Department of Medicine, Mayo Clinic, Rochester, MN, USA.
Department of Neurology, Mayo Clinic, Rochester, MN, USA.
Platelets. 2021 Oct 3;32(7):936-940. doi: 10.1080/09537104.2020.1828574. Epub 2020 Oct 1.
Spontaneous heparin-induced thrombocytopenia (HIT) syndrome, characterized by clinical and serologic features of HIT despite the absence of proximate heparin exposure, can be triggered by total knee arthroplasty (TKA). A 56-year-old female receiving aspirin thromboprophylaxis post-TKA presented with aphasia and thrombocytopenia on post-operative day 11. Imaging studies revealed cerebral venous sinus thrombosis (CVST) and intravenous bivalirudin was initiated. Her serum tested strong-positive for IgG anti-PF4/polyanion complexes and serotonin-release assay in the presence and absence of heparin; strong-positive IgG-specific chemiluminescent immunoassay; and moderate-positive latex immunoturbidimetric assay. Two 65 g doses of IVIG were administered. With the improvement of her platelet count, she was transitioned from bivalirudin to warfarin. At one-year follow-up, she remained free of recurrent thrombosis and neurologically stable with a normal platelet count. Previous reports of post-TKA spontaneous HIT syndrome include venous/arterial thrombosis and adrenal hemorrhage, and this report of CVST expands the clinical spectrum of this rare complication of orthopedic surgery.
自发性肝素诱导的血小板减少症（HIT）综合征的特征是存在 HIT 的临床和血清学特征，但没有近期肝素暴露，可以由全膝关节置换术（TKA）引发。一名 56 岁女性在 TKA 后接受阿司匹林血栓预防治疗，术后第 11 天出现语言障碍和血小板减少症。影像学研究显示脑静脉窦血栓形成（CVST），并开始静脉注射比伐卢定。她的血清在存在和不存在肝素的情况下检测出 IgG 抗 PF4/多阴离子复合物和 5-羟色胺释放试验呈强阳性；强阳性 IgG 特异性化学发光免疫测定；和中度阳性乳胶免疫比浊测定。给予两次 65g 的 IVIG。随着血小板计数的改善，她从比伐卢定转换为华法林。在一年的随访中，她没有再次发生血栓形成，神经状态稳定，血小板计数正常。TKA 后自发性 HIT 综合征的先前报告包括静脉/动脉血栓形成和肾上腺出血，本报告的 CVST 扩展了这种罕见骨科手术并发症的临床谱。
