Mandernach Molly W, Nandavaram Sravanthi, Salame Bilal, Machuca Tiago, Pelaez Andres
Department of Medicine, Division of Hematology and Oncology, University of Florida, PO Box 100278, 1600 SW Archer Road, Gainesville, FL, 32610, United States.
Department of Medicine, Division of Pulmonary, Critical Care & Sleep Medicine, University of Florida, Gainesville, FL, 32610, United States.
Transfus Apher Sci. 2019 Aug;58(4):505-507. doi: 10.1016/j.transci.2019.05.010. Epub 2019 Jul 22.
Lung transplantation surgery often relies on the use of intraoperative extracorporeal membrane oxygenation (ECMO) and necessitates the need for high dose anticoagulation. Heparin induced thrombocytopenia complicates intraoperative anticoagulation management during lung transplant surgery requiring ECMO. Though other anticoagulants such as argatroban and bivalrudin are utilized for the treatment of Heparin Induced Thrombocytopenia (HIT), the lack of reversal agents makes it difficult to use these agents intraoperatively in cases with high bleeding risk. This is especially true in patients with end stage fibrotic lung disease with calcified mediastinal lymphadenopathy and pulmonary hypertension undergoing lung transplantation. Here we describe a case of HIT in a patient with Sarcoidosis listed for lung transplant who was treated with Therapeutic Plasma Exchange and Intravenous Immune globulin preoperatively and successfully underwent lung transplantation with the use of intraoperative venoarterial ECMO and heparin anticoagulation.
肺移植手术通常依赖术中体外膜肺氧合（ECMO）的使用，且需要大剂量抗凝。肝素诱导的血小板减少症使需要ECMO的肺移植手术中的术中抗凝管理变得复杂。尽管其他抗凝剂如阿加曲班和比伐卢定用于治疗肝素诱导的血小板减少症（HIT），但缺乏逆转剂使得在出血风险高的情况下术中难以使用这些药物。对于患有终末期纤维化肺病、纵隔淋巴结钙化和肺动脉高压并接受肺移植的患者尤其如此。在此，我们描述了一例结节病患者的HIT病例，该患者在等待肺移植期间，术前接受了治疗性血浆置换和静脉注射免疫球蛋白治疗，并在术中使用静脉-动脉ECMO和肝素抗凝成功接受了肺移植。
