Crochemore Tomaz, Savioli Felicio Aragão, Pessoa Camila Menezes, Resende Adriana Abreu, Narciso Roberto Camargo
Unidade de Terapia Intensiva, Hospital Leforte Morumbi - São Paulo (SP), Brasil.
Rev Bras Ter Intensiva. 2018 Jul-Sept;30(3):394-397. doi: 10.5935/0103-507X.20180056.
Platelet transfusion is a common practice to prevent spontaneous bleeding or bleeding due to invasive procedures. Transfusion of allogeneic blood components is associated with increased mortality and a worse clinical outcome. The clot strength is assessed by thromboelastometry and determined by the interaction between platelets and fibrinogen. The compensatory effect of high levels of fibrinogen on clot strength in patients with thrombocytopenia has been demonstrated in different clinical settings including sepsis. We report the case of a patient with severe thrombocytopenia whose thromboelastometry showed clot strength that was compensated for by the increase in plasma fibrinogen levels as an acute phase reactant of septic patients. Here, we report a case of a 62-year-old female diagnosed with bone marrow aplasia admitted in the intensive care unit with septic shock and severe thrombocytopenia. During the first 24 hours in the intensive care unit, she presented acute respiratory insufficiency and circulatory shock. The use of invasive mechanical ventilation and norepinephrine was required. Her chest X-ray showed bilateral lung injury. Thus, bronchoscopy with bronchoalveolar lavage was requested. Thromboelastometry was performed and resulted in a normal coagulable profile. Despite severe thrombocytopenia (1,000/mm3), fibrinogen levels were increased (1,050mg/dL) due to septic shock. Bronchoscopy was performed without any active or further bleeding. Here, we report the use of thromboelastometry in the diagnosis of coagulation disorders, preventing unnecessary prophylactic platelet transfusion.
血小板输注是预防自发性出血或侵入性操作所致出血的常见做法。输注异体血液成分与死亡率增加及临床结局较差相关。通过血栓弹力图评估凝血强度，其由血小板与纤维蛋白原之间的相互作用决定。在包括脓毒症在内的不同临床环境中，已证实高水平纤维蛋白原对血小板减少症患者凝血强度具有代偿作用。我们报告了一例严重血小板减少症患者的病例，其血栓弹力图显示凝血强度因脓毒症患者急性期反应物血浆纤维蛋白原水平升高而得到代偿。在此，我们报告一例62岁女性，诊断为骨髓再生障碍，因脓毒性休克和严重血小板减少入住重症监护病房。在重症监护病房的最初24小时内，她出现急性呼吸功能不全和循环休克。需要使用有创机械通气和去甲肾上腺素。她的胸部X线显示双侧肺损伤。因此，要求进行支气管镜检查及支气管肺泡灌洗。进行了血栓弹力图检查，结果显示凝血指标正常。尽管存在严重血小板减少（1000/mm³），但由于脓毒性休克，纤维蛋白原水平升高（1050mg/dL）。支气管镜检查未出现任何活动性出血或进一步出血。在此，我们报告血栓弹力图在凝血障碍诊断中的应用，可预防不必要的预防性血小板输注。
