A case of heparin-induced thrombocytopenia with sepsis and congestive heart failure--first autopsy report on Japan--.
An 84-year-old man was referred to the emergency department with severe dyspnea. Based on his physical findings, electrocardiogram, X-ray and echocardiographic findings, congestive heart failure was suspected and drip infusion of prophylactic heparin against intracardiac thrombosis was commenced together with dopamine, nitroglycerin and furosemide. Diuresis occurred and the pulmonary congestion ameliorated remarkably. Starting on the 20th hospital day, the platelet count was gradually reduced (from 256,000 to 55,000 /microl) and the fibrin degradation product concentration rose (27.6 microg/ml). However, prothrombin time was not prolonged (89%), the concentration of antithrombin III was low -normal (69%) and the fibrinogen concentration was high (650 mg/dl). Thus, heparin-induced thrombocytopenia (HIT), rather than disseminated intravascular coagulation (DIC), was suspected. Heparin was withdrawn on the 24th hospital day and replaced by nafamostat mesilate after which the platelet count was restored to 100,000 /microl. Enzyme-linked immunosorbent assay for HIT antibodies was positive. Unfortunately, the patient died from uncontrolled sepsis on the 29th hospital day. At autopsy, platelet-rich thrombi were found in the small pulmonary arteries and intestinal arteries. No evidence of DIC, such as fibrin-rich thrombosis, was observed. This is the first autopsy report of HIT in Japan.
Sawaki
Daigo
D
Department of Cardiovascular Medicine, Japanese Red Cross Medical Center, Hiro-o, Shibuya-ku Tokyo, Japan.
Otani
Yoshitaka
Y
Kobayakawa
Naoshi
N
Sekita
Gaku
G
Fukushima
Kazuyuki
K
Takeuchi
Hiroaki
H
Ogawa
Takafumi
T
Takemura
Tamiko
T
Aoyagi
Teruhiko
T
D000368:Aged; D000369:Aged, 80 and over; D000906:Antibodies / Q000097:blood; D001550:Benzamidines; D004797:Enzyme-Linked Immunosorbent Assay; D017809:Fatal Outcome; D006146:Guanidines / Q000627:therapeutic use; D006333:Heart Failure / Q000139:chemically induced* / Q000150:complications*; D006493:Heparin / Q000009:adverse effects*; D006801:Humans; D008297:Male; D010976:Platelet Count; D019233:Retreatment; D018805:Sepsis / Q000150:complications*; D013921:Thrombocytopenia / Q000097:blood / Q000139:chemically induced* / Q000150:complications* / Q000276:immunology / Q000473:pathology; D013927:Thrombosis / Q000150:complications / Q000473:pathology
D000906:Antibodies; D001550:Benzamidines; D006146:Guanidines; D006493:Heparin; C032855:nafamostat