Heuer Lars, Blumenberg Detlef
Department of Anaesthesiology, Intensive Care Unit, Klinikum Osnabrück GmbH, Am Finkenhügel 1, D-49076 Osnabrück, Germany.
Blood Coagul Fibrinolysis. 2005 Jun;16(4):287-90. doi: 10.1097/01.mbc.0000169222.46420.cf.
Thrombocytopenia is a common condition in the critical care setting. Repetitive platelet transfusion might lead to formation of alloantibodies. HLA class I and human platelet antigen antibodies can lead to transfusion-refractory thrombocytopenia. Transfusion of cross-matched platelets often is effective in these patients. We report on the successful use of recombinant activated factor VII in an acute bleeding situation in a multi-transfused patient presenting with positive HLA class I alloantibody status and thrombocytopenia associated with platelet dysfunction refractory to even transfusion of cross-matched platelets. The 41-year-old female patient developed HLA class I antibodies during former episodes of massive transfusion. Her former medical history was empty concerning hemorrhagic events. During this specific bleeding episode the patient suffered from intractable profuse bleeding from the nasopharynx and oral cavity. Global coagulation tests were within the normal range. Platelet dysfunction was confirmed by PFA100. Initially the patient responded well to Desmopressin infusion, but after 36 h she became thrombocytopenic and refractory to even transfusion of cross-matched platelets. Recombinant activated factor VII was chosen as the last resort. Two identical boli of 160 microg/kg NovoSeven each were injected via a central line within an interval of 3 h. After the first injection bleeding was significantly reduced and vasopressor support discontinued. After the second bolus bleeding completely ceased and did not reoccur. We did not observe any side effects. The pluripotent hemostatic agent recombinant activated factor VII might be a new option in the treatment of hemorrhagic episodes in patients presenting with this rare disorder, especially when the patient is refractory to cross-matched platelets or matched platelets are not available.
血小板减少症是重症监护环境中的常见病症。反复输注血小板可能导致同种抗体形成。HLA - I类和人类血小板抗原抗体可导致输注无效性血小板减少症。输注交叉配型的血小板通常对这些患者有效。我们报告了重组活化因子VII在一名多次输血患者急性出血情况下的成功应用，该患者HLA - I类同种抗体呈阳性，且存在血小板功能障碍导致的血小板减少症，即使输注交叉配型的血小板也无效。这位41岁的女性患者在既往大量输血期间产生了HLA - I类抗体。她既往病史中无出血事件。在此次特定出血事件中，患者出现鼻咽部和口腔顽固性大出血。整体凝血试验在正常范围内。通过PFA100证实存在血小板功能障碍。最初患者对去氨加压素输注反应良好，但36小时后她出现血小板减少，即使输注交叉配型的血小板也无效。重组活化因子VII被选作最后手段。通过中心静脉导管在3小时间隔内分两次注射相同剂量的每千克160微克的诺其。首次注射后出血明显减少，血管升压药支持停用。第二次推注后出血完全停止且未再发生。我们未观察到任何副作用。多能止血剂重组活化因子VII可能是治疗患有这种罕见病症患者出血发作的一种新选择，尤其是当患者对交叉配型的血小板无效或无法获得匹配血小板时。
