title: An unusually prolonged case of heparin-induced thrombocytopenia and disseminated intravascular coagulation.
abstract: An unusually prolonged case of heparin-induced severe thrombocytopenia and decompensated disseminated intravascular coagulation (DIC) is described. The patient, treated with heparin at a dosage of 25,000 units/day for 3 days and 12,500 units/day for an additional 4 days because of a clinically suspected deep venous thrombosis, developed (4 days after the discontinuation of heparin) a clinical and laboratory picture of severe DIC, manifested by subcutaneous hematomas and ecchymoses. Platelet count was 24 x 10(9)/l, fibrinogen level 89 mg/dl and fibrin-degradation products between 3,200 to 6,400 ng/ml. A thorough laboratory and instrumental evaluation failed to demonstrate any underlying disorder. No heparin-dependent aggregating factor was detected in the serum of the patient. The patient recovered spontaneously. Whereas fibrinogen and fibrin-degradation products reverted to normality within four weeks, platelet count normalization was delayed until the sixth week after heparin discontinuation.
authors.affiliation: Dipartimento di Ematologia, Ospedale San Bortolo, Vicenza, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Castaman
authors.forename: M
authors.initials: M
authors.lastname: Ruggeri
authors.forename: R
authors.initials: R
authors.lastname: Girardello
authors.forename: F
authors.initials: F
authors.lastname: Rodeghiero
mesh_terms: D000368:Aged; D001780:Blood Coagulation Tests; D004211:Disseminated Intravascular Coagulation / Q000139:chemically induced*; D005260:Female; D006406:Hematoma / Q000139:chemically induced; D006493:Heparin / Q000009:adverse effects*; D006801:Humans; D010976:Platelet Count; D011696:Purpura, Thrombocytopenic / Q000139:chemically induced; D013921:Thrombocytopenia / Q000139:chemically induced*; D013924:Thrombophlebitis / Q000150:complications / Q000188:drug therapy; D013997:Time Factors; D014859:Warfarin / Q000627:therapeutic use
chemical_list: D014859:Warfarin; D006493:Heparin