Greinacher A, Michels I, Mueller-Eckhardt C
Institut für Klinische Immunologie und Transfusionsmedizin, Klinikum der Justus-Liebig-Universität Giessen, BRD.
Beitr Infusionsther. 1992;30:408-12.
Diagnosis of HAT type II and treatment of thromboembolic complications in these patients are difficult. Recently we have developed the heparin-induced platelet activation (HIPA) assay which allows a rapid confirmation of the tentative diagnosis of HAT type II. In vitro studies with sera of 25 patients revealed cross-reactivity to the LMW heparins Fragmin, Fraxiparin and Clexane whereas a LMW heparinoid, Org 10172 (Orgaran), did not. In a prospective study this heparinoid was selected for 10 HAT patients, for whom further parenteral anticoagulation was required. In 7 of these patients who received LMW heparins prior to laboratory investigations low platelet counts persisted under treatment with LMW heparins and 2 patients developed additional thromboembolic complications. Upon treatment with Org 10172 platelet counts normalized in 9 patients, in 1 patient thrombocytopenia was unrelated to parenteral anticoagulation, in 1 patient platelet count normalized after discontinuation of Org 10172. We conclude that the HIPA assay allows the laboratory diagnosis of HAT type II and the selection of a compatible heparin or heparinoid for further parenteral anticoagulation.
II型肝素诱导的血小板减少症（HAT）的诊断以及这些患者血栓栓塞并发症的治疗都很困难。最近我们开发了肝素诱导的血小板活化（HIPA）检测方法，该方法能够快速确认II型HAT的初步诊断。对25例患者血清进行的体外研究显示，其对低分子量肝素法安明、速碧林和克赛存在交叉反应，而低分子量类肝素奥加诺（Org 10172）则无此反应。在一项前瞻性研究中，为10例需要进一步胃肠外抗凝治疗的HAT患者选用了这种类肝素。在这些患者中，7例在实验室检查前接受过低分子量肝素治疗，在接受低分子量肝素治疗期间血小板计数持续偏低，2例出现了额外的血栓栓塞并发症。使用奥加诺治疗后，9例患者的血小板计数恢复正常，1例患者的血小板减少与胃肠外抗凝无关，1例患者在停用奥加诺后血小板计数恢复正常。我们得出结论，HIPA检测方法可用于II型HAT的实验室诊断，并为进一步的胃肠外抗凝选择合适的肝素或类肝素。
