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肝素诱导血小板减少症合并蓝趾综合征一例
Blue Toe Syndrome Accompanied with Heparin-induced Thromboscutopenia:a Case Report
【作者】 徐辉；
【导师】 郭晓纲；
【作者基本信息】 浙江大学 ， 内科学， 2015， 硕士
【摘要】 目的：提高对低分子肝素诱导血小板减少症的认识,促进其早诊断、早治疗。方法：报道分析1例低分子肝素诱导血小板减少症合并蓝趾综合征病例并复习相关文献。结果：通过血液细胞学、血清学、酶联免疫吸附试验及超声影像学等检查方法,患者排除肝素诱导血小板减少症合并动静脉栓塞诊断,明确了肝素诱导血小板减少症合并微循环栓塞的诊断,且以蓝趾综合征为临床表现。经阿司匹林、氯吡格雷双联抗血小板,前列地尔改善微循环等治疗后好转。结论：临床上肝素诱导血小板减少症有着较高的死亡率,尤其是合并肝素诱导的血小板减少并血栓形成综合征,因此,早期识别诊断并及时治疗就显得非常重要。经抗凝治疗的患者出现血小板计数减少,尤其是较基数值下降50%以上时,要高度怀疑肝素诱导血小板减少症的发生。本例患者抗凝治疗后血小板计数较治疗前下降达71.1%,结合4T评分系统及血小板因子4/肝素抗体检测,故其肝素诱导血小板减少症诊断明确。患者出现四肢末端青紫疼痛,考虑是肝素诱导血小板减少症合并微循环栓塞所致,其四肢末端颜色的改变符合蓝趾综合征的表现。阿司匹林、氯吡格雷及前列地尔是肝素诱导血小板减少症合并蓝趾综合征较为安全有效治疗方法。
【Abstract】 Objective:To improve understanding of low molecular weight heparin induced thrombocytopenia, and promote early diagnosis and treatment of heparin-induced thrombocytopenia (HIT).Methods:Report a case of low molecular weight heparin induced thrombocytopenia accompanied with blue toe syndrome (BTS) and deliver a literature review.Results:By blood cytology, serology, enzyme-linked immunosorbent assay (ELISA) and ultrasonography imaging techniques, we ruled out the diagnos of venous and arterial thromboembolis, and HIT with microcirculatory thromboembolis was clear, which manifestation was BTS. We maintained double antiplatelet therapy treatment of aspirin and clopidogrel. To improve of the micro-circulation of digits, Alprostadil was given. The sysptoms showned dramatic improvement in the patient after treatment.Conclusion:HIT has a higher mortality rate, especially combined with heparin-induced thrombocytopenia and thrombosis syndrome (HITTS). Therefore, early recognition and diagnosis and timely treatment for HIT is very important. When the patients after anticoagulant therapies occured an absolute drop in platelet count below the normal range or a relative decrease of50%from baseline counts, we should highly suspected HIT. The platelet count of the patient in the case decrease71.7%, compared with before anticoagulant therapies, and the diagnosis of HIT is makesured by4T scoring system and detection of PF4/H antibodies. The patient appeared blue, purple, and pain at the area of her serveral toes. The changes of the patient’s toes were consistented with the clinical manifestation of BTS, which was caused by HIT complicating with microcirculatory. Asprin, Clopidogrel and alprostadil are a safe and effective strategy for the treatment of HIT complicating with BTS.