術前に急激な血小板減少を来たし，ミコフェノール酸モフェチルの関与が示唆された生体腎移植の1例

Abstract

We present a patient who developed thrombocytopenia before blood type-incompatible living-donor renal transplantation, which inhibited proper evaluation and treatment of thrombocytopenia. A 45-year-old woman with kidney failure of unknown etiology who was on peritoneal dialysis for 2 years was admitted after receiving immunosuppressive drugs at an outpatient clinic. The platelet count gradually decreased and eventually reached a level that could interfere with surgery. Mycophenolate mofetil was considered the cause of thrombocytopenia. Thus, it was discontinued, which increased the platelet count. The patient also received platelet transfusion, and renal transplantation was successfully performed as planned. The patient did not develop hemorrhage after the transplantation. The pretransplantation administration of mycophenolate mofetil was suspected to have caused thrombocytopenia in this patient. Hence, sudden decline in platelet count before surgery should be promptly investigated to identify potential causes in order of their likelihood. It is important to confirm that there is no evidence of platelet consumption or destruction.