Preview

Meditsinskiy sovet = Medical Council

Advanced search

THROMBOCYTOPENIA IN THE STRUCTURE OF HEMATOLOGICAL DISORDERS IN PATIENTS OF A MULTIPROFILE HOSPITAL AND POSSIBLE WAYS TO OPTIMIZE ITS EVALUATION

https://doi.org/10.21518/2079-701X-2017-20-14-19

Abstract

Analysis of the prevalence of thrombocytopenia in a multidisciplinary hospital, where it is treated about 25,000 patients a year, shows that from 1.15% to 1.45% of patients have threat reduction platelets less than 100x109/l. 40,2% of them (on average, 127 people per year) receive heparin and can potentially be seen as patients that are suspected to heparin-induced thrombocytopenia (HIT). Timely identification of such patients, the use of two rules – 4T and «100–5—100» allows you not to miss the patient with the development of HIT, time to switch to alternative anticoagulants and, if necessary, to stop the flushing of venous catheters with heparin solution. This tactic allows to reduce the number of patients, receiving heparin and thrombocytopenia below 100 х 109/l, almost 3 times as took place among hospitalized and patients in intensive care units in 3 years of using the mentioned tactics.

About the Authors

S. Yu. Semigolovskii
Sokolov’ Hospital №122 of Federal Medical and Biological Agency; Sankt-Petersburg State University.
Russian Federation

MD, Prof.

Sankt-Petersburg.

 



T. V. Vavilova
Almazov’ National Medical Research Centre.
Russian Federation

MD, Prof.

Sankt-Petersburg.



V. A. Kashchenko
Sokolov’ Hospital №122 of Federal Medical and Biological Agency; Sankt-Petersburg State University.
Russian Federation

MD.

Sankt-Petersburg.



S. N. Semigolovskii
Sankt-Petersburg State University.
Russian Federation
Sankt-Petersburg.


A. A. Sapegin
Sokolov’ Hospital №122 of Federal Medical and Biological Agency.
Russian Federation

PhD in Medicine.

Sankt-Petersburg.



References

1. Вагнер Д.О., Вербицкий В.Г., Шлык И.В., Курыгин Ал.А. Негативные последствия антисекреторной терапии и способы их предупреждения у пострадавших с обширными ожогами. Вестник хирургии им. И.И. Грекова, 2015, 174(3): 108-112.

2. Дуткевич И.Г., Сухомлина Е.Н., Селиванов Е.А. (2010). Основы клинической гемостазиологии. СПб.: ООО ИПК Коста, 2010. 144 с.

3. Енисеева Е.С., Власюк Т.П. Острый стенттромбоз у больного с гепарин-индуцированной тромбоцитопенией. Сибирский мед. журнал, 2013, 5: 130-131.

4. Arepally GM, Ortel TL. Clinical practice. Heparin-induced thrombocytopenia. N. Engl. J. Med., 2006, 355(8): 809-817.

5. Arnold DM, Nazi I, Warkentin TE, Smith JW, et al. Approach to the diagnosis and management of drug-induced immune thrombocytopenia. Transfus. Med. Rev., 2013, 27(3): 137-145.

6. Aster RH. Drug-induced immune cytopenias. Toxicology, 2005, 209: 149-153.

7. Bangia AN, Kamath N, Mohan V. Ranitidineinduced thrombocytopeniа: a rare drug reaction. Indian J. Pharmacol., 2011, 43: 76-77.

8. Barilla D, Martinelli GL, Cotroneo A, Romano A, Iacopino P. Thrombosis due to Heparin-induced Thrombocytopenia in Cardiac Surgery: is Fondaparinux an Effective Treatment? J Cardiovasc Dis Diagn, 2016, 4(3): 240-245.

9. Boshkov LK, Warkentin TE, Hayward CP, Andrew M, Kelton JG. Heparin-induced thrombocytopenia and thrombosis: clinical and laboratory studies. Br J Haematol, 1993, 84(2): 322-328.

10. Cuker A, Gimotty PA, Crowther MA, Warkentin TE. Predictive value of the 4Ts scoring system for heparin-induced thrombocytopenia: a systematic review and meta-analysis. Blood, 2012, 120(20): 4160-4167.

11. Curtis BR. Drug-induced immune thrombocytopenia: incidence, clinical features, laboratory testing, and pathogenic mechanisms. Immunohematology, 2014, 30(2): 55-65.

12. Datta I, Ball CG, Rudmik L, et al. Complications related to deep venous thrombosis prophylaxis in trauma: a systematic review of the literature. J Trauma Manag Outcomes, 2010, 4: 1-21.

13. Fabris F, Ahmad S, Cella G, Jeske WP, Walenga JM, Fareed J. Pathophysiology of heparininduced thrombocytopenia. Clinical and diagnostic implications – a review. Arch Pathol Lab Med, 2000, 124(11): 1657-1666.

14. Gentilini G, Curtis BR, Aster RH. An antibody from a patient with ranitidine-induced thrombocytopenia recognizes a site on glycoprotein IX that is a favored target for drug-induced antibodies. Blood, 1998, 92(7): 2359-2365.

15. Greinacher A, Selleng K. Thrombocytopenia in the Intensive Care Unit Patient. ASH Education Book, 2010, 2010(1): 135-143.

16. Greinacher A, Warkentin ThE. Heparin-induced thrombocytopenia. New York, N.Y: Marcel Dekker. 2004: 106-107.

17. Jang I-K, Hursting MJ. Thrombocytopenia when heparins promote thrombosis: review of heparin-induced thrombocytopenia. Circulation, 2005, 111: 2671-2683.

18. Kang M, Alahmadi M, Sawh S, Kovacs MJ, LazoLangner A. Fondaparinux for the treatment of suspected heparin-induced thrombocytopenia: a propensity score-matched study. Blood, 2015, 125(6): 924-929.

19. Levi M. Platelets in sepsis. Hematology, 2005, 10(Supplement 1): 129-131.

20. Linkins LA, Dans AL, Moores LK, et al. Treatment and prevention of heparin-induced thrombocytopenia: antithrombotic therapy and prevention of thrombosis: American College of Chest Physicians evidence-based clinical practice guidelines. CHEST Journal, 2012, 141: e495S-e530S.

21. Motokawa S, Torigoshi T, Maeda Y, et al. IgG-class anti-PF4/heparin antibodies and symptomatic DVT in orthopedic surgery patients receiving different anti-thromboembolic prophylaxis therapeutics. BMC Musculoskelet Disord, 2011, 12: 22-34.

22. Pearson M, Nadeau Ch, Blais N. Correlation of ELISA Optical Density With Clinical Diagnosis of Heparin-Induced Thrombocytopenia. A Retrospective Study of 104 Patients With Positive Anti-PF4/Heparin ELISA. Clin Appl Thromb Hemost, 2014, 20(4): 349-354.

23. Pouplard C, May M-A, Iochmann S, et al. Antibodies to Platelet Factor 4–Heparin After Cardiopulmonary Bypass in Patients Anticoagulated With Unfractionated Heparin or a Low-Molecular-Weight Heparin: Clinical Implications for Heparin-Induced Thrombocytopenia. Circulation, 1999, 99: 2530-2536.

24. Salter BS, Weiner MW, Trinh MA, et al. HeparinInduced Thrombocytopenia: A Comprehensive Clinical Review. J Am Coll Cardiol, 2016, 67: 2519-2532.

25. Selleng K, Warkentin TE, Greinacher A. Heparininduced thrombocytopenia in intensive care patients. Crit Care Med, 2007, 35: 1165-1176.

26. Wilke T, Tesch S, Scholz A, et al. The costs of heparin-induced thrombocytopenia: a patientbased cost of illness analysis. J Thromb Haemost, 2009, 7: 766-773.

27. Schindewolf M, Steindl J, Beyer-Westendorf J, et al. Frequent of-label use of fondaparinux in patients with suspected acute heparin-induced thrombocytopenia (HIT)-findings from the GerHIT multi-centre registry study. Thrombosis research, 2014, 134: 29-35.

28. Warkentin TE. New approaches to the diagnosis of heparin-induced thrombocytopenia. Chest, 2005, 127: 35-45.

29. Warkentin TE. Heparin-induced thrombocytopenia in critically ill patients. Semin Thromb Hemost, 2015, 41(1): 49-60.

30. Warkentin TE. Clinical picture of heparininduced thrombocytopenia (HIT) and its differentiation from non-HIT thrombocytopenia. Thromb Haemost, 2016, 116(5): 813-822.

31. Warkentin TE, Aird WC, Rand JH. Plateletendothelial interactions: sepsis, HIT, and antiphospholipid syndrome. Hematology (Am Soc of Hematol Educ Program), 2003: 497-419.

32. Warkentin TE, Greinacher A. Management of heparin-induced thrombocytopenia. Curr Opin Hematol, 2016, 5: 462-470.

33. Warkentin TE, Greinacher A. So, does low-molecular-weight heparin cause less heparin-induced thrombocytopenia than unfractionated heparin or not? Chest, 2007, 132(4): 1108–1110.

34. Warkentin TE, Heddle NM. Laboratory diagnosis of immune heparin-induced thrombocytopenia. Curr. Hematol. Rep., 2003, 2(2): 148-157.

35. Warkentin TE, Kelton JG. Temporal aspects of heparin-induced thrombocytopenia. N Engl J Med, 2001, 344: 1286-1292.

36. Warkentin TE, Sheppard JA, Heels-Ansdell D et al. Heparin-induced thrombocytopenia in medical surgical critical illness. Chest, 2013, 144(3): 848-858.


Review

For citations:


Semigolovskii SY, Vavilova TV, Kashchenko VA, Semigolovskii SN, Sapegin AA. THROMBOCYTOPENIA IN THE STRUCTURE OF HEMATOLOGICAL DISORDERS IN PATIENTS OF A MULTIPROFILE HOSPITAL AND POSSIBLE WAYS TO OPTIMIZE ITS EVALUATION. Meditsinskiy sovet = Medical Council. 2017;(20):14-19. (In Russ.) https://doi.org/10.21518/2079-701X-2017-20-14-19

Views: 655


Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


ISSN 2079-701X (Print)
ISSN 2658-5790 (Online)