Clinical characteristics and laboratory testing of patients with suspected HIT: A survey on current practice in 11 university hospitals in France

Summary

We undertook a survey of French university hospital hematological laboratories to ascertain the clinical characteristics of patients with suspected HIT, the laboratory tests performed, and the therapeutic strategy adopted in current practice.

Methods

A standardized medical records database for patients with suspected HIT was sent to 19 laboratories. During two months, all consecutive patients for whom a biological test was performed were included.

Results

169 patients were included, 27 (16%) patients having a final diagnosis of HIT. At the time HIT was suspected, the heparin duration and the level of thrombocytopenia were similar in HIT- positive and HIT-negative groups. The use of unfractionated heparin, a therapeutic heparin dose regimen and the presence of thrombotic complications were significantly more frequent in HIT-positive patients. When the heparin dose regimen was taken into account, only thrombotic complications under a therapeutic dose regimen were significantly increased in HIT-positive patients. Eighty-six percent of patients presented at least one alternative diagnosis of thrombocytopenia without significant difference between the two groups. Laboratory tests were performed after a mean of 0.3 days and mainly consisted of antigen assays. At the time HIT was suspected, heparin was stopped in 56 (33%) patients, being replaced mainly by danaparoid. Only three laboratories declared they usually received all the necessary clinical information to establish the likelihood of HIT.

Conclusion

In current practice in France, the clinical probability of HIT is rarely established, leading to systematic requests for laboratory HIT tests.     

肝硬化患者Child-Pugh分级与血小板生成素的关系

目的:探讨肝硬化患者Child-Pugh分级与血小板生成素(TPO)的关系.方法:选取肝硬化患者119例,另选取与肝硬化组性别和年龄相匹配的30例健康人作为对照组;晨起空腹采血、离心分离血清,检测血液常规、血液生化、血离子、肝炎病毒标志物,肝脾B超检查:用ELISA法检测血清TPO含量.结果:肝硬化患者中Child-Pugh A、B、C级分别为43例、63例和13例.与对照组相比,肝硬化患者平均TPO水平无显著性差异,A级TPO水平有升高的趋势,但无统计学意义,而B级(43.44 ng/L±33.51 ng/L)和C级(45.16 ng/L±30.04 ng/L)则明显降低(P=0.001,0.048);血小板计数(PLT)在A级、B级和C级逐渐下降,与对照组相比,均有显著性差异(均P<0.001);TPO与PLT在对照组呈负相关(r=.0.363,P=0.048),在Child-Pugh A级和C级两者无相关性,在B级呈正相关且有统计学意义(r=0.383,P=0.002).结论:肝脏合成TPO减少是晚期肝硬化患者血小板减少的重要原因:TPO和PLT可以作为反应肝脏功能的指标.     

脾切除难治性特发性血小板减少型紫癜的临床分析

目的通过分析脾切除对难治性特发性血小板减少性紫癜病例,统计脾切除对难治性特发性血小板减少性紫癜（ITP）的治疗效果及影响因素,寻找术前如何预测判定脾切除的疗效的方法,并分析术后效果差、再用药物治疗的效果。探索难治性特发性血小板减少性紫癜有效的、副作用少的治疗方法。方法对1996年5月-2011年3月在山西医科大学第二附属医院行脾切除术治疗难治性特发性血小板减少型紫癜的62例（其中1例附加副脾摘除术）的年龄、性别、术前有无出血、术前对激素的反应、脾脏是否肿大、术后血小板峰值与脾切除疗效进行统计学分析。结果全部62例中,显效34例,良效13例,进步10例,无效5例,有效率（显效＋良效）为75.8%。性别和脾脏是否肿大与脾切除术疗效无统计学意义,有无出血症状、年龄、术后血小板峰值、骨髓巨核细胞数具有统计学意义,术前对激素的反应、术前血小板计数具有临床用应价值。结论术前对激素的反应、术前血小板计数可作为脾切除术的疗效预测指标。     

网织血小板在特发性血小板减少性紫癜中的临床价值

目的:探讨网织血小板(RP)的百分比对特发性血小板减少性紫癜(ITP)的临床意义.方法:采用流式细胞仪测定30例ITP患者治疗前后外周血中RP的百分率,并与15例再生障碍性贫血(AA)患者、30例正常体检者进行比较.结果:30例ITP病人治疗前网织血小板百分比(RP%)为(27.2±8.3)%,治疗后的ITP病人RP%为(8.3±2.4)%,治疗前后相比有统计学意义;正常对照组RP%为(8.4±2.3)%,治疗前的ITP病人RP%明显高于正常对照组,治疗后的ITP病人RP%与正常对照组无差异;15例AA的RP%为(6.3±2.1)%,与正常对照组相比差异无统计学意义(P>0.05).结论:外周血RP%测定,有助于ITP的诊断及治疗监测.     

Circuit lifespan during continuous renal replacement therapy for combined liver and kidney failure

Purpose

To evaluate circuit lifespan (CL) and bleeding risk during continuous renal replacement therapy (CRRT), in combined liver and renal failure.

Methods

Single-center retrospective analysis of adults with acute liver failure or decompensated cirrhosis who received CRRT, without anticoagulation or with heparinization in intensive care unit.

Results

Seventy-one patients with 539 CRRT circuits were evaluated. Median overall CL was 9 (6–16) hours. CL was 12 (7-24) hours in 51 patients never anticoagulated for CRRT. In 20 patients who subsequently received heparinization, CL was 7 (5-11) hours without anticoagulation, which did not improve with systemic or regional heparinization (P = .231), despite higher peri-circuit activated partial thromboplastin time (APTT) and heparin dose. Using multivariate linear regression, patients with higher baseline APTT or serum bilirubin, or who were not mechanically ventilated, had longer CL (P < .05). Additionally, peri-circuit thrombocytopenia (P < .0001) or higher international normalized ratio (P < .05) predicted longer CL. Of 71 patients, 33 had significant bleeding events. Using multivariate logistic regression, patients with higher baseline APTT, vasoactive drug use > 24 hours, or thrombocytopenia, had more bleeding complications (P < .05). Decreasing platelet counts (especially < 50 × 10⁹/mm³) had an incremental effect on CL (P < .0001).

Conclusion

CRRT CL is short in patients with liver failure despite apparent coagulopathy. Thrombocytopenia predicts longer CL and bleeding complications.     

Heparin-induced thrombocytopenia type II in a surgical intensive care unit

Purpose

The aim of this study was to investigate the epidemiology of and outcome from heparin-induced thrombocytopenia type II (HIT) in surgical intensive care unit (ICU) patients.

Patients and Methods

All 13 948 patients admitted to a university hospital surgical ICU between January 2004 and March 2008 were included in this retrospective cohort study.

Results

Of 349 patients with a clinical suspicion of HIT, 88 patients had platelet factor 4/heparin antibodies using enzyme-linked immunosorbent assay. The prevalence and incidence of HIT were 0.82% and 0.63%, respectively. The complication rate was 43.5%, and the ICU and hospital mortality rates were 23.9% and 33%, respectively. In a multivariable analysis, the nadir platelet count (odds ratio, 1.03; 95% confidence interval, 1.01-1.05; P = .048) was the only factor independently associated with risk of death in these patients. In a nested matched case-control analysis, mortality rates were similar in patients with HIT and in the matched controls. However, complication rates were higher, and ICU and hospital lengths of stay were longer in patients with HIT compared with those of the control group.

Conclusions

In this cohort of surgical ICU patients, HIT was associated with increased morbidity but not mortality rates compared with a nested matched control group. The nadir platelet count was independently associated with a higher risk of inhospital death in these patients.     

还原型谷胱甘肽钠致血小板减少1例

1病例资料患者,男,23岁,因全身皮疹伴发热、乏力10 d在笔者所在医院住院。诊断为三氯乙烯药疹样皮炎、中度肝损害。入院后查血小板:153×109.L1,肝功能:ALB 33.9 g.L1,ALT 744 U.L1,予以甲基强的松龙抑制免疫及还原型谷胱苷肽     

肝素和利奈唑胺致冠心病PCI术后严重血小板减少1例分析

目的:关注肝素和利奈唑胺致血小板减少的不良反应及处理方法。方法:通过分析临床病例资料,探讨不良反应发生原因,从而提出临床工作中的药学监护事项。结果:该患者出现的严重血小板减少可能与肝素诱导的免疫反应和利奈唑胺有关,根据不良反应关联性评价,与该2药存在可能相关性。结论:对于术中、术后应用肝素又合并感染的老年患者,应加强监护,尤其是加强血小板计数的监测,如出现血小板减少,在排除其他药物作用的情况下,应高度怀疑肝素诱导的血小板减少症,给予正确处理。     

7例人感染新型布尼亚病毒病临床分析

目的分析我院2011～2012年确诊人感染新型布尼亚病毒病患者的临床特征,为预防控制提供依据。方法采用统一的诊断标准对病例进行调查。结果 7例患者均经大连市疾控中心监测新型布尼亚病毒核酸阳性。临床表现主要为发热,乏力,呕吐,腹泻,心肌损害;血常规检查有血小板和白细胞减少;病例均为农民,中老年为主,发病时间6～9月,部分病例发病前有明确蜱叮咬史。结论人感染新型布尼亚病毒病发病初期临床症状不典型,散发病例多见,及早治疗,大多预后良好。     

系统性红斑狼疮合并血小板减少危险因素Logistic回归分析

目的分析系统性红斑狼疮（SLE）合并血小板减少危险因素。方法采用回顾性研究方法,对85例系统性红斑狼疮合并血小板减少相关因素进行多因素非条件Logistic回归分析,并血小板减少的住院患者进行回顾性分析．以同期住院的无血小板减少的SLE患者作为对照,探讨血小板减少的危险因素。结果85例SLE住院患者,出现血小板减少者有24例,占28．24％,其中14例出现轻度血小板减少,6例出现中度血小板减少,4例为重度血小板减少。SLE患者合并浆膜炎、血液系统受累、ACA阳性及脾大者易出现血小板减少。血小板减少组肾脏损害的发生率高于血小板正常患者,但蝶形红斑的发生率低于后者,差异均有统计学意义（P〈0．05）。结论SLE患者合并浆膜炎、血液系统受累、ACA阳性及脾大者易出现血小板减少。