title: [Heparin-associated platelet aggregation syndrome with skin necrosis during hemodialysis].
abstract: METHODS
  A 52-year-old man had been in terminal renal failure for 6 years. On haemodialysis under heparin without complications, acral skin necroses occurred. Even with low-molecular heparin anticoagulation further lesions developed. Within 12 weeks of haemodialysis being performed without heparin the necroses healed, but they recurred when heparin was again added for dialysis. On admission the patient was in poor general condition, with a weight of 55 kg (height 175 cm). LABORATORY INVESTIGATIONS: The heparin-induced platelet aggregation (HIPA) test was positive in the absence of thrombocytopenia. Na-heparin reacted positively in three out of four tests, but Danaparoid did not react.
  
  
  METHODS
  The skin necroses once again healed after the heparinoid Danaparoid, which had not reacted in the HIPA test, had been substituted for heparin.
  
  
  CONCLUSIONS
  This case illustrates that skin necroses, thrombocytopenia and thromboembolism can be independent signs of immunologically induced platelet aggregation.
authors.affiliation: Abteilung Dermatologie, Universität Ulm.
authors.forename: R O
authors.initials: RO
authors.lastname: Bredlich
authors.forename: S
authors.initials: S
authors.lastname: Stracke
authors.forename: H
authors.initials: H
authors.lastname: Gall
authors.forename: T M
authors.initials: TM
authors.lastname: Proebstle
mesh_terms: D000925:Anticoagulants / Q000009:adverse effects* / Q000627:therapeutic use; D002809:Chondroitin Sulfates / Q000494:pharmacology / Q000627:therapeutic use; D003871:Dermatan Sulfate / Q000494:pharmacology / Q000627:therapeutic use; D004338:Drug Combinations; D005533:Foot Dermatoses / Q000139:chemically induced / Q000473:pathology; D006493:Heparin / Q000009:adverse effects* / Q000627:therapeutic use; D006496:Heparinoids / Q000494:pharmacology / Q000627:therapeutic use; D006497:Heparan Sulfate / Q000494:pharmacology / Q000627:therapeutic use; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D010974:Platelet Aggregation / Q000187:drug effects; D006435:Renal Dialysis / Q000009:adverse effects; D012867:Skin / Q000187:drug effects / Q000473:pathology*; D012871:Skin Diseases / Q000139:chemically induced* / Q000473:pathology
chemical_list: D000925:Anticoagulants; D002809:Chondroitin Sulfates; D003871:Dermatan Sulfate; D004338:Drug Combinations; D006493:Heparin; D006496:Heparinoids; D006497:Heparan Sulfate; C035838:danaparoid
vernacular_title: Heparinassoziiertes Thrombozyten-Aggregationssyndrom mit Hautnekrosen bei Hmodialyse.