The patient was a 73-year-old man. We have performed an ascending aortic prosthesis replacement for a thoracic aortic aneurysm complicated by idiopathic thrombocytopenic purpura (ITP). The platelet count was not sufficiently increased neither by preoperative Helicobacter pylori (H. pylori) eradication nor corticosteroid therapy. After treatment with high-dose intravenous gammaglobulin (400 mg/kg/ day×5 days) and the use of thrombopoietin receptor agonists, the platelet count increased to 8.9×104/ μl and the operation was safely performed. With a steady increase in platelet count, the patient continued to do well post-operatively. We report a case in which a stable platelet count was achieved throughout the perioperative period by the effective combination of high-dose intravenous gammaglobulin and a thrombopoietin receptor agonist in a patient with ITP refractory to corticosteroid therapy.
"},{"@language":"ja","@value":"症例は73歳，男性．特発性血小板減少性紫斑病 （idiopathic thrombocytopenic purpura；ITP）を合併した胸部大動脈瘤に対して人工血管置換術を施行した．Helicobacter pylori（H. pylori）除菌療法や副腎皮質ステロイド療法を行ったが，十分な血小板数の増加は得られなかった．ガンマグロブリン大量静注療法（400 mg/kg/day×5日間）の施行およびトロンボポエチン受容体作動薬を使用した結果，血小板数は8.9×104/μlまで上昇し，手術を安全に遂行し得た．術後も血小板数は順調に増加し，良好な経過を辿った．副腎皮質ステロイド療法抵抗性のITPに対して，ガンマグロブリン大量静注療法およびトロンボポエチン受容体作動薬を効果的に併用することで，周術期を通して安定した血小板数を得ることができたと考えられる症例を経験したため報告する．
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