Abteilung für Transfusionsmedizin, Institut für Immunologie und Transfusionsemedizin, Ernst-Moritz-Arndt University Greifswald , Germany.
Ups J Med Sci. 2013 Nov;118(4):279-84. doi: 10.3109/03009734.2013.838811.
Thrombocytopenia can cause diagnostic challenges in patients who have received heparin. Heparin-induced thrombocytopenia (HIT) is often considered in the differential diagnosis, and a positive screening can be mistaken as confirmation of the disorder. We present two patients who both received low-molecular-weight heparin for several days. In the first patient, clinical judgment rejected the suspicion of HIT despite a positive screening assay, and treatment for the alternative diagnosis of post-transfusion purpura was correctly initiated. In the second patient, the inaccurate diagnosis HIT was pursued due to a positive screening assay, while the alternative diagnosis of drug-dependent thrombocytopenia caused by piperacillin/tazobactam was rejected. This resulted in re-exposure to piperacillin/tazobactam which caused a second episode of severe thrombocytopenia. A positive screening assay for platelet factor 4/heparin-antibody should be verified by a functional assay, especially in patients with low pretest probability for HIT.
血小板减少症可导致接受肝素治疗的患者出现诊断挑战。肝素诱导的血小板减少症（HIT）通常被认为是鉴别诊断的一部分，而阳性筛选可能被误认为是该疾病的确诊。我们介绍了两名均接受低分子肝素治疗数天的患者。在第一个患者中，尽管筛选试验呈阳性，但临床判断排除了 HIT 的怀疑，并且正确地开始了对输血后紫癜的替代诊断的治疗。在第二个患者中，由于筛选试验阳性，HIT 的误诊被追踪，而由哌拉西林/他唑巴坦引起的药物依赖性血小板减少症的替代诊断被拒绝。这导致重新接触哌拉西林/他唑巴坦，引起第二次严重血小板减少症发作。血小板因子 4/肝素抗体的阳性筛选试验应通过功能试验来验证，尤其是在 HIT 低预测试概率的患者中。
