Matsuo Takefumi, Matsuo Miyako, Sugimoto Takaki, Wanaka Keiko
Hyogo Prefectural Awaji Hospital, Sumoto, Japan.
Pathophysiol Haemost Thromb. 2007;36(6):305-10. doi: 10.1159/000296281. Epub 2010 Mar 13.
Heparin-induced thrombocytopenia (HIT) is known to complicate disseminated intravascular coagulation (DIC), but rarely to be complicated by DIC. We measured the titers of anti-PF4/hepatin complex antibodies by ELISA (HIT-Elisa) and examined 4 parameters of coagulation and fibrinolysis [D-dimer, thrombin/antithrombin complex (TAT), plasmin/alpha2-plasmin inhibitor complex (PIC), and antithrombin levels] in 80 patients with DIC diagnosed by a DIC scoring system. Fourteen patients were HIT-Elisa-positive, 11 of whom received heparin. In 3 of these 11 patients, platelet counts were < or =10 x 10(9)/l and/or reduced by more than 50% for 5-10 days after the heparin (2 patients treated with renal replacement therapy for chronic uremia and postoperative renal failure, and 1 with DIC from a solid tumor). The 3 patients had an optical density reading of >1.0 and a high level of IgG for HIT antibodies, and were thus considered to have DIC complicated with HIT (DIC-HIT). The other 8 patients had optical density readings of 0.4-1.0, and it was unclear whether their thrombocytopenia was caused by HIT alone or by sustained DIC. There were no significant differences in platelet counts and the 4 parameters of coagulation and fibrinolysis between the patients with DIC-HIT and DIC patients with a weakly positive result (0.4-1.0). No differences were observed in platelet counts, or levels of D-dimer and antithrombin between HIT-Elisa-positive and -negative DIC patients. However, the HIT-Elisa-negative patients showed significantly higher levels of TAT and PIC, presumably reflecting DIC-related hypercoagulability. In conclusion, DIC patients treated with heparin occasionally showed HIT antibody seroconversion and developed HIT. HIT-Elisa could assist in the diagnosis of HIT.
肝素诱导的血小板减少症（HIT）已知会并发弥散性血管内凝血（DIC），但很少由DIC并发。我们通过酶联免疫吸附测定法（HIT-ELISA）检测抗PF4/肝素复合物抗体滴度，并检查了80例通过DIC评分系统诊断为DIC的患者的4项凝血和纤溶参数[D-二聚体、凝血酶/抗凝血酶复合物（TAT）、纤溶酶/α2-纤溶酶抑制剂复合物（PIC）和抗凝血酶水平]。14例患者HIT-ELISA呈阳性，其中11例接受了肝素治疗。在这11例患者中的3例中，血小板计数≤10×10⁹/L和/或在使用肝素后5至10天内降低超过50%（2例因慢性尿毒症和术后肾衰竭接受肾脏替代治疗，1例因实体瘤发生DIC）。这3例患者的光密度读数>1.0且HIT抗体的IgG水平较高，因此被认为患有并发HIT的DIC（DIC-HIT）。其他8例患者的光密度读数为0.4 - 1.0，尚不清楚其血小板减少是仅由HIT引起还是由持续性DIC引起。DIC-HIT患者与弱阳性结果（0.4 - 1.0）的DIC患者之间的血小板计数以及4项凝血和纤溶参数无显著差异。HIT-ELISA阳性和阴性的DIC患者之间在血小板计数、D-二聚体水平和抗凝血酶方面未观察到差异。然而，HIT-ELISA阴性的患者显示出显著更高的TAT和PIC水平，这可能反映了与DIC相关的高凝状态。总之，接受肝素治疗的DIC患者偶尔会出现HIT抗体血清转化并发生HIT。HIT-ELISA有助于HIT的诊断。
