Use of Plasma Exchange in Patients With Heparin-Induced Thrombocytopenia: A Report of Two Cases and a Review of the Literature
Use of Plasma Exchange in Patients With Heparin-Induced Thrombocytopenia: A Report of Two Cases and a Review of the Literature
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DOI：
10.1002/jca.20289
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发表时间：
2011-01-01
影响因子：
1.5
通讯作者：
Winters, Jeffrey L.
中科院分区：
文献类型：
--
作者：
Jaben, Elizabeth A.;Torloni, A. Sergio;Winters, Jeffrey L.
肝素诱导的血小板减少症（HIT），其特征是血小板减少和潜在的严重血栓形成，可能在暴露于肝素抗凝治疗的患者中发生。HIT是由肝素/血小板因子4 （PF4）复合物抗体引起的。HIT的治疗包括停用肝素和抗凝治疗，使用非肝素替代药物，如直接凝血酶抑制剂（DTI）。这对需要接受体外循环手术（CPB）的患者的管理提出了挑战，因为CPB需要使用肝素抗凝，而dti的标准化使用方案尚未广泛可用。我们报告了两例HIT患者，他们在血浆交换（PE）后接受了成功的CPB和肝素抗凝治疗，以降低肝素/PF4抗体滴度。病例1是一名46岁男性，患有心脏淀粉样变性，需要紧急放置左心室辅助装置。病例2是一名患有急性心肌炎的34岁女性，她需要放置双心室辅助装置。两例患者肝素/PF4抗体酶联免疫吸附试验均呈阳性，PE前有HIT的临床证据。在PE和CPB之后，两名患者均无HIT的临床或实验室证据。文献关于使用PE治疗并发症的HIT和预防前CPB回顾。j .中国。科学通报，2011,26(2):519 - 524。(C) 2011 Wiley-Liss, Inc。
Heparin-induced thrombocytopenia (HIT), which is characterized by thrombocytopenia and potentially serious thromboses, may develop in patients exposed to heparin anticoagulation. HIT is caused by antibodies to the heparin/platelet factor 4 (PF4) complex. Management of HIT involves discontinuation of heparin and anticoagulation with a nonheparin alternative such as a direct thrombin inhibitor (DTI). This poses a challenge in the management of patients who need to undergo cardiopulmonary bypass surgery (CPB), because CPB requires anticoagulation with heparin and standardized protocols for use of DTIs are not widely available. We report two patients with HIT who underwent successful CPB with heparin anticoagulation following plasma exchange (PE) to reduce heparin/PF4 antibody titers. Case 1 is a 46-year-old male with cardiac amyloidosis who needed urgent placement of a left ventricular assist device. Case 2 is a 34-year-old woman with acute myocarditis who needed placement of a biventricular assist device. Both patients had positive enzyme-linked immunosorbent assay assays for heparin/PF4 antibodies and clinical evidence of HIT before PE. Following PE and subsequent CPB, neither patient had clinical or laboratory evidence of HIT. The literature regarding the use of PE for the treatment of complications of HIT and as prophylaxis before CPB is reviewed. J. Clin. Apheresis 26:219-224, 2011. (C) 2011 Wiley-Liss, Inc.