title: Concurrence of anaphylaxis and acute heparin-induced thrombocytopenia in a patient with heparin-induced antibodies.
abstract: We report the occurrence of acute heparin-induced thrombocytopenia in a patient with anaphylaxis that began immediately after an intravenous bolus dose of unfractionated heparin. This case report is the first to document the concurrence of these 2 reactions to heparin. An abrupt fall in platelet count was documented immediately after the anaphylactic response. Study results for antibodies characteristic of heparin-induced thrombocytopenia were positive in 2 assays: serotonin release assay and heparin platelet factor 4 enzyme-linked immunosorbent assay. The patient's antibody was exclusively immunoglobulin G. Any explanation for the relationship between the antibody response observed and the histamine release remains speculative.
authors.affiliation: Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA.
authors.forename: R L
authors.initials: RL
authors.lastname: Hewitt
authors.forename: D L
authors.initials: DL
authors.lastname: Akers
authors.forename: C A
authors.initials: CA
authors.lastname: Leissinger
authors.forename: J I
authors.initials: JI
authors.lastname: Gill
authors.forename: R H
authors.initials: RH
authors.lastname: Aster
mesh_terms: D000208:Acute Disease; D000707:Anaphylaxis / Q000209:etiology*; D000906:Antibodies / Q000097:blood*; D000936:Antigen-Antibody Complex / Q000032:analysis; D001792:Blood Platelets / Q000276:immunology; D006493:Heparin / Q000276:immunology*; D006801:Humans; D007074:Immunoglobulin G / Q000032:analysis; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D010978:Platelet Factor 4 / Q000276:immunology; D013921:Thrombocytopenia / Q000276:immunology*
chemical_list: D000906:Antibodies; D000936:Antigen-Antibody Complex; D007074:Immunoglobulin G; D010978:Platelet Factor 4; D006493:Heparin