{"created":"2023-06-19T10:30:04.436902+00:00","id":2165,"links":{},"metadata":{"_buckets":{"deposit":"98e7e0bf-0b81-4b85-a99d-dba20f96f981"},"_deposit":{"created_by":31,"id":"2165","owners":[31],"pid":{"revision_id":0,"type":"depid","value":"2165"},"status":"published"},"_oai":{"id":"oai:kwmed.repo.nii.ac.jp:00002165","sets":["1709617079800:35:686"]},"author_link":["109611","109612","109613","109614","109615","109616"],"item_10001_biblio_info_7":{"attribute_name":"書誌情報","attribute_value_mlt":[{"bibliographicIssueDates":{"bibliographicIssueDate":"2019","bibliographicIssueDateType":"Issued"},"bibliographicPageEnd":"17","bibliographicPageStart":"11","bibliographicVolumeNumber":"45","bibliographic_titles":[{"bibliographic_title":"川崎医学会誌","bibliographic_titleLang":"ja"},{"bibliographic_title":"Kawasaki medical journal","bibliographic_titleLang":"en"}]}]},"item_10001_description_33":{"attribute_name":"記事種別(日)","attribute_value_mlt":[{"subitem_description":"症例報告","subitem_description_language":"ja","subitem_description_type":"Other"}]},"item_10001_description_34":{"attribute_name":"記事種別(英)","attribute_value_mlt":[{"subitem_description":"Case Report","subitem_description_language":"en","subitem_description_type":"Other"}]},"item_10001_publisher_8":{"attribute_name":"出版者","attribute_value_mlt":[{"subitem_publisher":"川崎医学会","subitem_publisher_language":"ja"}]},"item_10001_relation_14":{"attribute_name":"DOI","attribute_value_mlt":[{"subitem_relation_type":"isIdenticalTo","subitem_relation_type_id":{"subitem_relation_type_id_text":"https://doi.org/10.11482/KMJ-J201945011","subitem_relation_type_select":"DOI"}}]},"item_10001_relation_17":{"attribute_name":"関連サイト","attribute_value_mlt":[{"subitem_relation_type_id":{"subitem_relation_type_id_text":"http://igakkai.kms-igakkai.com/wp/wp-content/uploads/2019/KMJ-J201945011.pdf","subitem_relation_type_select":"URI"}}]},"item_10001_relation_35":{"attribute_name":"医中誌ID","attribute_value_mlt":[{"subitem_relation_type":"isIdenticalTo","subitem_relation_type_id":{"subitem_relation_type_id_text":"2020200370","subitem_relation_type_select":"ICHUSHI"}}]},"item_10001_source_id_11":{"attribute_name":"書誌レコードID","attribute_value_mlt":[{"subitem_source_identifier":"AN00045593","subitem_source_identifier_type":"NCID"},{"subitem_source_identifier":"AN12940574","subitem_source_identifier_type":"NCID"}]},"item_10001_source_id_9":{"attribute_name":"ISSN","attribute_value_mlt":[{"subitem_source_identifier":"0386-5924","subitem_source_identifier_type":"PISSN"},{"subitem_source_identifier":"2758-089X","subitem_source_identifier_type":"EISSN"}]},"item_10001_text_31":{"attribute_name":"著者所属(日)","attribute_value_mlt":[{"subitem_text_language":"ja","subitem_text_value":"川崎医科大学血液内科学"},{"subitem_text_language":"ja","subitem_text_value":"川崎医科大学血液内科学"},{"subitem_text_language":"ja","subitem_text_value":"川崎医科大学血液内科学"}]},"item_10001_text_32":{"attribute_name":"著者所属(英)","attribute_value_mlt":[{"subitem_text_language":"en","subitem_text_value":"Department of Hematology, Kawasaki Medical School"},{"subitem_text_language":"en","subitem_text_value":"Department of Hematology, Kawasaki Medical School"},{"subitem_text_language":"en","subitem_text_value":"Department of Hematology, Kawasaki Medical School"}]},"item_10001_textarea_5":{"attribute_name":"抄録(英)","attribute_value_mlt":[{"subitem_textarea_language":"en","subitem_textarea_value":"　The treatment for thrombotic microangiopathy (TMA), which develops after hematopoietic stem cell transplantation, has not been established. TMA has a poor prognosis in which multiple organ failure and serious bleeding occur. We hereby report a case in which TMA and alveolar hemorrhage developed following hematopoietic stem cell transplantation and romiplostim administration was effective for the treatment. The subject was a man in his twenties. He was diagnosed with extranodal NK/T-cell lymphoma, nasal type in June 20XX and underwent mother–child peripheral stem cell transplantation after chemotherapy. No relapse had occurred, and the administration of immunosuppressive drugs was terminated one year after transplantation. Due to treatment, he had renal dysfunction, which was exacerbated by hypertension. We determined it to be hypertensive crisis and immediately initiated the administration of antihypertensive drugs. However, since renal dysfunction further advanced, the platelet count gradually decreased and then, suddenly dropped to 8,000/μL; he was then admitted to the hospital for intensive examination and treatment. The examination showed severe anemia, high lactate dehydrogenase (LD) levels, low haptoglobin levels, and the emergence of schizocytes, and neither a decrease in ADAMTS13 activity nor its inhibitors were observed. Therefore, the patient was diagnosed with TMA. Although the patient was treated with plasma exchange, periodical transfusion of fresh frozen plasma (FFP), and recombinant thrombomodulin (rTM) administration, neither the platelet count nor pathological conditions improved in five weeks. On day 38 of admission, the patient developed alveolar hemorrhage. We considered platelet transfusion to be very risky under the condition of a long-term presence of TMA and initiated romiplostim administration. Consequently, due to an increase in the platelet count, alveolar hemorrhage improved and the patient could be treated without any new symptoms of organ failure. Although there is no established therapy for patients with transplantassociated TMA, the results suggest that romiplostim may be effective for bleeding due to a decrease in platelet counts without causing adverse events. The off-label use of romiplostim has been approved by the medical ethics committee of Kawasaki Medical School Hospital."}]},"item_10001_textarea_6":{"attribute_name":"抄録(日)","attribute_value_mlt":[{"subitem_textarea_language":"ja","subitem_textarea_value":"　造血幹細胞移植後に発症する血栓性微小血管障害症（thrombotic microangiopathy：TMA）は，治療法が確立されておらず，多臓器不全や重症出血をきたす予後不良な疾患である．今回，造血幹細胞移植後TMA と肺胞出血を発症し，ロミプロスチム投与が奏効した症例を経験したので報告する．症例は20歳代の男性．20XX 年６月節外性NK/T 細胞リンパ腫, 鼻型と診断し，化学療法後に母子間末梢血幹細胞移植を施行した．再発することなく経過し，移植１年後に，免疫抑制剤を中止した．治療による腎機能障害を呈していたが，高血圧に伴い腎機能障害が増悪した．高血圧緊急症と判断し，直ちに降圧剤を開始したが，腎機能障害はさらに進行し，血小板数は徐々に低下し，その後0.8万/μL まで急激に低下したため，精査治療目的に入院となった．貧血の進行，LD 高値，ハプトグロビン低値，破砕赤血球の出現を認め，ADAMTS13活性の低下やインヒビターは認めなかったため，TMA と診断した．血漿交換療法や新鮮凍結血漿（FFP）の定期輸注，rTM (recombinantthrombomodulin) 投与で治療したが，５週間経過しても血小板数や病態の改善を認めなかった。その後、入院38日目に肺胞出血を発症した．長期間のTMA 存在下での血小板輸血はリスクが高いと考え，ロミプロスチムの投与を開始した．その結果，血小板数増加により，肺胞出血は改善し，新たな臓器不全症状がでることなく治療し得た．移植後TMA における確立された治療法はないが，血小板減少に伴う出血症状に対してロミプロスチムが有害事象なく奏効する可能性が示唆された．ロミプロスチムの適応外使用については川崎医科大学附属病院医療倫理委員会にて承認されている． "}]},"item_10001_version_type_20":{"attribute_name":"著者版フラグ","attribute_value_mlt":[{"subitem_version_resource":"http://purl.org/coar/version/c_970fb48d4fbd8a85","subitem_version_type":"VoR"}]},"item_creator":{"attribute_name":"著者","attribute_type":"creator","attribute_value_mlt":[{"creatorNames":[{"creatorName":"佐野, 史典","creatorNameLang":"ja"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"近藤, 英生","creatorNameLang":"ja"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"和田, 秀穂","creatorNameLang":"ja"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"SANO, Fuminori","creatorNameLang":"en"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"KONDO, Eisei","creatorNameLang":"en"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"WADA, Hideho","creatorNameLang":"en"}],"nameIdentifiers":[{}]}]},"item_files":{"attribute_name":"ファイル情報","attribute_type":"file","attribute_value_mlt":[{"accessrole":"open_date","date":[{"dateType":"Available","dateValue":"2020-04-01"}],"displaytype":"detail","filename":"KMJ-J201945011.pdf","filesize":[{"value":"2.2 MB"}],"format":"application/pdf","licensetype":"license_note","mimetype":"application/pdf","url":{"label":"PDF","objectType":"fulltext","url":"https://kwmed.repo.nii.ac.jp/record/2165/files/KMJ-J201945011.pdf"},"version_id":"82992d10-2308-4acc-8505-961b0978acb9"}]},"item_keyword":{"attribute_name":"キーワード","attribute_value_mlt":[{"subitem_subject":"血栓性微小血管障害症","subitem_subject_language":"ja","subitem_subject_scheme":"Other"},{"subitem_subject":"肺胞出血","subitem_subject_language":"ja","subitem_subject_scheme":"Other"},{"subitem_subject":"ロミプロスチム","subitem_subject_language":"ja","subitem_subject_scheme":"Other"},{"subitem_subject":"Thrombotic microangiopathy","subitem_subject_language":"en","subitem_subject_scheme":"Other"},{"subitem_subject":"Alveolar hemorrhage pulmonary","subitem_subject_language":"en","subitem_subject_scheme":"Other"},{"subitem_subject":" Romiplostim","subitem_subject_language":"en","subitem_subject_scheme":"Other"}]},"item_language":{"attribute_name":"言語","attribute_value_mlt":[{"subitem_language":"jpn"}]},"item_resource_type":{"attribute_name":"資源タイプ","attribute_value_mlt":[{"resourcetype":"journal article","resourceuri":"http://purl.org/coar/resource_type/c_6501"}]},"item_title":"ロミプロスチムが奏効した肺胞出血併発移植後血栓性微小血管障害症","item_titles":{"attribute_name":"タイトル","attribute_value_mlt":[{"subitem_title":"ロミプロスチムが奏効した肺胞出血併発移植後血栓性微小血管障害症","subitem_title_language":"ja"},{"subitem_title":"Transplantation-associated thrombotic microangiopathy and complicating diffuse alveolar hemorrhage successfully treated with romiplostim","subitem_title_language":"en"}]},"item_type_id":"10001","owner":"31","path":["686"],"pubdate":{"attribute_name":"PubDate","attribute_value":"2020-04-01"},"publish_date":"2020-04-01","publish_status":"0","recid":"2165","relation_version_is_last":true,"title":["ロミプロスチムが奏効した肺胞出血併発移植後血栓性微小血管障害症"],"weko_creator_id":"31","weko_shared_id":-1},"updated":"2024-04-19T04:10:49.047511+00:00"}