Cerebral venous sinus thrombosis associated with SRA-negative heparin-induced thrombocytopenia: case report.
Cerebral venous sinus thrombosis associated with SRA-negative heparin-induced thrombocytopenia: case report.
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DOI：
10.1186/s12959-023-00490-7
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发表时间：
2023-04-21
影响因子：
3.1
通讯作者：
Desai, Masoom J. J.
中科院分区：
文献类型：
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作者：
Silva, Floyd D. D.;Burnett, Allison E. E.;Padmanabhan, Anand;Rollins-Raval, Marian A. A.;Splinter, Noah P. P.;Desai, Masoom J. J.
关键词：
免疫介导的肝素诱导的血小板减少症（HIT）引起脑静脉窦血栓形成（CVST）的文献报道很少。此外，当测试免疫介导的HIT时，很少有假阴性5-羟色胺释放测定（SRA）的报道。我们报告一例60岁男性患者，近期使用普通肝素预防静脉血栓栓塞，4 T评分升高至5分，急性CVST疑似免疫介导的HIT。酶联免疫吸附试验（ELISA）筛选试验为PF 4抗体阳性，随后的反射性SRA试验为阴性。然而，鉴于临床表现，怀疑（并最终证实）假阴性SRA，促使使用替代的PF 4依赖性p-选择素表达测定（PEA），该测定被证实为阳性。患者通过比伐卢定输注成功治疗，最终转为阿哌沙班治疗。免疫介导的HIT伴血栓形成表现为CVST是罕见的。同样，假阴性SRA在免疫介导的HIT中也不常见。从我们的病例报告中获得的教训包括在4 T评分升高的CVST患者中考虑HIT，并在解释阴性HIT检测结果时考虑HIT的整个临床表现和怀疑程度。PEA结合4 Ts评分可被视为HIT的替代诊断测定。
There are very few documented reports in literature of cerebral venous sinus thrombosis (CVST) caused by immune-mediated heparin-induced thrombocytopenia (HIT). Further, there are very few reports of false negative serotonin release assays (SRAs) when testing for immune-mediated HIT. We present a case of a 60- year-old male with recent unfractionated heparin administration for venous thromboembolism prophylaxis, an elevated 4T score of 5 and acute CVST in which immune-mediated HIT was suspected. The enzyme-linked immunosorbent assay (ELISA) screening assay was positive for PF4 antibodies and subsequent reflexive SRA testing was negative. However, given the clinical picture, a false-negative SRA was suspected (and eventually confirmed), prompting use of the alternative PF4-dependent p-selectin expression assay (PEA) which was confirmed to be positive. The patient was successfully managed with a bivalirudin infusion and eventually transitioned to apixaban. It is uncommon for immune-mediated HIT with thrombosis to manifest as CVST. Similarly, false-negative SRA is uncommon in immune-mediated HIT. Take-away lessons from our case report include considering HIT in CVST patients with an elevated 4T score and considering the entire clinical picture and degree of suspicion for HIT when interpreting negative HIT testing results. The PEA, in conjunction with the 4Ts score, may be considered as an alternate diagnostic assay for HIT.
影响因子：
--
作者：
Warkentin, TE;Roberts, RS;Kelton, JG
通讯作者：
Kelton, JG
影响因子：
12.8
作者：
Warkentin, Theodore E.;Nazy, Ishac;Arnold, Donald M.
通讯作者：
Arnold, Donald M.
DOI：
10.1161/atvbaha.120.315445
发表时间：
2021-01
期刊：
Arteriosclerosis, thrombosis, and vascular biology
影响因子：
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作者：
Arepally GM;Padmanabhan A
通讯作者：
Padmanabhan A