[Rare complication of a heparin-induced thrombocytopenia type II].
METHODS
A 63-year-old man was admitted to a surgery department with fracture of the acetabulum and luxation of the hip joint. Eight days after intracondylar nail-extension during subcutaneous heparin prophylaxis he developed a dramatic deterioration of his condition with severe abdominal pain and fever and was admitted to our hospital.


METHODS
White cell count was 12,000/microliter, C-reactive protein 7.90 mg/dl. CT-scan, abdominal ultrasound, mesenteric angiography and exploratory laparotomy revealed no pathological findings. At day 13 abdominal ultrasound showed adrenal haemorrhages on the right. Together with a drop in platelet count below 50,000/microliter, adrenal haemorrhage caused by heparin-induced thrombocytopenia (type II; immunological [HIT II]) was suggested.


METHODS
After discontinuation of heparin and starting therapy with recombinant hirudin and hydrocortisone, a dramatic clinical recovery followed within 24 hours. One year after the initial diagnosis the patient is in a good condition.


CONCLUSIONS
When abdominal pain, hypotension and fever occurs with a drop in platelet count during heparin therapy HIT II should be considered. An early diagnosis is essential for treatment of this life-threatening complication at an early stage.
Scheffold
N
N
Medizinische Klinik I/Schwerpunkt Kardiologie, Klinikum Heilbronn. Norbert.Scheffold@t-online.de
Schöngart
H
H
Berentelg
J
J
Prager
P
P
Cyran
J
J
D000077:Acetabulum / Q000293:injuries; D000307:Adrenal Gland Diseases / Q000000981:diagnostic imaging / Q000209:etiology; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000925:Anticoagulants / Q000009:adverse effects* / Q000627:therapeutic use; D000991:Antithrombins / Q000627:therapeutic use; D050723:Fractures, Bone / Q000601:surgery; D006470:Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology; D006493:Heparin / Q000009:adverse effects* / Q000627:therapeutic use; D006617:Hip Dislocation / Q000601:surgery; D024764:Hirudin Therapy; D006801:Humans; D006854:Hydrocortisone / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D011183:Postoperative Complications / Q000517:prevention & control; D013921:Thrombocytopenia / Q000139:chemically induced* / Q000175:diagnosis / Q000628:therapy; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography
D000893:Anti-Inflammatory Agents; D000925:Anticoagulants; D000991:Antithrombins; D006493:Heparin; D006854:Hydrocortisone