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BJA Advance Access published online on August 16, 2006
British Journal of Anaesthesia, doi:10.1093/bja/ael234
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org
Accepted July 5, 2006

Case Report

Disseminated intravascular clotting associated with Fc-receptor IIa-mediated platelet activation in a patient with endocarditis after aortic valve replacement

E. Kottenberg-Assenmacher 1 *, L. Volbracht 2, H. Jakob 3, A. Greinacher 4, and J. Peters 1

1 Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Essen, Hufelandstrasse 55, D-45122 Essen, Germany
2 Abteilung für Klinische Chemie und Laboratoriumsdiagnostik, Universitätsklinikum Essen, Hufelandstrasse 55, D-45122 Essen, Germany
3 Klinik für Thorax- und Kardiovaskuläre Chirurgie, Universitätsklinikum Essen, Hufelandstrasse 55, D-45122 Essen, Germany
4 Klinik für Immunologie und Transfusionsmedizin, Universitätsklinikum Greifswald, Fleischmannstrasse 8, 17475 Greifswald, Germany

* To whom correspondence should be addressed.
E. Kottenberg-Assenmacher, E-mail: eva.kottenberg{at}uni-essen.de


  Abstract

This report describes fatal disseminated cardiovascular thrombosis associated with Fc-receptor IIa-mediated platelet activation during surgery for aortic valve replacement in a patient with endocarditis. The patient's serum contained antibodies which strongly activated platelets via the Fc-receptor IIa. Antibodies did not bind to platelet factor 4 or aprotinin and binding was independent of heparin. The mechanisms and differential diagnosis for such a complication are discussed. Our data show for the first time in a patient with endocarditis that, beside HIT, other immune complexes can induce massive intravascular coagulation via platelet Fc-receptor IIa activation.

Keywords: blood, coagulation, intravascular; blood, cells, platelets; Fc-receptor IIa.
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Fatal Thrombosis during Cardiac Surgery for Endocarditis: possible role of subclinical DIC
John Augoustides MD, FASE
British Journal of Anaesthesia, 4 Jan 2007 [Full text]
Re: Fatal Thrombosis during Cardiac Surgery for Endocarditis: possible role of subclinical DIC
Dr. Eva Kottenberg-Assenmacher, et al.
British Journal of Anaesthesia, 24 Jan 2007 [Full text]

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