Four Limb Ischemia: A Severe Case of Heparin Induced Thrombocytopenia

  • Kartik AnandEmail author
  • Ibrahim Ibrahim

Dear Editor,

Heparin-induced thrombocytopenia (HIT) is an immune-mediated complication secondary to exposure to heparin due to the formation of antibodies against complexes of platelet factor 4 (PF4) and heparin [1]. This antibody activates platelets causing venous or arterial thrombosis in nearly half of the cases with HIT [2]. Risk of HIT is 10 times higher after exposure to unfractionated heparin (UF) compared to low molecular weight heparin (LMWH) [3]. Herein, we present a case of a patient developing four limb ischemia secondary to HIT.

A 48 year-old-old previously healthy female presented with nausea and abdominal pain. Imaging reveled a large retroperitoneal mass invading the inferior vena cava (IVC) and extending cranially through the IVC to the right atrium. Endovascular biopsy of IVC mass showed features suspicious for sarcoma. Post procedure she developed bilateral lower extremity deep venous thrombosis for which she was started on therapeutic (full-dose) dose of UF titrated...


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Conflict of interest

Both authors declare that they have no conflicts of interest.


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© Indian Society of Hematology and Blood Transfusion 2019

Authors and Affiliations

  1. 1.Houston Methodist Cancer Center/Weill Cornell MedicineHoustonUSA
  2. 2.Division of Hematology and Oncology, Department of Internal MedicineUniversity of Texas SouthwesternDallasUSA

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