title: Bilateral lower extremity gangrene requiring amputation associated with heparin-induced thrombocytopenia--a case report.
abstract: Heparin use, both prophylactically and therapeutically, is prevalent among hospitalized patients. Patients on heparin may develop a thrombocytopenia that is self-limited. Fewer patients develop a heparin-induced thrombocytopenia that can cause severe bleeding and thrombosis owing to intravascular platelet aggregation. The authors present a case report of heparin-induced thrombocytopenia in a patient who underwent aortic arch and aortic valve replacement that resulted in bilateral above-knee amputations. The patient developed limb ischemia related to heparin-associated thrombosis, but had a delay in antibody seroconversion. Early and accurate diagnosis of heparin-induced thrombocytopenia requires a high clinical suspicion and may be present despite the absence of serum antibodies.
authors.affiliation: University of California Los Angeles Division of Vascular Surgery, Gonda Goldschmied Vascular Center, Los Angeles, CA 90095, USA.
authors.forename: Brian P
authors.initials: BP
authors.lastname: Dickinson
authors.forename: Daniel A
authors.initials: DA
authors.lastname: De Ugarte
authors.forename: Todd D
authors.initials: TD
authors.lastname: Reil
authors.forename: Bryce D
authors.initials: BD
authors.lastname: Beseth
authors.forename: Peter F
authors.initials: PF
authors.lastname: Lawrence
mesh_terms: D000368:Aged; D000671:Amputation, Surgical; D000906:Antibodies / Q000097:blood; D000925:Anticoagulants / Q000009:adverse effects*; D005734:Gangrene / Q000097:blood / Q000209:etiology* / Q000601:surgery; D006493:Heparin / Q000009:adverse effects* / Q000276:immunology; D006801:Humans; D007511:Ischemia / Q000097:blood / Q000209:etiology* / Q000601:surgery; D007717:Knee / Q000601:surgery; D035002:Lower Extremity / Q000098:blood supply* / Q000601:surgery; D008297:Male; D013921:Thrombocytopenia / Q000097:blood / Q000209:etiology*; D013927:Thrombosis / Q000097:blood / Q000209:etiology* / Q000601:surgery
chemical_list: D000906:Antibodies; D000925:Anticoagulants; D006493:Heparin