Furukawa Nathan W, Jumalon Fernando M, Friedman Daniel B, Kelly Linda R
Adult Inpatient Medical Services, Presbyterian Hospital, Albuquerque, New Mexico, USA.
Presbyterian Heart Group, Presbyterian Hospital, Albuquerque, New Mexico, USA.
BMJ Case Rep. 2018 Oct 21;2018:bcr-2017-224069. doi: 10.1136/bcr-2017-224069.
A 78-year-old man with a history of severe aortic stenosis presented with confusion, irregular behaviour and dyspnoea 8 days following transcatheter aortic valve replacement. His exam was consistent with a heart failure exacerbation and he had elevated aminotransferases, bilirubin and prothrombin time suggestive of shock liver. A CT head scan demonstrated a subacute large left temporoparietal infarction. His aminotransferase and prothrombin time levels normalised with diuresis, but his indirect bilirubin remained elevated and he developed anaemia and thrombocytopenia consistent with a haemolytic anaemia. A transthoracic echocardiogram demonstrated a paravalvular leak. His thrombocytopenia continued to worsen prompting testing for antibodies against heparin-PF4 complexes which was positive. A serotonin release assay later returned positive, confirming the diagnosis of heparin-induced thrombocytopenia. This case illustrates that the presence of haemolytic anaemia does not necessarily exclude other causes of thrombocytopenia that may occur concurrently.
一名有严重主动脉瓣狭窄病史的78岁男性，在经导管主动脉瓣置换术后8天出现意识模糊、行为异常和呼吸困难。他的检查结果与心力衰竭加重相符，且转氨酶、胆红素升高，凝血酶原时间延长，提示存在休克肝。头颅CT扫描显示左侧颞顶叶有一个亚急性大面积梗死灶。随着利尿治疗，他的转氨酶和凝血酶原时间水平恢复正常，但间接胆红素仍升高，并且出现了与溶血性贫血相符的贫血和血小板减少。经胸超声心动图显示有瓣周漏。他的血小板减少持续恶化，促使检测抗肝素-PF4复合物抗体，结果呈阳性。随后的5-羟色胺释放试验结果也呈阳性，确诊为肝素诱导的血小板减少症。该病例表明，溶血性贫血的存在并不一定排除可能同时发生的其他血小板减少原因。
