Zöhrer' B, Zenz W, Rettenbacher A, Covi P, Kurnik K, Kroll H, Grubbauer H M, Muntean W
Department of Paediatrics, Karl Franzens University of Graz, Austria.
Acta Paediatr. 2001 Jul;90(7):765-71.
We report on four children with heparin-induced thrombocytopenia type II. In three patients, therapy with unfractionated heparin was associated with development of cardiac thrombi or with thrombosis progression up to the inferior vena cava or with aggravation of peripheral arterial occlusion. In the fourth child, the disease was recognized early on, and no complication occurred. Heparin-induced thrombocytopenia type II was confirmed by heparin-induced platelet activation assay and/or heparin/platelet factor 4-ELISA. Concomitant elevated antiphospholipid antibodies were seen in all patients. Danaparoid sodium applied at a dosage of between 1.2 and 7.1 U/kg/h stopped the disease progression in each patient. Three children had a clinical recovery with partial recanalization, but for the child with peripheral arterial occlusion disease, amputation of some of the toes became necessary.
Our data indicate that heparin-induced thrombocytopenia type II is a potential life-threatening disease in children and danaparoid sodium is beneficial in this age group.
我们报告了4例Ⅱ型肝素诱导的血小板减少症患儿。在3例患者中,普通肝素治疗与心脏血栓形成、血栓进展至下腔静脉或外周动脉闭塞加重有关。在第4例患儿中,疾病早期得到诊断,未发生并发症。通过肝素诱导的血小板活化试验和/或肝素/血小板因子4-酶联免疫吸附测定确诊为Ⅱ型肝素诱导的血小板减少症。所有患者均伴有抗磷脂抗体升高。以1.2至7.1 U/kg/h的剂量应用达那肝素钠可阻止每位患者的疾病进展。3例患儿临床康复,部分血管再通,但对于患有外周动脉闭塞性疾病的患儿,不得不进行部分脚趾截肢。
我们的数据表明,Ⅱ型肝素诱导的血小板减少症在儿童中是一种潜在的危及生命的疾病,达那肝素钠对该年龄组有益。