Deep venous thrombosis, myocardial infarction, and occlusion of vascular access associated with heparin-induced thrombocytopenia in a diabetic hemodialysis patient.
We report a patient with diabetic endstage renal disease with an initial platelet count of 17.6 x 10(4)/mm3 who developed type-II heparin-induced thrombocytopenia (HIT) during the induction period of hemodialysis (HD) when unfractionated heparin was used. Because the recognition of the condition and the treatment of this patient with HIT was unsatisfactory, she developed deep venous thrombosis, myocardial infarction, and occlusion of vascular access, at times of platelet counts of 4.1 x 10(4), 7.7 x 10(4), and 6.4 x 10(4)/mm3, respectively, with antibodies to heparin/platelet factor 4 complex. Unfortunately, we misjudged in our belief that the thromboembolic events might be associated with an underlying procoagulant state in diabetic nephrotic syndrome, rather than being associated with the clinical picture of HIT. This case report suggests that the clinician must consider HIT in the differential diagnosis for thromboembolic complications during the induction period of HD, because unfractionated heparin is the major anticoagulant used in HD.
Igaki
Naoya
N
Department of Internal Medicine, Takasago Municipal Hospital, 33-1 Kamimachi, Arai-cho, Takasago 676-8585, Japan.
Matsuda
Tomokazu
T
Yatani
Hirofumi
H
Kawaguchi
Takayuki
T
Kida
Aritoshi
A
Yanase
Kimihiko
K
Moriguchi
Rintarou
R
Sakai
Makoto
M
Tamada
Fumihiko
F
Goto
Takeo
T
D000925:Anticoagulants / Q000009:adverse effects*; D002408:Catheters, Indwelling; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D003928:Diabetic Nephropathies / Q000150:complications* / Q000628:therapy*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006493:Heparin / Q000009:adverse effects*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy*; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications*; D010690:Phlebography; D006435:Renal Dialysis; D013921:Thrombocytopenia / Q000139:chemically induced* / Q000150:complications*; D013988:Ticlopidine / Q000627:therapeutic use; D020246:Venous Thrombosis / Q000150:complications*; D014859:Warfarin / Q000627:therapeutic use
D000925:Anticoagulants; D005343:Fibrinolytic Agents; D014859:Warfarin; D006493:Heparin; D013988:Ticlopidine