Autoimmune heparin-induced thrombocytopenia of delayed onset: a clinical challenge
Autoimmune heparin-induced thrombocytopenia of delayed onset: a clinical challenge
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DOI：
10.1111/trf.14814
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发表时间：
2018-12-01
期刊：
影响因子：
2.9
通讯作者：
Laine, Outi
中科院分区：
文献类型：
--
作者：
Kuitunen, Anne;Sinisalo, Marjatta;Laine, Outi
背景：肝素诱导的血小板减少症（HIT）通常出现在开始使用肝素后 5 至 10 天。自身免疫性 HIT 可能在停止肝素治疗后出现（迟发性 HIT）或之前没有任何肝素暴露（自发性 HIT 综合征）。病例报告：此病例呈现迟发性自身免疫性 HIT 病程。患者因流感肺炎住院，并接受低分子肝素血栓预防9天。出院7天后，她因脑窦静脉血栓形成和严重血小板减少症再次入院。颅内出血和脑梗死导致她死亡。讨论：通过功能性肝素诱导血小板（PLT）激活试验证实自身免疫性HIT。颅内出血阻碍了持续有效的抗凝治疗。尽管由于血栓栓塞事件的潜在风险，一般建议 HIT 患者不要进行 PLT 输血。结论：该病例表明，在存在和不存在当前肝素治疗的情况下测试 PLT 激活抗体有助于诊断自身免疫性 HIT 患者。当 HIT 并发危及生命的出血时，拒绝 PLT 输血的证据相互矛盾。
BACKGROUND: Heparin-induced thrombocytopenia (HIT) usually appears at 5 to 10 days after initiation of heparin. Autoimmune HIT can arise after discontinuation of heparin treatment (delayed-onset HIT) or without any preceding heparin exposure (spontaneous HIT syndrome).CASE REPORT: This case presents a course of autoimmune HIT with delayed onset. The patient was hospitalized due to influenza pneumonia and received low-molecular-weight heparin thromboprophylaxis for 9 days. Seven days after discharge, she was readmitted because of a cerebral sinus vein thrombosis and severe thrombocytopenia. Intracranial bleeding and brain infarction caused her death.DISCUSSION: Autoimmune HIT was confirmed by functional heparin-induced platelet (PLT) activation test. Intracranial bleeding prevented continuous and effective anticoagulation. PLT transfusions were given, although they are generally advised against in HIT patients due to potential risk of thromboembolic events.CONCLUSION: This case presents that testing PLT-activating antibodies both in the presence and in the absence of current heparin treatment helps to diagnose patients with autoimmune HIT. There is conflicting evidence to refuse PLT transfusion when HIT is complicated with life-threatening bleeding.