Heparin-induced thrombocytopenia: a case report and literature overview

Czech version

Authors: Pavel Polák ¹; Yvona Kaloudová ²; Hana Krupicová ²; Pavel Coufal ²; Břetislav Lipový ²; Jiřina Zavřelová ^1,3; Marie Prudková ^1,3; Andrea Štěpařová ^1,3; Lucie Říhová ^1,3; Renata Bezděková ¹; Romana Králová ¹; Lukáš Frola ⁴; Miroslav Penka ^1,3
Authors‘ workplace: Oddělení klinické hematologie FN Brno, pracoviště Bohunice ¹; Klinika popálenin a plastické chirurgie LF MU a FN Brno, pracoviště Bohunice ²; Katedra laboratorních metod LF MU Brno ³; Ústav patologie LF MU a FN Brno, pracoviště Bohunice ⁴
Published in: Vnitř Lék 2020; 66(4): 242-248
Category: Case Report

Overview

Heparin-induced thrombocytopenia (HIT) is an immunologically-mediated complication, which usually follows heparin exposition, less frequently exposition to other drugs or even occurs spontaneously. The type of heparin, its dose and mode of application as well as the exposition time, major trauma or operation, and obesity represent the main risk factors for HIT. The probability of HIT correlates with so-called 4T-score. A confirmatory laboratory diagnostic should be exclusively reserved for patients with a medium to a high probability of HIT development (more than 3 points in 4T-score). The screening method is based on serological detection of antibodies against heparin-platelet factor-4 complexes; confirmation tests aim to identify the activation of platelets. The treatment of HIT requires an immediate interruption of heparin application and rigorous antithrombotic treatment with an alternative agent. Herein authors describe a clinical case of HIT manifested as an extreme urticarial reaction in the location of nadroparin application as well as thrombosis of deep subcutaneous veins in a polymorbid obese patient with an extensive and infected burn. Due to timely diagnosis and fondaparinux treatment, no more severe thrombotic events occurred in this patient.

Keywords:

thrombosis – direct oral anticoagulants – fondaparinux – heparin‑induced thrombocytopenia – 4T-scores

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