Disseminated intravascular clotting associated with Fc-receptor IIa-mediated platelet activation in a patient with endocarditis after aortic valve replacement.
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.
Kottenberg-Assenmacher
E
E
Klinik für Anästhesiologie und Intensivmedizin Hufelandstrasse 55, D-45122 Essen, Germany. eva.kottenberg@uni-essen.de
Volbracht
L
L
Jakob
H
H
Greinacher
A
A
Peters
J
J
D015703:Antigens, CD / Q000502:physiology*; D001021:Aortic Valve / Q000601:surgery*; D004211:Disseminated Intravascular Coagulation / Q000209:etiology*; D004697:Endocarditis, Bacterial / Q000150:complications; D017809:Fatal Outcome; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D007431:Intraoperative Complications; D008875:Middle Aged; D015539:Platelet Activation; D017452:Receptors, IgG / Q000502:physiology*
D015703:Antigens, CD; C080568:Fc gamma receptor IIA; D017452:Receptors, IgG