Surgical Experience of the Kasabach-Merritt Syndrome

Kasabach-Merritt 증후군의 수술적 치험례

  • Bae, Joon Sung (Department of Plastic Surgery, The Catholic University of Korea, College of Medicine) ;
  • Choi, Yun Seok (Department of Plastic Surgery, The Catholic University of Korea, College of Medicine) ;
  • Lim, Jin Soo (Department of Plastic Surgery, The Catholic University of Korea, College of Medicine)
  • 배준성 (가톨릭대학교 의과대학 성형외과학교실) ;
  • 최윤석 (가톨릭대학교 의과대학 성형외과학교실) ;
  • 임진수 (가톨릭대학교 의과대학 성형외과학교실)
  • Received : 2004.10.21
  • Published : 2005.09.10

Abstract

In 1940, Kasabach and Merritt first described the association of a large vascular tumor and thrombocytopenia and termed this Kasabach-Merritt(KM) syndrome. It is characterized by a rapidly enlarging vascular anomaly and consumptive coagulopathy with thrombocytopenia, prolonged prothrombin time and partial thromboplastin time, hypofibrinogenemia, and the presence of D-dimer and fibrin split product, with or without microangiopathic hemolytic anemia. This is a potentially life-threatening condition with mortality rates from 20 to 30% as a result of severe sepsis, coagulopathy, or invasion of vital organs. Treatment modalities are corticosteroids, interferon alfa-2a or 2b, chemotherapy(vincristine, cyclophosphamide, etc.), aspirin, dipyridamole, com- pression, radiation therapy, embolization of feeding vessels and surgical excision. A standard treatment regimen for KM syndrome has not been established and most reports on definitive management of these complex vascular lesions have been anecdotal, involving small numbers of patients. The authors have successfully treated a patient of KM syndrome with actively bleeding huge hemangioma by surgical excision. They present it with the review of articles.

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References

  1. Enjolras O, Wasseff M, Mazoyer E: Infants with Kasabach-Merritt phenomenon do not have 'true' hemangiomas. J Pediatr 130: 631, 1997 https://doi.org/10.1016/S0022-3476(97)70249-X
  2. Larsen EC, Zinkham WH, Eggleston JC, Zitelli BS: Kasabach-Merritt syndrome: Therapeutic consideration. Pediatrics 79: 971, 1987
  3. Wananukul S, Nuchprayoon I, Seksam P: Treatment of Kasabach-Merritt syndrome: a stepwise regimen of prednison, dipyridamole, and interferon. Int J Dermatol 42: 741, 2003 https://doi.org/10.1046/j.1365-4362.2003.01796.x
  4. George M, Singhal V: Successful Surgical Excision of a Complex Vascular Lesion in a Infant with Kasabach-Merritt Syndrome. Pediatr Dermatol 19: 340, 2002 https://doi.org/10.1046/j.1525-1470.2002.t01-1-00097.x
  5. Hall GW: Kasabach-Merritt syndrome: pathogenesis and management. Br J Haematol 112: 851, 2001 https://doi.org/10.1046/j.1365-2141.2001.02453.x
  6. Boon LM, MacDonald DM, Mulliken JB: Complications of systemic corticosteroid therapy for problematic hemangiomas. Plast Reconstr Surg 104: 1616, 1999 https://doi.org/10.1097/00006534-199911000-00002
  7. Mitsuhashi N, Furuta M, Sakurai H: Outcome of radiation therapy for patients with Kasabach-Merritt syndrome. Int J Radiat Oncol Biol Phys 39: 1997, 467
  8. Park J, Yang WY, Yang YM, Lee DH, Choi WS.: A case of Kasabach-Merritt syndrome with generalized hemorrhagic diathesis. J Korean Soc Plast Reconstr Surg 109: 1177, 1999