Grazioli Alison, Splinter Noah P, Plazak Michael E, Griffith Bartley P, Dahi Siamak, Bathula Allison H, Cheung Nora H, Padmanabhan Anand
Department of Medicine, University of Maryland School of Medicine, Program in Trauma, Baltimore, Maryland, USA.
Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA.
Res Pract Thromb Haemost. 2023 Feb 23;7(2):100089. doi: 10.1016/j.rpth.2023.100089. eCollection 2023 Feb.
Urgent surgery requiring heparin exposure during cardiopulmonary bypass can be challenging in patients with acute heparin-induced thrombocytopenia (HIT). The use of treatments such as therapeutic plasma exchange (TPE) to remove HIT antibodies and intravenous immunoglobulin (IVIg) to antagonize HIT antibody-mediated platelet activation are increasingly reported in patients who undergo cardiac surgery. The optimal treatment approach to mitigate the risks of heparin administration in this situation is not known.
Can TPE coupled to IVIg allow for safe heparin exposure in patients with HIT?
TPE and IVIg were used to enable heparin exposure for surgical placement of a left ventricular assist device in a patient with HIT. Serial patient samples were tested in antigen-based and functional HIT assays.
Dissociation between antigen-based (enzyme-linked immunosorbent assay) and functional (serotonin release assay) testing was noted, and TPE coupled to IVIg was associated with an excellent clinical response.
在体外循环期间需要使用肝素的紧急手术，对于急性肝素诱导的血小板减少症（HIT）患者而言可能具有挑战性。越来越多的报道称，在接受心脏手术的患者中，使用治疗性血浆置换（TPE）去除HIT抗体以及静脉注射免疫球蛋白（IVIg）拮抗HIT抗体介导的血小板活化等治疗方法。目前尚不清楚在这种情况下减轻肝素给药风险的最佳治疗方法。
TPE联合IVIg能否使HIT患者安全使用肝素？
在一名HIT患者中，使用TPE和IVIg以使肝素能够用于左心室辅助装置的手术植入。对患者的系列样本进行了基于抗原的和功能性HIT检测。
注意到基于抗原的（酶联免疫吸附测定）和功能性的（5-羟色胺释放测定）检测结果存在解离，且TPE联合IVIg与良好的临床反应相关。
