在一名甲型血友病患者进行腹部血管内动脉瘤修复术期间，采用血栓弹力图进行凝血评估。
Coagulation assessment with thromboelastography during abdominal endovascular aneurysm repair in a patient with hemophilia A.
作者信息
Sato Kazuki, Katori Nobuyuki, Suga Yoshifumi, Kiyama Shuya, Uezono Shoichi
机构信息
Department of Anesthesiology, The Jikei University School of Medicine, 3-25-8 Nishishinbashi, Minato-ku, Tokyo, 105-8461, Japan.
出版信息
JA Clin Rep. 2020 Feb 4;6(1):7. doi: 10.1186/s40981-020-0316-0.
BACKGROUND
As both APTT and APTT-based coagulation method cannot distinguish heparin effect from intrinsic coagulation factor deficiency, we implemented thromboelastography (TEG) for the coagulation assessment in a patient with hemophilia A undergoing an endovascular surgery with heparinization.
CASE PRESENTATION
A 68-year-old male with hemophilia A underwent endovascular aortic repair for abdominal aortic aneurism. TEG results showed recovery of coagulation time (R) in both kaolin assay (CK) and kaolin-heparinase assay (CKH) after factor VIII replacement before heparinization. Against our expectations, R-CKH was slightly prolonged (9.0 min) during heparinization. After the administration of protamine sulfate, R in both assays showed similar values within the normal ranges.
CONCLUSIONS
The combination of CK and CKH assays could be useful to estimate factor VIII (FVIII) level when heparin concentration is low or without heparin; however, caution should be necessary for estimation of FVIII level by TEG under the effect of medium- or high-dose heparin.
背景
由于活化部分凝血活酶时间（APTT）及其凝血方法均无法区分肝素效应与内源性凝血因子缺乏，因此我们采用血栓弹力图（TEG）对一名接受肝素化血管内手术的甲型血友病患者进行凝血评估。
病例介绍
一名68岁的甲型血友病男性患者接受了腹主动脉瘤的血管内主动脉修复术。TEG结果显示，在肝素化前进行因子VIII替代后，高岭土试验（CK）和高岭土-肝素酶试验（CKH）中的凝血时间（R）均恢复正常。出乎我们意料的是，肝素化期间R-CKH略有延长（9.0分钟）。在给予硫酸鱼精蛋白后，两种试验中的R值均显示在正常范围内且相近。
结论
当肝素浓度较低或无肝素时，CK和CKH试验相结合可能有助于评估因子VIII（FVIII）水平；然而，在中高剂量肝素作用下，通过TEG评估FVIII水平时应谨慎。
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