Тромбоцитопения у больных многопрофильного стационара и возможные пути оптимизации ее оценки

Журнал "Медицинский совет. Оториноларингология" № 20 2017г.

Н.Ю. Семиголовский^1,2, д.м.н., профессор, Т.В. Вавилова³, д.м.н., профессор, В.А. Кащенко^1,2, д.м.н., С.Н. Семиголовский², А.А. Сапегин¹, к.м.н.
¹ Клиническая больница №122 им. Л.Г. Соколова Федерального медико-биологического агентства России, Санкт-Петербург
² Санкт-Петербургский государственный университет
³ Национальный медицинский исследовательский центр им. В.А. Алмазова Минздрава России, Санкт-Петербург

Аннотация

Анализ распространенности тромбоцитопении в многопрофильном стационаре, где пролечивается около 25 000 больных в год, показывает, что от 1,15 до 1,45% пациентов имеют опасное снижение тромбоцитов менее 100 x 109/л. Так, 40,2% из них (в среднем 127 человек в год) получают гепарин и могут потенциально рассматриваться как больные, подозрительные на гепарининдуцированную тромоцитопению (ГИТ). Своевременное выявление таких пациентов, применение двух правил – 4Т и «100–5–100» – позволяет не пропустить больного с развитием ГИТ, вовремя перейти на альтернативные антикоагулянты и при необходимости прекратить промывание венозных катетеров раствором гепарина. Такая тактика позволяет уменьшить количество пациентов, получающих гепарин и имеющих тромбоцитопению ниже 100 х 109/л, почти в 3 раза как в общебольничных, так и в реанимационных отделениях за 3 года использования указанной тактики.

Ключ. слова: тромбоцитопения, гепарин-индуцированная тромбоцитопения (ГИТ), лекарственная тромбоцитопения, гепарины, иммунодиагностика, тромбоз, оригинальное Правило экспресс-диагностики ГИТ «100-5-100»

N.Yu. Semigolovskii^1,2 , MD, Prof., T.V. Vavilova³, MD, Prof., V.A. Kashchenko^1,2, MD, S.N. Semigolovskii², A.A. Sapegin¹, PhD in Medicine
¹ Sokolov’ Hospital №122 of Federal Medical and Biological Agency
² Sankt-Petersburg State University
³ Almazov’ National Medical Research Centre

Thrombocytopenia in the structure of hematological disorders in patients of a multiprofile hospital and possible ways to optimize its evaluation

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.

Keywords: thrombocytopenia, heparin-induced thrombocytopenia (HIT), drug-induced hrombocytopenia, heparins,immunodiagnostics, thrombosis, the original «Rule» of HIT diagnostics «100-5-100».

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