Background: It is common that unfractionated heparin (UFH) is subcutaneously used for chronic DIC cases such as abdominal aortic aneurism (AAA).

Aims: We report a long term survival chronic DIC with ITP treated with low dose steroid.

Methods:
Case presentation: A ninety-six-old male who had a past history of asymptomatic cerebral infarction admitted to our hospital because of his marked low level of platelet of 14×10⁹/L. Laboratory data showed APTT of 30.1sec, PT-INR of 1.05, Fbg of 193.5mg/dL, FDP of 37.3µg/mL, DD of 16.7µg/mL, PAIgG of 51.4ng/10⁷Plt, and Helicobacter pylori antigen of stool was negative. BM findings showed Mgk of 75/µL and mild dysplasia of 3 series of hematopoiesis.
Clinical course: This case was diagnosed as chronic DIC complicated with ITP and administration of 20mg of prednisolone (PSL) was started. One week later platelet count increased to 87×10⁹/L, and then gradually could tapered to 5mg of PSL. More than 3 years later, platelet count was stable with 100-120×10⁹/L and no bleeding was observed in spite of sustained hypercoagulable laboratory data. Because of patient’s super advanced age, he received no surgical treatment at all.

Results: Chronic DIC based on AAA often shows bleeding tendency and UFH is often subcutaneously used for it. Our case was diagnosed as DIC complicated ITP and was started with oral low dose PSL, which improved platelet count and bleeding after passing more than three years. It was thought that ITP treatment with PSL let platelet life extended and participated in the improvement of the platelet counts.

Conclusions: There is the need to search concurrence of ITP in the chronic DIC, and the case that low dose PSL is effective for a long term exist although there is no effect of PSL for DIC in general.

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ISTH Congress Abstracts - https://abstracts.isth.org/abstract/a-long-term-survival-chronic-dic-with-itp-treated-with-low-dose-steroid/