Postviral Platelet-Activating Anti-PF4 Disorder Responsive to High-Dose Intravenous Immunoglobulin

A 54-year-old man presented with diffuse bleeding and thrombosis and was initially considered to have immune thrombocytopenia and, later, disseminated intravascular coagulation. Ultimately, the condition was determined to be due to a platelet-activating antiplatelet factor 4 (anti-PF4) disorder, pre...

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Bibliographic Details
Main Authors: Min Woo Hwang, William B. Ershler
Format: Article
Language:English
Published: American College of Physicians 2024-06-01
Series:Annals of Internal Medicine: Clinical Cases
Online Access:https://www.acpjournals.org/doi/10.7326/aimcc.2024.0095
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Summary:A 54-year-old man presented with diffuse bleeding and thrombosis and was initially considered to have immune thrombocytopenia and, later, disseminated intravascular coagulation. Ultimately, the condition was determined to be due to a platelet-activating antiplatelet factor 4 (anti-PF4) disorder, preceded by an upper respiratory infection in the absence of prior heparin use. The heparin antibody assay showed a highly positive titer at 2.301 OD, with a strongly positive serotonin release assay at 78% with 0.1 U/mL unfractionated heparin, confirming the diagnosis. We successfully managed the postviral anti-PF4 disorder with intravenous immunoglobulin, in addition to anticoagulation with argatroban.
ISSN:2767-7664