Spontaneous Heparin-Induced Thrombocytopenia and Venous Thromboembolism following Total Knee Arthroplasty

A 72-year-old Caucasian woman was admitted for an elective left total knee arthroplasty. Her surgery was uncomplicated and she was discharged to a rehabilitation facility. Twelve days later, she developed acute shortness of breath followed by a syncopal episode. She was hypoxic and cyanotic, requiri...

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Main Authors: Kevin Baker, Ming Y. Lim
Format: Article
Language:English
Published: Wiley 2017-01-01
Series:Case Reports in Hematology
Online Access:http://dx.doi.org/10.1155/2017/4918623
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author Kevin Baker
Ming Y. Lim
author_facet Kevin Baker
Ming Y. Lim
author_sort Kevin Baker
collection DOAJ
description A 72-year-old Caucasian woman was admitted for an elective left total knee arthroplasty. Her surgery was uncomplicated and she was discharged to a rehabilitation facility. Twelve days later, she developed acute shortness of breath followed by a syncopal episode. She was hypoxic and cyanotic, requiring hospitalization and intubation, and was subsequently diagnosed with bilateral submassive pulmonary emboli and bilateral lower extremity deep vein thrombosis. She was started on unfractionated heparin infusion. Within 24 hours of exposure, she had an acute decrease in platelet count to 48,000. Heparin was discontinued and argatroban was initiated due to concern for heparin-induced thrombocytopenia (HIT). Both quantitative enzyme immunoassay and functional assay confirmed the diagnosis of HIT. The patient had no prior lifetime heparin exposure. Given the absence of preceding heparin therapy, this case is consistent with the diagnosis of spontaneous HIT.
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spelling doaj-art-4be95edbd5ef4091b2c7f037523b002b2025-08-20T03:20:13ZengWileyCase Reports in Hematology2090-65602090-65792017-01-01201710.1155/2017/49186234918623Spontaneous Heparin-Induced Thrombocytopenia and Venous Thromboembolism following Total Knee ArthroplastyKevin Baker0Ming Y. Lim1Department of Medicine, Medical University of South Carolina, Charleston, SC, USADepartment of Medicine, Division of Hematology/Oncology, Medical University of South Carolina, Charleston, SC, USAA 72-year-old Caucasian woman was admitted for an elective left total knee arthroplasty. Her surgery was uncomplicated and she was discharged to a rehabilitation facility. Twelve days later, she developed acute shortness of breath followed by a syncopal episode. She was hypoxic and cyanotic, requiring hospitalization and intubation, and was subsequently diagnosed with bilateral submassive pulmonary emboli and bilateral lower extremity deep vein thrombosis. She was started on unfractionated heparin infusion. Within 24 hours of exposure, she had an acute decrease in platelet count to 48,000. Heparin was discontinued and argatroban was initiated due to concern for heparin-induced thrombocytopenia (HIT). Both quantitative enzyme immunoassay and functional assay confirmed the diagnosis of HIT. The patient had no prior lifetime heparin exposure. Given the absence of preceding heparin therapy, this case is consistent with the diagnosis of spontaneous HIT.http://dx.doi.org/10.1155/2017/4918623
spellingShingle Kevin Baker
Ming Y. Lim
Spontaneous Heparin-Induced Thrombocytopenia and Venous Thromboembolism following Total Knee Arthroplasty
Case Reports in Hematology
title Spontaneous Heparin-Induced Thrombocytopenia and Venous Thromboembolism following Total Knee Arthroplasty
title_full Spontaneous Heparin-Induced Thrombocytopenia and Venous Thromboembolism following Total Knee Arthroplasty
title_fullStr Spontaneous Heparin-Induced Thrombocytopenia and Venous Thromboembolism following Total Knee Arthroplasty
title_full_unstemmed Spontaneous Heparin-Induced Thrombocytopenia and Venous Thromboembolism following Total Knee Arthroplasty
title_short Spontaneous Heparin-Induced Thrombocytopenia and Venous Thromboembolism following Total Knee Arthroplasty
title_sort spontaneous heparin induced thrombocytopenia and venous thromboembolism following total knee arthroplasty
url http://dx.doi.org/10.1155/2017/4918623
work_keys_str_mv AT kevinbaker spontaneousheparininducedthrombocytopeniaandvenousthromboembolismfollowingtotalkneearthroplasty
AT mingylim spontaneousheparininducedthrombocytopeniaandvenousthromboembolismfollowingtotalkneearthroplasty