Heparin-induzierte Thrombozytopenie und Hämofiltration: Regionale Antikoagulation des extrakorporalen Kreislaufs mit Natriumcitrat

Zusammenfassung.

Die heparin-induzierte Thrombozytopenie (HIT) gewinnt gerade auch in der Intensivmedizin zunehmende Bedeutung. Wir beschreiben Symptomatik, Diagnostik und Therapie bei einem Patienten mit Sepsis und akutem Nierenversagen mit kontinuierlicher Hämofiltration und Heparinantikoagulation, der eine HIT Typ II entwickelte. Verschiedene Alternativen der Antikoagulation des extrakorporalen Kreislaufs werden diskutiert. Die Durchführung einer Antikoagulation mit Natriumcitrat wird besprochen. Engmaschige Überwachung und gegebenenfalls Korrekturen von Serumkalziumspiegel und Säure-Basen-Haushalt sind notwendig. Es wird gezeigt, daß die regionale Antikoagulation mit Natriumcitrat ein effektives und sicheres Verfahren darstellt.

The symptoms, diagnosis, and therapy for a septic patient with acute renal failure on continuous hemofiltration and heparin-anticoagulation who developed heparin-induced thrombocytopenia type II are described. Different alternatives for anticoagulation of extracorporal circulation are discussed. The principles of anticoagulation with sodium citrate are presented. lt is necessary to closely monitor and, if need be, correct the serum calcium levels and acid base metabolism. We show that regional anticoagulation with sodium citrate is an effective and safe treatment.

Schlüsselwörter:

Heparininduzierte Thrombozytopenie - Regionale Antikoagulation - Natriumcitrat - Hämofiltration

Key words:

Heparin-induced - Regional anticoagulation - Sodium citrate - Hemofiltration

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