[Difficulties in the detection of heparin-induced thrombocytopenia type II].
We report about a 29 year old female who developed right-sided leg vein thrombosis over three levels. Thrombectomy was attempted followed by intravenous anticoagulation with heparin. The platelet count dropped acutely from 176,000/microliter to 11,000/microliter after the sixth day. A lung perfusion-ventilation-scintigraphy suggested recent pulmonary embolism by lateral, predominantly right-sided perfusion deficits. ACT scan of the pelvic region showed rethrombosis of the right common iliac vein. The clinical suspicion of heparin-induced thrombocytopenia (HIT) type II was confirmed by a positive heparin-induced platelet aggregation test and the detection of antibodies by heparin-platelet factor 4-ELISA. The patient was treated with lepirudin at body-weight-adapted dose. After recovery of the platelet count to 102,000/microliter within seven days the treatment was changed to Orgaran after exclusion of immunologic cross reactivity. An overlapping oral anticoagulation with Marcoumar was initiated. Although HIT type II usually develops over a few days, acute thrombopenia can also occur. There is therefore no safe diagnostic interval permitting a timely detection.
Goyen
M
M
Klinik und Poliklinik für Angiologie, Universitätsklinikum Essen. mathias@goyen.de
Kröger
K
K
Massalha
K
K
Manz
S
S
Bräunlich
S
S
Rudofsky
G
G
D000328:Adult; D003937:Diagnosis, Differential; D005260:Female; D006493:Heparin / Q000009:adverse effects*; D006801:Humans; D013921:Thrombocytopenia / Q000139:chemically induced* / Q000175:diagnosis*
D006493:Heparin