Proposed Role of Thromboelastometry Assay in Discerning Coagulation Pattern of Patients Suffering Immune-Mediated Thrombocytopenia
Journal Title: Journal of Anesthesia and Surgery - Year 2017, Vol 4, Issue 1
Abstract
Platelet-derived antigens can trigger immune-mediated responses the most common of which is heparin-induced thrombocytopenia HIT IgG antibodies to platelet factor 4 PF4 -heparin complexes trigger the clinical manifestations of HIT Only a subset of these antibodies will activate platelets and release of platelet-derived microparticles PMPs which heightened thrombin generation TG and fibrin polymerization leading to modify fibrin network structure All together result in heparin-induced thrombosis thrombocitopenia HITT. The effectiveness of HIT laboratory testing by means of immunoassays is largely dependent on the method used whereas functional tests which can demonstrate the platelet-activating properties of HIT-antibodies are currently limited to a few laboratories We present 3 patients with suspected diagnosis of HIT Thromboelastometry ROTEM reg assay with the first derivative of the clot growth velocity curve V-curve variables was used for rapid differential diagnosis Despite of standard variables similarity the V-curve differed in the 3 patients In the patient who developed HITT the V-curve showed an exceptionally high maximum velocity of fibrin formation 22 mm s-1 with a critically low maximal lysis 1 suggesting procoagulant state whereas these values were normal 10 mm s-1 and 12 respectively in the patient without HITT In the patient with a definitive diagnosis of irofiban-induced severe thrombocitopenia maximum velocity of fibrin formation was markedly low 5 mm s-1 with moderate hyperfibrinolysis 21 indicating hypocoagulable state In patients suffering from immune-mediated thrombocytopenia viscoelastic assays could provide useful information
Authors and Affiliations
Pilar Taura
Keywords
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- EP ID EP418835
- DOI 10.15436/2377-1364.17.066
- Views 123
- Downloads 0
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