A woman in her 50s presented to the emergency department with acute, severe, left flank pain. There was no medical history of trauma, fever, or hematuria. She was receiving therapy for mantle cell lymphoma and had previously undergone 1 cycle of the Nordic protocol (comprising cyclophosphamide, doxorubicin, vincristine, prednisolone, cytarabine, and rituximab).¹ However, this resulted in tumor lysis syndrome and neutropenic sepsis. The patient was reluctant to undergo further infusional therapy and was switched to ibrutinib, 560 mg, once daily. During the 2-month period that she was receiving ibrutinib therapy, there were no concurrent administrations of anticoagulants. At presentation, she was hypotensive (blood pressure, 79/45 mm Hg) with conjunctival pallor and left renal angle tenderness. The patient’s hemoglobin count was low (7.6 g/dL; reference range, 12-16 g/dL; to convert to g/L, multiply by 10.0), which represented a significant decrease from the baseline (10.6 g/dL) measured 1 month before presentation. She was also found to have acute-onset thrombocytopenia (40×10⁹/L; reference range, 140-400×10⁹/L) and leukocytosis (12.75×10⁹/L, reference range, 4-10×10⁹/L). Her coagulation profile (prothrombin time) was normal. A computed tomographic (CT) scan of the abdomen and pelvis was performed (Figure 1A) and compared with a similar scan performed 4 months prior (Figure 1B).

一名五十多岁的妇女因急，严重的左胁腹疼痛向急诊科求诊。没有外伤，发烧或血尿的病史。她正在接受套细胞淋巴瘤的治疗，并且之前接受过北欧疗法的1个周期（包括环磷酰胺，阿霉素，长春新碱，泼尼松龙，阿糖胞苷和利妥昔单抗）。^1个但是，这导致了肿瘤溶解综合征和中性粒细胞减少症。患者不愿接受进一步的输液治疗，每天换一次560 mg依鲁替尼。在她接受依鲁替尼治疗的2个月期间，没有同时使用抗凝药。在介绍时，她血压低（血压为79/45 mm Hg），结膜苍白，左肾角压痛。患者的血红蛋白计数低（7.6 g / dL；参考范围12-16 g / dL；转换为g / L，乘以10.0），与测量的基线值（10.6 g / dL）相比有显着降低1演示前一个月。还发现她患有急性血小板减少症（40×10 ⁹ / L;参考范围140-400×10 ⁹ / L）和白细胞增多症（12.75×10⁹ / L，参考范围4-10×10 ⁹ / L）。她的凝血曲线（凝血酶原时间）正常。进行了腹部和骨盆的计算机断层扫描（CT）扫描（图1A），并与4个月前进行的类似扫描（图1B）进行了比较。