Abstract
Background
We report a case of heparin-induced thrombocytopenia (HIT) that was complicated by acute intracerebral hemorrhage (ICH) and bilateral adrenal hemorrhage. In the setting of worsening thrombocytopenia, the risk of expansion of ICH and additional thrombotic events is concerning; hence, we employed plasmapheresis to reduce thrombotic risk.
Methods
We followed serial daily heparin antibody enzyme-linked immunosorbent assay (ELISA) optical density measurements as well as heparin-induced platelet aggregation (HIPA) assays on both pre- and post-pheresis samples in order to objectively determine when thrombotic risk was sufficiently decreased.
Results
After four cycles of plasmapheresis, both heparin antibody ELISA and HIPA assays became negative.
Conclusion
This case helps illustrate the utility of plasmapheresis in management of HIT when anticoagulation is contraindicated.
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References
Arepally GM, Ortel TL. Heparin-induced thrombocytopenia. N Engl J Med. 2006;355(8):809–17.
Kelton JG, Arnold DM, Bates SM. Nonheparin anticoagulants for heparin-induced thromobocytopenia. N Engl J Med. 2013;368(8):737–44.
Lanzarotti S, Weigelt JA. Heparin-induced thrombocytopenia. Surg Clin North Am. 2012;92(6):1559–72.
Jaben EA, Torloni AS, Pruthi RK, Winters JL. Use of plasma exchange in patients with heparin-induced thrombocytopenia: a report of two cases and a review of the literature. J Clin Apher. 2011;26(4):219–24.
Warkentin TE. Heparin-induced thrombocytopenia in critically ill patients. Crit Care Clin. 2011;27(4):805–23.
Whitlach NL, Perry SL, Ortel TL. Anti-heparin/platelet factor 4 antibody optical density values and the confirmatory procedure in the diagnosis of heparin-induced thrombocytopenia. Thromb Haemost. 2008;100(4):678–84.
Lo GK, Junl D, et al. Evaluation of pretest clinical score (4T’s) for the diagnosis of heparin induced thrombocytopenia in two clinical settings. J Thromb Haemost. 2006;4(4):759–65.
Cuker A, Gimotty PA, et al. Predictive value of the 4Ts scoring system for heparin-induced thrombocytopenia: a systematic review and meta-analysis. Blood. 2012;120(20):4160–7.
Tun NM, Bo ZM, et al. A rare case of intracerebral hemorrhage complicating heparin-induced thrombocytopenia with thrombosis: a clinical dilemma ameliorated by novel use of plasmapheresis. Int J Hematol. 2012;96(4):513–5.
Hertle DN, Hahnel S, et al. The use of danaparoid to manage coagulopathy in a neurosurgical patient with heparin-induced thrombocytopenia type II and intracerebral hemorrhage. Br J Neurosurg. 2011;25(1):117–9.
Chow VW, Abnousi F, et al. Heparin-induced thrombocytopenia after total knee arthroplasty, with subsequent adrenal hemorrhage. J Arthroplast. 2012;27(7):1413.
Bakaeen FG, Walkes JC, Reardon MJ. Heparin-induced thrombocytopenia with bilateral adrenal hemorrhage after coronary artery bypass surgery. Ann Thorac Surg. 2005;79(4):1388–90.
Kramer R, Oberg-Higgins P, et al. Heparin-induced thrombocytopenia with thrombosis syndrome managed with plasmapheresis. Interact Cardiovasc Thorac Surg. 2009;8(4):439–41.
Kim SY, Kim HK, Hans KS, et al. Utility of ELISA optical density values and clinical scores for the diagnosis of and thrombosis prediction in heparin-induced thrombocytopenia. Korean J Lab Med. 2011;31(1):1–8.
Ruf KM, Bensadoun ES, et al. A clinical-laboratory algorithm incorporating optical density value to predict heparin-induced thrombocytopenia. Thromb Haemost. 2011;105(3):553–9.
McFarland J, Lochowicz A, et al. Improving the specificity of the PF4 ELISA in diagnosing heparin induced thrombocytopenia. Am J Hematol. 2012;87(8):776–81.
Zwicker JI, Uhl L, Huang WY, Shaz BH, Bauer KA. Thrombosis and ELISA optical density values in hospitalized patients with heparin induced thrombocytopenia. J Thromb Haemost. 2004;2(12):2133–7.
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Iluonakhamhe, E., Ibekwe, O., Samuel, S. et al. Plasmapheresis May Be an Option in Urgent Management of Heparin-Induced Thrombocytopenia in the Setting of Acute Intracerebral Hemorrhage. Neurocrit Care 22, 140–145 (2015). https://doi.org/10.1007/s12028-014-0052-2
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DOI: https://doi.org/10.1007/s12028-014-0052-2