Thrombocytopenia After PDA Occlusion 动脉导管未闭封堵术后血小板减少症 1 例 Xu Li （徐 立） Wang Lefeng （王乐丰） Heart Center, Beijing Chaoyang Hospital 北京朝阳医院 Beijing Chaoyang Hospital

History Female ， 45yrs dyspnea for 2 months UCG ： PDA ， SPAP=62mmHg 。 ECG ： Af SO 2 ： 97.8% 。 Hb ： 139g/L ， PLT ： 169×10 9 /L

Heparin of 5000U was usedHeparin of 5000U was used Pulmonary artery pressure: 69/32 (48) mmHgPulmonary artery pressure: 69/32 (48) mmHg

PDA occluder of 18/20 mm was implanted Repeat angiography 10 minutes later showed minor residual shunt

Test 1 day later showed Hb of 126g/L and PLT of 78×10 9 /L ， which was ignored Pseudo aneurysm in femoral artery was confirmed by echo 2 days later –Hb ： 113g/L ， and PLT ： 29×10 9 /L 。 –Repeat examination: PLT of 28×10 9 /L ， –Manual count ： PLT of 33×10 9 /L Urine and blood test ： bilirubin level was normal PA-IgG: negative UCG ： minor residual shunt (v:100cm/s) History

Rare BG ： O type ， and RH (-) Glucocorticoids were used from the 4th day after operation ： –DXM 10mg+NS100ml ivgtt Qd×3 days ， followed by –Prednisone 10mg tid ×3 days ，  10mg bid ×3 days  10mg qd 5% NaHCO3 125ml qd ×3 days Respondence to glucocorticoids ： –1 day later: PLT:37× 10 9 /L –3 days later: PLT count was normal (109 × 10 9 /L) Pseudo aneurysm in FA was closed by thrombin injection with guidance of echo History

Follow-up Repeat UCG showed no residual shunt 10 days after operation The patient was discharged, and prednisone (10mg qd ) was prescribed for 1 month. During follow-up of 12 months, the patient was good, and PLT count was normal.

入院 手术 2 地塞米松 10mg 强的松 10mg tid 血小板血小板 × 10/L × 10 9 /L Trend of PLT counts 极少量残余分流 无残 余分流 10 少量残余分流

Discussion ： what’s the reason? Medication related? –Antibiotic ？ Levofloxacin for urinary infection. –Heparin induced thrombocytopenia ？ Type I of HIT: HIT I occurs in 1-2 days after heparin administration. However, PLT Count is more than 100×10 9 /L mostly. Type II of HIT: HIT II is with severe PLT Count decrease ( less than 100×10 9 /L). However, HIT II occurs lately (in 4-14 days after heparin administration mostly).

Mechanical injury related? –No ： No significant decrease of hemoglobin （ g/L ） Normal bilirubin level in urine and blood test –Yes ： Trend of PLT count recovery after glucocorticoids therapy There were residual shunt immediately and 24 hrs after operation. While repeat echo showed residual shunt disappeared, PLT count was normal. Similar with IABP related thrombocytopenia? Discussion ： what’s the reason?

Conclusion Sever thrombocytopenia might occurs after PDA occlusion. If there is residual shunt, mechanical injury may be the reason Correct therapy of glucocorticoids in time by monitoring PLT count and residual shunt is important

Thanks ！ 北京朝阳医院 Beijing Chaoyang Hospital