Goyen M, Kröger K, Massalha K, Manz S, Bräunlich S, Rudofsky G
Klinik und Poliklinik für Angiologie, Universitätsklinikum Essen.
Praxis (Bern 1994). 1999 Mar 11;88(11):485-90.
We report about a 29 year old female who developed right-sided leg vein thrombosis over three levels. Thrombectomy was attempted followed by intravenous anticoagulation with heparin. The platelet count dropped acutely from 176,000/microliter to 11,000/microliter after the sixth day. A lung perfusion-ventilation-scintigraphy suggested recent pulmonary embolism by lateral, predominantly right-sided perfusion deficits. ACT scan of the pelvic region showed rethrombosis of the right common iliac vein. The clinical suspicion of heparin-induced thrombocytopenia (HIT) type II was confirmed by a positive heparin-induced platelet aggregation test and the detection of antibodies by heparin-platelet factor 4-ELISA. The patient was treated with lepirudin at body-weight-adapted dose. After recovery of the platelet count to 102,000/microliter within seven days the treatment was changed to Orgaran after exclusion of immunologic cross reactivity. An overlapping oral anticoagulation with Marcoumar was initiated. Although HIT type II usually develops over a few days, acute thrombopenia can also occur. There is therefore no safe diagnostic interval permitting a timely detection.
我们报告了一名29岁女性，其右侧腿部静脉出现三级血栓形成。尝试进行血栓切除术，随后用肝素进行静脉抗凝。第六天后血小板计数从176,000/微升急剧降至11,000/微升。肺部灌注-通气闪烁扫描显示近期有肺栓塞，表现为外侧、主要是右侧的灌注缺损。盆腔区域的CT扫描显示右髂总静脉再次形成血栓。肝素诱导的血小板聚集试验呈阳性以及通过肝素-血小板因子4-ELISA检测到抗体，证实了临床对II型肝素诱导的血小板减少症（HIT）的怀疑。患者接受了根据体重调整剂量的来匹卢定治疗。血小板计数在七天内恢复到102,000/微升后，在排除免疫交叉反应后将治疗改为奥曲肽。开始与苄丙酮香豆素进行重叠口服抗凝。虽然II型HIT通常在几天内发展，但也可能发生急性血小板减少。因此，没有安全的诊断间隔时间允许及时检测。
