Kramer Robert, Oberg-Higgins Payson, Russo Louis, Braxton John H
Division of Cardiothoracic Surgery, Maine Medical Center, Portland, ME 04102, USA.
Interact Cardiovasc Thorac Surg. 2009 Apr;8(4):439-41. doi: 10.1510/icvts.2008.193177. Epub 2009 Jan 7.
Heparin-induced thrombocytopenia with thrombosis syndrome is an antibody-mediated disorder that has a high mortality in cardiac surgical patients in spite of early diagnosis and management with direct thrombin inhibitors. Plasmapheresis, an extracorporeal technique that has been designed for the removal of large molecular weight substances from the plasma, can remove the offending antibodies from these desperately ill patients. We describe a case of a postoperative cardiac surgery patient with heparin-induced thrombocytopenia with thrombosis syndrome and multi-system failure who was dependent upon a left ventricular assist device. He was treated successfully with plasmapheresis with recovery of his platelet count from 25,000/microl to over 200,000/microl, along with multi-organ recovery. This patient survived because of plasmapheresis. Removing the antibodies to the heparin-platelet factor four complex with plasmapheresis is an effective strategy to treat these patients. We believe that the use of plasmapheresis as a bail-out procedure in these often desperately ill post-operative cardiac surgical patients who have heparin-induced thrombocytopenia with thrombosis syndrome could be lifesaving.
肝素诱导的血小板减少伴血栓形成综合征是一种抗体介导的疾病，尽管早期诊断并使用直接凝血酶抑制剂进行治疗，但心脏手术患者的死亡率仍然很高。血浆置换是一种体外技术，旨在从血浆中去除大分子物质，可以从这些危重病患者体内清除致病抗体。我们描述了一例心脏手术后患者，患有肝素诱导的血小板减少伴血栓形成综合征和多系统衰竭，依赖左心室辅助装置。他通过血浆置换成功治愈，血小板计数从25,000/微升恢复到超过200,000/微升，同时多器官功能恢复。该患者因血浆置换而存活。通过血浆置换去除针对肝素 - 血小板因子4复合物的抗体是治疗这些患者的有效策略。我们认为，对于这些患有肝素诱导的血小板减少伴血栓形成综合征的术后危重心脏手术患者，将血浆置换作为一种挽救措施可能会挽救生命。
