Severe heparin-induced thrombocytopenia: When the obvious is not obvious, a case report

被引：11

作者：

Cormack G.M. ^{[1
]}

Kaufman L.J. ^{[1
]}

机构：

[1] Department of Medicine, University of Hawaii, St. Francis Medical Center, Honolulu, HI

来源：

Journal of Medical Case Reports | / 1卷 / 1期

关键词：

Bivalirudin; Argatroban; Lepirudin; Intraaortic Balloon Pump; Heparin Exposure;

D O I：

10.1186/1752-1947-1-13

中图分类号：

学科分类号：

摘要：

Thrombocytopenia commonly occurs in hospitalized patients, particularly critically ill patients. We present an exemplifying case of severe heparin-induced thrombocytopenia (HIT) in an effort to solidify its high priority in the differential diagnosis of thrombocytopenia. A 75-year-old female underwent cardiac surgery with intraaortic balloon pump (IABP) placement. A platelet count drop to 25 × 10(9)/L by the third postoperative day was attributed to the IABP, which was removed. Her thrombocytopenia remained refractory to multiple platelet transfusions over several days. Right hand cyanosis then developed, attributed to a right radial arterial catheter, which was removed. All toes and fingers then showed severe ischemic changes. Ten days after the initial platelet count drop, a critical care specialist new to the treating team suspected HIT. Heparin exposure was stopped and argatroban was initiated. A HIT antibody test was subsequently strongly positive. The patients thrombocytopenia gradually resolved. No additional thromboses occurred during a 27-day intensive care unit stay. This case underscores the need for vigilance in suspecting HIT in patients with thrombocytopenia and recent heparin exposure. To avoid catastrophic outcomes in such patients, heparin should be stopped and alternative anticoagulation should be initiated, at least until HIT is excluded. © 2007 Cormack and Kaufman; licensee BioMed Central Ltd.

引用

共 14 条

[1]

Campbell K.R., Mahaffey K.W., Lewis B.E., Bivalirudin in patients with heparin-induced thrombocytopenia undergoing percutaneous coronary intervention, J Invas Cardiol, 12, SUPPL. F, (2000)

[2]

Jang I.K., Hursting M.J., When heparins promote thrombosis: Review of heparin-induced thrombocytopenia, Circulation, 111, pp. 2671-2683, (2005)

[3]

Warkentin T.E., Greinacher A., Heparin-induced thrombocytopenia: Recognition, treatment, and prevention: The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy, Chest, 126, (2004)

[4]

Rice L., Heparin-induced thrombocytopenia: Myths and misconceptions (that will cause trouble for you and your patient), Arch Intern Med, 164, pp. 1961-1964, (2004)

[5]

Harenberg J., Huhle G., Giese C., Determination of serotonin release from platelets by enzyme immunoassay in the diagnosis of heparin-induced thrombocytopenia, Br J Haematol, 109, pp. 182-186, (2000)

[6]

Warkentin T.E., Heparin-induced thrombocytopenia: Diagnosis and management, Circulation, 110, 18

[7]

Warkentin T.E., Kelton J.G., A 14-year study of heparin-induced thrombocytopenia, Am J Med, 101, pp. 502-507, (1996)

[8]

Greinacher A., Farner B., Kroll H., Clinical features of heparin-induced thrombocytopenia including risk factors for thrombosis: A retrospective analysis of 408 patients, Thromb Haemost, 94, pp. 132-135, (2005)

[9]

Hirsh J., Heddle N., Kelton J.G., Treatment of heparin-induced thrombocytopenia: A critical review, Arch Int Med, 164, pp. 361-369, (2004)

[10]

Wallis D.E., Workman D.L., Lewis B.E., Failure of early heparin cessation as treatment for heparin-induced thrombocytopenia, Am J Med, 106, pp. 629-635, (1999)

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