Delhumeau A, Houet J F, Bourrier P, Bukowski J G, Granry J C
Département d'Anesthésie-Réanimation, CHRU d'Angers.
Ann Fr Anesth Reanim. 1989;8(6):656-8. doi: 10.1016/s0750-7658(89)80183-2.
Three cases of acute adrenal haemorrhage complicating heparin induced thrombocytopaenia are described. The patients were 2 men and 1 woman, respectively 62, 74 and 76-year old. They all had orthopaedic problems requiring a treatment by subcutaneous calcium heparinate. Thrombocytopaenia occurred 7 to 10 days after the beginning of treatment, with a progressive return to normal of platelet count on stopping heparin. A syndrome suggestive of adrenal failure appeared on the 10 th to 12 th day consisting of abdominal pain, hyperpyrexia, arterial hypotension, asthenia, altered consciousness. Adrenal hormone levels were decreased. Abdominal scanography demonstrated adrenal haemorrhage in 2 patients. The third patient died before further investigations could be carried out. Hormonal replacement therapy brought things back to normal. Six other similar cases have already been published. The heparin induced thrombocytopaenia probably explains the two paradoxes of adrenal haemorrhage complicating heparin therapy: its occurrence in the absence of excessive anticoagulation, and adrenal venous thrombosis. The presence of abdominal pain, fever, collapse, or hyponatraemia with heparin induced thrombocytopaenia should suggest a possible adrenal haemorrhage. Adrenal CT scans should be carried out rapidly, so that hormone treatment can be initiated without delay.
本文描述了3例肝素诱导的血小板减少症并发急性肾上腺出血的病例。患者为2名男性和1名女性，年龄分别为62岁、74岁和76岁。他们均有骨科问题，需要皮下注射肝素钙进行治疗。血小板减少症在治疗开始后7至10天出现，停用肝素后血小板计数逐渐恢复正常。在第10至12天出现了提示肾上腺功能衰竭的综合征，包括腹痛、高热、动脉低血压、乏力、意识改变。肾上腺激素水平降低。腹部扫描显示2例患者有肾上腺出血。第3例患者在进一步检查之前死亡。激素替代疗法使情况恢复正常。另外6例类似病例已经发表。肝素诱导的血小板减少症可能解释了肝素治疗并发肾上腺出血的两个矛盾现象：在没有过度抗凝的情况下发生以及肾上腺静脉血栓形成。肝素诱导的血小板减少症患者出现腹痛、发热、虚脱或低钠血症时，应提示可能存在肾上腺出血。应迅速进行肾上腺CT扫描，以便及时开始激素治疗。
