Academic Journal
Very severe thrombocytopenia and fragmentation hemolysis mimicking thrombotic thrombocytopenic purpura associated with a giant intracardiac vegetation infected with Staphylococcus epidermidis: Role of monocyte procoagulant activity induced by bacterial supernatant
| العنوان: | Very severe thrombocytopenia and fragmentation hemolysis mimicking thrombotic thrombocytopenic purpura associated with a giant intracardiac vegetation infected with Staphylococcus epidermidis: Role of monocyte procoagulant activity induced by bacterial supernatant |
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| المؤلفون: | Selleng, Kathleen, Warkentin, Theodore E., Greinacher, Andreas, Morris, Andrew M., Walker, Irwin R., Heggtveit, H. Alexander, Eichler, Petra, Cybulsky, Irene J. |
| المصدر: | American Journal of Hematology ; volume 82, issue 8, page 766-771 ; ISSN 0361-8609 1096-8652 |
| بيانات النشر: | Wiley |
| سنة النشر: | 2006 |
| المجموعة: | Wiley Online Library (Open Access Articles via Crossref) |
| الوصف: | The pathogenesis of very severe thrombocytopenia in bacterial endocarditis is uncertain. We report a 50‐year‐old male with platelet counts < 10 × 10 9 /l and fragmentation hemolysis complicating Staphyloccoccus epidermidis pacemaker endocarditis with a giant vegetation. Antibiotics, corticosteroids, high‐dose intravenous gammaglobulin, and plasmapheresis (for initially‐suspected thrombotic thrombocytopenic purpura) failed to produce significant platelet count increase. However, therapeutic‐dose heparin anticoagulation was associated with a platelet count increase from <10 to ∼40 × 10 9 /l, with parallel reduction in thrombin‐antithrombin complexes (from 8.9 to 3.5 μg/l), facilitating surgical intervention. The thrombocytopenia promptly resolved following surgical removal of the vegetation. Culture supernatant from S. epidermidis isolated from the patient's blood induced monocytes to express procoagulant activity (assessed by factor Xa generation) equivalent to lipopolysaccharide (1 μg/ml), with half‐maximal activation seen with culture supernatant diluted to 1:12,800. These data are consistent with previous animal models of endocarditis demonstrating staphylococci‐induced procoagulant changes in monocytes. This case demonstrates that heparin anticoagulation can be therapeutic in infective endocarditis‐associated severe thrombocytopenia in a non‐bleeding patient, and that such therapy may ameliorate the platelet count enough to permit surgical intervention. Am. J. Hematol 2007. © 2006 Wiley‐Liss, Inc. |
| نوع الوثيقة: | article in journal/newspaper |
| اللغة: | English |
| DOI: | 10.1002/ajh.20821 |
| الاتاحة: | http://dx.doi.org/10.1002/ajh.20821 https://api.wiley.com/onlinelibrary/tdm/v1/articles/10.1002%2Fajh.20821 https://onlinelibrary.wiley.com/doi/pdf/10.1002/ajh.20821 |
| Rights: | http://onlinelibrary.wiley.com/termsAndConditions#vor |
| رقم الانضمام: | edsbas.519711F1 |
| قاعدة البيانات: | BASE |
| DOI: | 10.1002/ajh.20821 |
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