-old Caucasian female patient without cirrhosis. The patient had a history of heterozygous factor 5 Leiden mutation and abnormal lupus anticoagulant profile with development of a portal vein thrombus. She had undergone previous TIPS placement complicated by a TIPS thrombosis 3 years after initial placement requiring venoplasty and extension of the stent. Within one month, the patient developed hemolytic anemia with extensive evaluation that did not yield an alternative cause. Due to temporal association and clinical symptoms, the hemolytic anemia was attributed to the recent TIPS revision.
CONCLUSIONS: This particular case of TIPS-induced hemolysis in a patient who does not have cirrhosis has not been previously described in the literature. Our case highlights that TIPS-induced hemolysis should be considered in anyone who could have potential underlying red blood cell dysfunction, not just those with cirrhosis. Further, the case demonstrates an important point that mild hemolysis (i.e., not requiring blood transfusion) can likely be managed conservatively, without stent removal.
摘要：
背景：在1990年代，使用裸金属支架进行经颈静脉肝内门体分流（TIPS），支架引起的溶血是10%患者的并发症。这是由于来自未覆盖的间隙的湍流产生的机械应力。聚四氟乙烯（PTFE）支架在2000年代初开始常规使用，成为TIPS放置的标准设备，主要覆盖。由于这个原因,支架引起的溶血已成为一种罕见的现象。
方法：我们描述了一例53岁无肝硬化的白人女性患者发生TIPS诱导的溶血。该患者有杂合子因子5Leiden突变和狼疮抗凝物异常的病史，并伴有门静脉血栓的发展。在初次放置需要静脉成形术和支架延伸的3年后，她经历了先前的TIPS放置，并发了TIPS血栓形成。一个月内,患者出现溶血性贫血,并进行了广泛的评估,但未发现其他原因.由于时间关联和临床症状，溶血性贫血归因于最近的TIPS修订.
结论：在没有肝硬化的患者中，这种特殊的TIPS诱导的溶血病例以前没有在文献中描述过。我们的案例强调，TIPS诱导的溶血应该被考虑到任何可能有潜在潜在的潜在红细胞功能障碍的人，不仅仅是那些患有肝硬化的人。Further,该病例证明了一个重要的观点，即轻度溶血(即，不需要输血)可以保守管理，无需支架移除。
方法：我们描述了一例53岁无肝硬化的白人女性患者发生TIPS诱导的溶血。该患者有杂合子因子5Leiden突变和狼疮抗凝物异常的病史，并伴有门静脉血栓的发展。在初次放置需要静脉成形术和支架延伸的3年后，她经历了先前的TIPS放置，并发了TIPS血栓形成。一个月内,患者出现溶血性贫血,并进行了广泛的评估,但未发现其他原因.由于时间关联和临床症状，溶血性贫血归因于最近的TIPS修订.
结论：在没有肝硬化的患者中，这种特殊的TIPS诱导的溶血病例以前没有在文献中描述过。我们的案例强调，TIPS诱导的溶血应该被考虑到任何可能有潜在潜在的潜在红细胞功能障碍的人，不仅仅是那些患有肝硬化的人。Further,该病例证明了一个重要的观点，即轻度溶血(即，不需要输血)可以保守管理，无需支架移除。
