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A CASE OF NORMAL PLATELET COUNT HEPARIN INDUCED THROMBOCYTOPENIA (HIT)
Abstract number: P-W-330
Lerner1 R.G., Hosur2 S., Gennarelli2 M.
11Medicine, New York Medical College, Westchester Medical Center, Valhalla, NY 22Medicine, New York Medical College, Westchester Medical Center, Valhalla,NY, United States
How-to-cite Lerner RG, Hosur S, Gennarelli M. A CASE OF NORMAL PLATELET COUNT HEPARIN INDUCED THROMBOCYTOPENIA (HIT). J Thromb Haemost 2007; 5 Supplement 2: P-W-330
Abstract
Introduction: HIT is not typically considered unless a patient has a platelet count of less than 100,000/mm3 or a fall of greater than 50% from baseline. We discuss a patient presenting with extensive thrombosis and a normal platelet count while receiving prophylactic doses of heparin.
Methods: A 27 yo man was admitted to hospital from a rehab facility with a 2 day history of LLE swelling and pain. He had sustained multiple fractures including a depressed skull fracture with subarachnoid hemorrhage in a motor vehicle accident 30 days earlier and had an IVC filter inserted the next day. After craniectomy, 4 orthopedic surgeries and 19 days he was transferred to rehab. Unfractionated heparin 5000 units twice daily was then started and 9 days later leg swelling occurred. There were no pulmonary symptoms. Physical examination revealed normal vital signs, slow mentation, and scars from recent craniectomy, left humeral and femoral surgery, healing facial lacerations and marked swelling of the left lower extremity. Lab:platelet count 245,000/mm3, elevated alkaline phosphatase. Ultrasound examination: non-compressible thrombosis of the left external iliac and femoral veins. Spiral CT:no pulmonary embolism. Because of thrombosis occurring while receiving heparin, HIT was considered. Heparin was stopped.
Results: Lab studies from the prior hospital stay: a normal platelet count rose to 413,000/mm3 at the time of discharge. ELISA test for heparin/PF4 antibody drawn at the time of the second admission and reported 3 days later was positive. Treatment with fondaparinux and leg elevation improved the leg symptoms. Over a one week period the platelets rose to 450,000/mm3. Recovery and conversion to warfarin were uneventful.
Conclusions: The case illustrates that HIT with thrombosis can occur with a normal platelet count, the need to consider what the platelet count might have been due to reactive thrombocytosis, that treatment with fondaparinux can be successful and the complications of IVC filter placement.
To cite this abstract use the following format:
Journal of Thrombosis and Haemostasis 2007; Volume 5, Supplement 2: abstract number
Session Details
| Date: |
01/08/2007
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| Time: |
00:00-00:00
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| Session name: |
XXIst ISTH Congress |
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| Location: |
Oxford, UK |
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