Management of bleeding in a multi-transfused patient with positive HLA class I alloantibodies and thrombocytopenia associated with platelet dysfunction refractory to transfusion of cross-matched platelets
Management of bleeding in a multi-transfused patient with positive HLA class I alloantibodies and thrombocytopenia associated with platelet dysfunction refractory to transfusion of cross-matched platelets
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DOI：
10.1097/01.mbc.0000169222.46420.cf
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发表时间：
2005-06-01
影响因子：
1.1
通讯作者：
Blumenberg, D
中科院分区：
文献类型：
--
作者：
Heuer, L;Blumenberg, D
血小板减少症是重症监护环境中的常见病症。重复血小板输注可能导致同种抗体的形成。 HLA I 类和人血小板抗原抗体可导致输血难治性血小板减少症。交叉配血血小板的输注通常对这些患者有效。我们报道了重组活化因子 VII 成功用于治疗多次输血患者的急性出血情况，该患者呈现 HLA I 类同种抗体阳性状态和与血小板功能障碍相关的血小板减少症，即使输注交叉配型血小板也难以治愈。这名 41 岁女性患者在之前的大量输血过程中出现了 H LA I 类抗体。她以前的病史中没有关于出血事件的记录。在这次特定的出血事件中，患者鼻咽和口腔出现顽固性大量出血。整体凝血测试在正常范围内。 PFA(100)证实血小板功能障碍。最初，患者对去氨加压素输注反应良好，但 36 小时后，她出现血小板减少症，甚至无法输注交叉配型血小板。选择重组激活因子 VII 作为最后的手段。在3小时的间隔内通过中心线注射两个相同的160μg/kg NovoSeven的大剂量。第一次注射后，出血明显减少，血管加压药支持停止。第二次推注后，出血完全停止并且没有再次发生。我们没有观察到任何副作用。多能止血剂重组激活因子 VII 可能是治疗患有这种罕见疾病的患者出血事件的新选择，特别是当患者对交叉匹配血小板无效或无法获得匹配血小板时。 (C) 利平科特·威廉姆斯·威尔金斯
Thrombocytopenia is a common condition in the critical care setting. Repetitive platelet transfusion might lead to formation of alloantibodies. HLA class I and human platelet antigen antibodies can lead to transfusion-refractory thrombocytopenia. Transfusion of cross-matched platelets often is effective in these patients. We report on the successful use of recombinant activated factor VII in an acute bleeding situation in a multi-transfused patient presenting with positive HLA class I alloantibody status and thrombocytopenia associated with platelet dysfunction refractory to even transfusion of cross-matched platelets. The 41-year-old female patient developed H LA class I antibodies during former episodes of massive transfusion. Her former medical history was empty concerning hemorrhagic events. During this specific bleeding episode the patient suffered from intractable profuse bleeding from the nasopharynx and oral cavity. Global coagulation tests were within the normal range. Platelet dysfunction was confirmed by PFA(100). Initially the patient responded well to Desmopressin infusion, but after 36 h she became thrombocytopenic and refractory to even transfusion of cross-matched platelets. Recombinant activated factor VII was chosen as the last resort. Two identical boli of 160 mu g/kg NovoSeven(R) each were injected via a central line within an interval of 3 h. After the first injection bleeding was significantly reduced and vasopressor support discontinued. After the second bolus bleeding completely ceased and did not reoccur. We did not observe any side effects. The pluripotent hemostatic agent recombinant activated factor VII might be a new option in the treatment of hemorrhagic episodes in patients presenting with this rare disorder, especially when the patient is refractory to cross-matched platelets or matched platelets are not available. (C) Lippincott Williams & Wilkins