부산대학교 도서관

Although adenomyosis is known to increase the risk of deep vein thrombosis (DVT) and pulmonary thromboembolism (PTE), association of disseminated intravascular coagulation (DIC) is rare. We report two patients with adenomyosis presenting with PTE, in whom DIC was noted by massive vaginal bleeding. Case 1 : a 42-year-old woman with adenomyosis complained of excessive vaginal bleeding and lower abdominal pain on the second day of menstruation. A blood sample showed a low platelet count (Plt, 68,000/μl),elevated FDP-D dimer (FDP-DD, 125.5μg/ml) and low fibrinogen (Fib, 83.2mg/dl), indicating DIC. Case 2 : a 49-year-old woman with adenomyosis was suffering from massive vaginal bleeding after estrogen-progestin therapy for hypermenorrhea. DIC was noted by low Plt (117,000/μl), elevated FDP-DD (314.6μg/ml) and low Fib (69.2mg/dl). Their DIC and massive bleeding improved with coagulation factor replacement for DIC. Case 1 underwent hysterectomy 22 days after the diagnosis of DIC. Case 2 underwent hysterectomy when the disappearance of PTE was confirmed after 5 months of gonadotropin-releasing hormone agonist and anti-coagulation therapy. These two cases suggest that an adenomyosis-induced hyper-coagulation status as indicated by PTE, and vaginal bleeding may trigger DIC due to the consumption of coagulation factors. Great care should therefore be paid to thrombosis as well as DIC in patients with adenomyosis.