Abstract
On the basis of a patient with fulminant meningococcaemia and severe disseminated intravascular coagulation (DIC) syndrome, the diagnostic potential of a clot impedance test — Sonoclot coagulation analysis — was used to evaluate plasma exchange. A 17-yr-old girl was treated for a fulminant infection with Neisseria meningitidis in our intensive care unit. She developed severe DIC. Whereas platelet administration caused immediate arterial oxygen desaturation necessitating ventilatory support, plasma exchange improved pulmonary and mental function. Three separate exchanges all improved haemostasis. Sonoclot analysis was used together with routine coagulation analyses to evaluate this DIC treatment. Sonoclot signs, such as lack of the shoulder and peak, prolonged shoulder-peak interval and peak time predicted clinical bleeding manifestations (haematuria, haemoptysis, epistaxis) and were improved by platelet transfusion and plasma exchange. Plasma exchange was successful even at a very low platelet count of < 23 × 109 · L−1. Sonoclot coagulation analyses were normalised several days before routine coagulation analyses. The Sonoclot gave additional information to routine coagulation studies, correctly indicated insufficient haemostasis and predicted a positive outcome. Also, plasma exchanges and platelet transfusions could be controlled in the management of DIC.
Résumé
A l’occasion d’une méningococcémie fulminante (syndrome de Waterhouse-Friderichsen) compliquée d’une coagulation intravasculaire disséminée grave (CIVD), le potentiel diagnostic du test d’impédance du caillot, l’analyse de coagulation Sonoclot, est utilisé pour évaluer la plasmaphérèse. Une jeune fille de 17 ans déjà sous traitement pour une méningite fulminante neissérienne dans notre unité de soins intensifs développe une CIVD grave. Comme l’administration de plaquettes produit une désaturation artérielle subite nécessitant une assistance ventilatoire, on a recours à la plasmaphérèse qui amélior l’activité mentale et pulmonaire. Trois échanges consécutifs restaurent l’hémostase. L’analyse au Sonoclot est utilisée en même temps que les tests de coagulation habituels pour évaluer le traitement de la CIVD. Les indications du Sonoclot, comme l’absence d’épaule et de pointe, la prolongation de l’intervalle épaule-pointe et l’instant du pic prédisent les manifestations cliniques du saignement (hématurie, hémoptysie, epistaxis) qui sont améliorés par la plasmaphérèse. La plasmaphérèse est efficace même lorsque le décompte des plaquettes est inférieur à 23 × 109 · L−1. Les analyses du Sonoclot sont redevenues à la normale plusieurs jours avant les tests de coagulations habituels. Le Sonoclot a donné des renseignements supplémentaires sur les épreuves de coagulation habaituels en décelant l’insuffisance de l’hémostase et en prédisant l’évolution favorable. La plasmaphérèse et les transfusions de plaquettes ont pu être contrôlées pendant le traitement de la CIVD
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References
Fox B. Disseminated intravascular coagulation and the Waterhouse-Friderichsen syndrome. Arch Dis Child 1971; 46: 680–5.
Raman GV. Meningococcal septicaemia and meningitis: a rising tide (Editorial). BMJ 1988; 296: 1141–2.
Anonymous: Fever with purpura (Editorial). The Lancet 1990; 335: 889.
Bjorvatn B, Bjertnaes L, Fadnes HO, et al. Meningococcal septicaemia treated with combined plasmapheresis and leucapheresis or with blood exchange. BMJ 1984; 288: 439–41.
Scharfman WB, Tillotson JR, Taft EG, Wright E. Plasmapheresis for meningococcemia with disseminated intravascular coagulation (Letter). N Engl J Med 1979; 300: 1277–8.
Drapkin MS, Wisch JS, Gelfand JA, Cannon JG, Dinarello CA. Plasmapheresis for fulminant meningococcemia. Pediatr Infect Dis J 1989; 8: 399–400.
van Deuren M, Santman FW, van Dalen R, Sauerwein RW, Span LFR, van der Meer JWM. Plasma and whole blood exchange in meningococcal sepsis. Clin Infect Dis 1992; 15: 424–30.
McClelland P, Williams PS, Yaqoob M, Mosafa SM, Bone JM. Multiple organ failure — a role for plasma exchange? Intensive Care Med 1990; 3: 100–3.
Gurland HJ, Lysaght MJ, Samtleben W. Immunomodulation: clinical aspects. Artif Organs 1986; 10: 122–7.
Zuckerman L, Cohen E, Vagher JP, Woodward E, Caprini JA. Comparison of thrombelastography with common coagulation tests. Thromb Haemost 1981; 46: 752–6.
von Kaulla KN, Ostendorf P, von Kaulla E. The impedance machine: a new bedside coagulation recording device. J Med 1975; 6: 73–88.
Saleem A, Bitfeld C, Saleh SA, et al. Viscoelastic measurement of clot formation: a new test of platelet function. Ann Clin Lab Sci 1983; 13: 115–24.
Tuman KJ, Spiess BD, McCarthy RJ, Ivankovich AD. Comparison of viscoelastic measures of coagulation after cardiopulmonary bypass. Anesth Analg 1989; 69: 69–75.
Bitfeld C, Courtney JT, Gross JR. Assessment of neonatal platelet function using a viscoelastic technique. Ann Clin Lab Sci 1986; 16: 373–81.
Tesoro LJ, Selbst SM. Factors affecting outcome in meningococcal infections. American Journal of Diseases of Children 1991; 145: 218–20.
Nikson I, Schött U. Sonoclot coagulation analysis and antithrombin treatment (Abstract) Thromb Haemost 1991; 65: 909.
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Schött, U., Björsell-Östling, E. Sonoclot coagulation analysis and plasma exchange in a case of meningococcal septicaemia. Can J Anaesth 42, 64–68 (1995). https://doi.org/10.1007/BF03010573
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DOI: https://doi.org/10.1007/BF03010573