Trombocitopenia adquirida e cirurgia cardíaca: relato de caso

Abstract

RBCCV 44205-587Giffhorn H, Rampinelli A, Bonatelli Filho L, Collaço J -Trombocitopenia adquirida e cirurgia cardíaca: relato de caso. Rev Bras Cir Cardiovasc 2002; 17(2): 58-62.RESUMO: Trombocitopenia é um grande problema hemostático em pacientes submetidos à cirurgia cardíaca. Relataremos dois casos de pacientes com diminuição adquirida das plaquetas: um devido a uremia e outro por disfunção valvar (disfunção de prótese em posição mitral). Estes pacientes tiveram períodos de transoperatório e pós-operatório imediato sem intercorrência. A perda sangüínea não foi maior do que a esperada. A transfusão de plaquetas realizada durante a operação pode prevenir futuras complicações na recuperação do paciente.

Trombocitopenia em cirurgia cardíaca: importância diagnóstica e prognóstica

“…Nevertheless, if we consider that studies show up to 70% of patients undergoing CABG with positive antibodies, it may not have other clinical findings of HIT and, the absence of antibody does not exclude the diagnosis of HIT, with possible further seroconversion [5]. Moreover, in a recent study [33], the 4Ts score is compared with the laboratory diagnosis of HIT and then the perspective of this score to be a clinical tool for screening is discussed, in order to identify the individual risk of each patient to have this disease.…”

“…Patients undergoing cardiac surgery has a high probability of developing thrombocytopenia, from 35% to 65% of the patients. A recognized cause of thrombocytopenia, among many, is the heparin-induced thrombocytopenia (HIT) that has two types: I -caused by direct interaction between heparin and platelets, with no immunologic etiology and appears very early; II -caused by immune reaction mediated by antibodies which react with the heparin-platelet factor 4 complex and, bind themselves to the platelets surface to induce the important thrombocytopenias [3][4][5].…”