Heparin-Induced Thrombocytopenia Associated with Massive Intracardiac Thrombosis: A Case Report
A 60-years old patient was admitted to a community hospital with septic arthritis. He was treated with antibiotics and subcutaneous unfractionated heparin (UH) was used for venous thromboprophylaxis. After three days, he developed leg deep venous thrombosis and was treated with IV heparin. One day l...
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| Format: | Article |
| Language: | English |
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Wiley
2012-01-01
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| Series: | Case Reports in Hematology |
| Online Access: | http://dx.doi.org/10.1155/2012/257023 |
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| author | Atheer Ahmed Hamid AL-Mondhiry Truman J. Milling David Campbell |
| author_facet | Atheer Ahmed Hamid AL-Mondhiry Truman J. Milling David Campbell |
| author_sort | Atheer Ahmed |
| collection | DOAJ |
| description | A 60-years old patient was admitted to a community hospital with septic arthritis. He was treated with antibiotics and subcutaneous unfractionated heparin (UH) was used for venous thromboprophylaxis. After three days, he developed leg deep venous thrombosis and was treated with IV heparin. One day later, the patient developed pulmonary emboli, which was found using ventilation/perfusion scan. He was transferred to the University Hospital for further management. Upon arrival, antibiotic and intravenous UH were continued. Trans-Esophageal Echocardiogram showed a thrombus in the right atrium, a small portion of which extended to the left atrium through a patent foramen ovale. Another large thrombus was noted in the right ventricle, which extended to the pulmonary artery. Review of the patient’s medical records revealed a halving of his platelet count three days following the heparin administration. Therefore, HIT seemed very likely. Intravenous UH was stopped and an emergency thrombectomy was performed. ELISA testing of HIT antibodies came negative. This made HIT diagnosis unlikely and the patient received dalteparin. A week later, as the platelet count declined again, HIT antibodies’ testing using ELISA and C-14 serotonin release was repeated, and both assays were positive. Argatroban was restarted and the platelet count normalized. |
| format | Article |
| id | doaj-art-6a00e3ffb44c4ceca5612ced428484bc |
| institution | Kabale University |
| issn | 2090-6560 2090-6579 |
| language | English |
| publishDate | 2012-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Hematology |
| spelling | doaj-art-6a00e3ffb44c4ceca5612ced428484bc2025-02-03T05:48:16ZengWileyCase Reports in Hematology2090-65602090-65792012-01-01201210.1155/2012/257023257023Heparin-Induced Thrombocytopenia Associated with Massive Intracardiac Thrombosis: A Case ReportAtheer Ahmed0Hamid AL-Mondhiry1Truman J. Milling2David Campbell3The Department of Emergency Medicine, Killeen Metroplex Hospital, Killeen, TX 76549, USAThe Division of Hematology-Oncology, The Penn State Milton S. Hershey Medical Center, Hershey, PA 17033-0850, USAThe Department of Emergency Medicine, The University Medical Center at Brackenridge, Austin, TX 78701, USADepartment of Surgery, The Penn State Milton S. Hershey Medical Center, Hershey, PA 17033-0850, USAA 60-years old patient was admitted to a community hospital with septic arthritis. He was treated with antibiotics and subcutaneous unfractionated heparin (UH) was used for venous thromboprophylaxis. After three days, he developed leg deep venous thrombosis and was treated with IV heparin. One day later, the patient developed pulmonary emboli, which was found using ventilation/perfusion scan. He was transferred to the University Hospital for further management. Upon arrival, antibiotic and intravenous UH were continued. Trans-Esophageal Echocardiogram showed a thrombus in the right atrium, a small portion of which extended to the left atrium through a patent foramen ovale. Another large thrombus was noted in the right ventricle, which extended to the pulmonary artery. Review of the patient’s medical records revealed a halving of his platelet count three days following the heparin administration. Therefore, HIT seemed very likely. Intravenous UH was stopped and an emergency thrombectomy was performed. ELISA testing of HIT antibodies came negative. This made HIT diagnosis unlikely and the patient received dalteparin. A week later, as the platelet count declined again, HIT antibodies’ testing using ELISA and C-14 serotonin release was repeated, and both assays were positive. Argatroban was restarted and the platelet count normalized.http://dx.doi.org/10.1155/2012/257023 |
| spellingShingle | Atheer Ahmed Hamid AL-Mondhiry Truman J. Milling David Campbell Heparin-Induced Thrombocytopenia Associated with Massive Intracardiac Thrombosis: A Case Report Case Reports in Hematology |
| title | Heparin-Induced Thrombocytopenia Associated with Massive Intracardiac Thrombosis: A Case Report |
| title_full | Heparin-Induced Thrombocytopenia Associated with Massive Intracardiac Thrombosis: A Case Report |
| title_fullStr | Heparin-Induced Thrombocytopenia Associated with Massive Intracardiac Thrombosis: A Case Report |
| title_full_unstemmed | Heparin-Induced Thrombocytopenia Associated with Massive Intracardiac Thrombosis: A Case Report |
| title_short | Heparin-Induced Thrombocytopenia Associated with Massive Intracardiac Thrombosis: A Case Report |
| title_sort | heparin induced thrombocytopenia associated with massive intracardiac thrombosis a case report |
| url | http://dx.doi.org/10.1155/2012/257023 |
| work_keys_str_mv | AT atheerahmed heparininducedthrombocytopeniaassociatedwithmassiveintracardiacthrombosisacasereport AT hamidalmondhiry heparininducedthrombocytopeniaassociatedwithmassiveintracardiacthrombosisacasereport AT trumanjmilling heparininducedthrombocytopeniaassociatedwithmassiveintracardiacthrombosisacasereport AT davidcampbell heparininducedthrombocytopeniaassociatedwithmassiveintracardiacthrombosisacasereport |