• Kana Hayakawa, Shinobu Tamura, Hiroya Gima, Takahiro Hayakawa, Toshio Kurihara, Maki Ooura, Yoshio Nakano, Masayoshi Souri, Akitada Ichinose, and Tokuzo Fujimoto.
• Department of Internal Medicine, Kinan Hospital.
• Rinsho Ketsueki. 2014 Nov 1;55(11):2300-5.

AbstractA 62-year-old man had a history of acute aortic dissection (Stanford type A) and had been diagnosed with polycystic kidney disease three years earlier, and then developed end-stage renal failure. He was referred with chief complaints of difficult hemostasis and consecutive hemorrhagic episodes at the puncture site of the shunt soon after dialysis introduction. We suspected chronic disseminated intravascular coagulation (DIC) due to mild thrombocytopenia and a fibrinolytic system abnormality. Plasma factor XIII activity was decreased, but no inhibitor was detected. In addition, contrast-enhanced computed tomography showed exacerbation of a dissecting aortic aneurysm. We finally diagnosed chronic DIC and secondary factor XIII deficiency associated with the aortic aneurysm. We selected treatment involving recombinant human soluble thrombomodulin (rTM) because he was on maintenance dialysis and required long-term follow-up bofore the operation. Hemostatic function improved with regular administration of rTM, and was well-controlled preoperatively.

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