Extreme Thrombocytosis in a Patient with Rupturd Colon Cancer and Iron Deficiency Anemia

反應性血小板增生超過百萬以上並不是一個常見的狀況，本文報告一位59歲女性，因腹痛及血小板高達1726×103/μL，經一系列之檢查，發現患者罹患直腸乙狀結腸癌，並已破裂慢性出血造成缺鐵性貧血，及形成腹內膿瘍引起發炎反應，骨髓檢查並未發現有癌細胞轉移或慢性骨髓增生疾病。此病患經手術切除腫瘤，清除膿瘍及矯正貧血，血小板隨即下降至正常值。之後，因癌症復發轉移，血小板再度升高，經使用化學治療控制癌症後，血小板乃再度恢復至正常值。本文結論認為：極度之血小板增生症並不一定表示骨髓之病變，其他諸如惡性腫瘤，急慢性之發炎反應或缺鐵性貧血，皆可能是原因之一，仍需詳細探查真實之病因。

關鍵字

血小板增多症；大腸癌；缺鐵性貧血

並列摘要

Extreme thrombocytosis defined as a platelet count exceeding 1000×103/μL was most often thought to be due to clonal myelopro-liferative disorders. Here we report a case of extreme thrombocytosis in a patient with colon cancer who had no evidence of myeloproliferative disorders. This 59-year-old woman presented with abdominal pain and extreme thrombocytosis of 1726×103/μL. Investigations disclosed recto-sigmoid cancer and iron deficiency anemia. Surgical exploration revealed the recto-sigmoid cancer was ruptured with surrounding abscess formation. Bone marrow examination showed no evidence of clonal myeloprolifera-tive disorders. The platelet count returned to the normal range after surgical resection of the primary tumor and resolution of the abscess and the iron deficiency anemia. Eight months later, evidence of progression of multiple liver metastases was found, again accompanied by elevation of the platelet count to 639×103/μL. After successful salvage chemotherapy wit oxaliplatin plus high dose 5-FU and leucovorin, the platelet count returned to normal. We conclude that the combined effects of malignancy, abscess formation and iron deficiency contributed to the extreme thrombocytosis in this case. We suggest that a search for secondary causes is still required for a patient with a platelet count exceeding 1000×103/μL.

並列關鍵字

thrombocytosis ； colon cancer ； iron deficiency anemia

國際替代計量

Extreme Thrombocytosis in a Patient with Rupturd Colon Cancer and Iron Deficiency Anemia

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