PDF(Pubmed)
Abstract：
A 68-year-old woman was admitted to the hospital for elective total knee arthroplasty in both knees without preceding heparin exposure. She developed adrenal haemorrhage and thrombocytopaenia on postoperative day 12, followed by right leg arterial occlusion and multiple venous intra-abdominal sites thrombosis. After given unfractionated heparin to treat arterial occlusion, platelet count was gradually declined. Spontaneous heparin-induced thrombocytopaenia was diagnosed by heparin-induced platelet activation test with light transmission aggregometry. The patient was successfully treated with fondaparinux and intravenous immunoglobulin. Apixaban was given after recovery of platelet count. Resolution of both thrombus along aorta and adrenal haemorrhage were shown by CT of whole abdomen after 2 months of treatment. Our case demonstrates that this serious complication is important but seldom recognised early.
摘要：
一名68岁的妇女在没有事先接触肝素的情况下被送往医院进行双膝选择性全膝关节置换术。她在术后第12天出现肾上腺出血和血小板减少症，随后出现右腿动脉闭塞和多个静脉腹内部位血栓形成。在给予普通肝素治疗动脉闭塞后，血小板计数逐渐下降。自发性肝素诱导的血小板减少症通过肝素诱导的血小板活化试验和光透射聚集测定法诊断。患者成功接受磺达肝素和静脉注射免疫球蛋白治疗。血小板计数恢复后给予阿哌沙班。治疗2个月后，整个腹部的CT显示沿主动脉的血栓和肾上腺出血的消退。我们的案例表明，这种严重的并发症很重要，但很少早期发现。
