H1N1 Influenza (Swine Flu)-Associated Thrombotic Microangiopathy with a Markedly High Plasma Ratio of von Willebrand Factor to ADAMTS13
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概要
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We describe an 18-year-old woman infected with H1N1 influenza followed by thrombotic microangiopathy. During the acute phase, her plasma levels of von Willebrand factor (VWF) were remarkably elevated, whereas those of ADAMTS13 were reduced without its inhibitors, generating a markedly high ratio of VWF to ADAMTS13 in circulation. A retrospective analysis established the following hypothesis: an influenza-mediated cytokine storm induced an enhanced release of unusually large VWF multimers (UL-VWFM) from vascular endothelial cells, generating platelet thrombi in microcirculatures under high shear stress. Plasma exchange removed UL-VWFM and cytokines, and rescued her life. This report sheds a light on a hitherto unrecognized influenza complication.
著者
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Fujimura Yoshihiro
Department Of Blood Transfusion Medicine Nara Medical University
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Isonishi Ayami
Department Of Blood Transfusion Medicine Nara Medical University
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Matsumoto Masanori
Department Of Anesthesiology Nagasaki University School Of Medicine
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Fujimura Yoshihiro
Department of Blood Transfusion Medicine, Nara Medical University, Japan
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Hiramoto Ryugo
Department of Pediatrics, Matsudo City Hospital Children's Medical Centre, Japan
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Akiyama Rui
Department of Pediatrics, Matsudo City Hospital Children's Medical Centre, Japan
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Komori Isao
Department of Pediatrics, Matsudo City Hospital Children's Medical Centre, Japan
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Isonishi Ayami
Department of Blood Transfusion Medicine, Nara Medical University, Japan
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