Use of ROTEM and MEA in a cardiac surgical patient with ITP.
Use of ROTEM and MEA in a cardiac surgical patient with ITP.
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ROTEM 和 MEA 在患有 ITP 的心脏外科患者中的使用。
DOI：
10.1007/s00540-013-1690-9
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发表时间：
2014
期刊：
影响因子：
--
通讯作者：
Kaneko G.
中科院分区：
文献类型：
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作者：
Ichikawa J;Kodaka M;Kaneko G.
致编辑：特发性血小板减少性紫癜（ITP）的围手术期处理具有挑战性，因为血小板计数不能直接指示血小板功能。我们报告了使用旋转血栓弹性测定法（ROTEM; Tem International，慕尼黑，德国）和使用Multiplate分析仪（Dynabyte Medical，慕尼黑，德国）的多电极聚集测定法（MEA）（补充图1）来管理一名需要主动脉瓣置换术的71岁男性患者，该患者有8年ITP病史。ITP的特征在于靶向血小板膜糖蛋白的抗血小板抗体的形成，导致血小板加速破坏。麻醉诱导后，EXTEM试验中的最大血凝块硬度（MCF）较低，但在FIBTEM试验中正常，MEA测量值均低于正常范围，与激活剂无关（补充表1、2）。这些结果表明，如MCFextem-MCFectem [1]所反映的血小板组分减少，MEA上传感器线的占用更慢且密度更低，从而降低了聚集速度和最大聚集[2]。体外循环期间，EXTEM和FIBTEM试验中MCF降低，这些结果与所有MEA测量结果一起表明血液稀释、凝血因子耗竭和血小板功能障碍（补充表1、2）。根据基于ROTEM的算法，输注30 U血小板和5 U新鲜冷冻血浆，这使ROTEM数据和未令人满意地校正的MEA数据标准化（补充表1、2）。这些结果反映了由于单采和储存而导致的血小板聚集减少。已报道MEA可用于评估血小板对抗血小板治疗的反应性。由于ROTEM无法评价原发性止血，因此ROTEM和MEA一起使用可能具有功能互补性。然而，患者不需要任何更多的血液制品，MEA的结果不影响输血决定。
To the Editor: Perioperative management of idiopathic thrombocytopenic purpura (ITP) is challenging because the platelet count does not directly indicate platelet function. We report the use of rotation thromboelastometry (ROTEM; Tem International, Munich, Germany) and multiple electrode aggregometry (MEA) using a Multiplate analyzer (Dynabyte Medical, Munich, Germany)(Supplemental Fig. 1) to manage a 71-year-old man with an 8-year history of ITP who required an aortic valve replacement. ITP is characterized by the formation of antiplatelet antibodies that target platelet membrane glycoproteins, resulting in accelerated platelet destruction. After induction of anesthesia, the maximum clot firmness (MCF) was low in the EXTEM test but was normal in the FIBTEM test, and MEA measurements were all below the normal range, which are independent of activators (Supplemental Tables1, 2). These results indicated a reduction in the platelet component as reflected by MCFextem–MCFfibtem [1] and slower and less dense occupation of the sensor wires on MEA, decreasing the aggregation velocity and the maximum aggregation [2]. During cardiopulmonary bypass, the MCF was reduced in EXTEM and FIBTEM tests, and these results together with all MEA measurements indicated hemodilution, coagulation factor depletion, and platelet dysfunction (Supplemental Tables 1, 2). According to the ROTEM-based algorithm, 30 U platelets and 5 U fresh frozen plasma were transfused, which normalized the ROTEM data and the unsatisfactorily corrected MEA data (Supplemental Tables 1, 2). These results reflected reduced platelet aggregation because of apheresis and storage. MEA has been reported to be useful for assessment of platelet responsiveness to antiplatelet therapy. As ROTEM is unable to evaluate primary hemostasis, use of ROTEM and MEA together might be functionally complementary. However, the patient did not require any more blood products, and the results of MEA did not affect the transfusion decision.