Heparin-Induced Thrombocytopenia Associated with Massive Intracardiac Thrombosis: A Case Report

Ahmed, Atheer; AL-Mondhiry, Hamid; Milling Jr, Truman J.; Campbell, David
January 2012
Case Reports in Hematology;2012, p1
Academic Journal
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.


Related Articles

  • D-Dimer for the Exclusion of Acute Venous Thrombosis and Pulmonary Embolism. Stein, Paul D.; Hull, Russell D.; Patel, Kalpesh C.; Olson, Ronald E.; Ghali, William A.; Brant, Rollin; Biel, Rita K.; Bharadia, Vinay; Kalra, Neeraj K. // Annals of Internal Medicine;4/20/2004, Vol. 140 Issue 8, p589 

    Background: Despite extensive literature, the diagnostic role of D-dimer for deep venous thrombosis (DVT) or pulmonary embo-lism (PE) remains unclear, reflecting multiple D-dimer assays and concerns about differing sensitivities and variability. Purpose: To systematically review trials that...

  • Review: ELISA D-dimer is sensitive but not specific in diagnosing pulmonary embolism in an ambulatory clinical setting. Bounameaux, Henri // ACP Journal Club;Jan/Feb2003, Vol. 138 Issue 1, p24 

    Comments on a study which investigated the accuracy of the enzyme-linked immunosorbent assay D-dimer test in diagnosing pulmonary embolism in an ambulatory clinical setting. Data sources; Studies selected for the investigation; Results and findings.

  • D-dimer useful for excluding deep vein thrombosis and pulmonary embolism.  // Journal of Family Practice;Sep2004, Vol. 53 Issue 9, p686 

    This article presents a meta-analysis of 78 high-quality studies searched in Medline and EMBASE in all languages in order to determine the role of D-dimer testing in patients with suspected deep vein thrombosis (DVT) or pulmonary embolism (PE). Of the various methods of measuring D-dimer,...

  • Diagnosing pulmonary embolism. Moser, Kenneth M. // BMJ: British Medical Journal (International Edition);12/10/94, Vol. 309 Issue 6968, p1525 

    Focuses on the diagnosis of pulmonary embolism. Symptoms of pulmonary embolism; Use of enzyme-linked immunosorbent assay and latex assays in the diagnosis; Measurement of D-dimer, a degradation product of crosslinked fibrin released when endogenous fibrinolytic system attacks fibrin matrix.

  • ELISA D-Dimer Testing: High Sensitivity but Low Specificity. Sadovsky, Richard // American Family Physician;12/15/2002, Vol. 66 Issue 12, p2310 

    Discusses the research 'The Accuracy of the Enzyme-linked Immunosorbent Assay D-dimer Tests in the Diagnosis of Pulmonary embolism: A Meta-analysis,' by M.D. Brown et al., from the August 2002 issue of the 'Annals of Emergency Medicine.'

  • Enoxaparin sodium.  // Reactions Weekly;5/17/2008, Issue 1202, p14 

    The article describes the case of a 74-year-old woman with deep vein thrombosis (DVT) who developed thrombocytopenia and heparin-induced thrombocytopenia (HIT) after receiving enoxaparin sodium. Particular focus is given to her dosing regimen. The results of her enzyme-linked immunosorbent assay...

  • Rapid immunoassays for diagnosis of heparin-induced thrombocytopenia: Comparison of diagnostic accuracy, reproducibility, and costs in clinical practice. Bankova, Andriyana; Andres, Yvonne; Horn, Michael P.; Alberio, Lorenzo; Nagler, Michael // PLoS ONE;6/8/2017, Vol. 12 Issue 6, p1 

    Background: Immunoassays are crucial in the work-up of patients with suspected heparin-induced thrombocytopenia (HIT) and rapid tests have been recently developed. However, comparative data on diagnostic accuracy, reproducibility, and analytical costs of different immunoassays in clinical...

  • Ability of Different D-Dimer Tests To Exclude Deep Venous Thrombosis and Pulmonary Embolism.  // Annals of Internal Medicine;4/20/2004, Vol. 140 Issue 8, pI42 

    Presents a summary of a study report indicating the ability of different D-dimer tests to diagnose deep venous thrombosis (DVT) and pulmonary embolism (PE). Explanation of DVT and PE conditions and the many tests that are used for their diagnosis; Methodology of the study; Findings that ELISA...

  • Imaging findings on heparin-induced thrombocytopenia with thrombosis. Rohena-Quinquilla, Iván R.; Baird, Dean // Applied Radiology;Apr2014, Vol. 43 Issue 4, p28 

    No abstract available.


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics