Heparin induced thrombocytopenia type II complicating coronary artery bypass surgery: a tale of caution.
OBJECTIVE
To highlight an uncommon problem of heparin induced thrombocytopenia after coronary artery bypass operation.


METHODS
We report the case of a 59-year-old man who suffered severe type II heparin induced thrombocytopenia (HIT) after coronary artery bypass operation. He experienced extensive skin necrosis at sites of saphenous vein harvesting, which progressed to cause soft tissue necrosis of both feet. He also exhibited secondary clinical features arising from pulmonary, hepatic and renal dysfunction suggestive of extensive venous thrombosis. Primary treatment of the haematological disorder was achieved by discontinuation of all forms of heparin and the administration of a heparinoid intravenously. Secondary treatment included forefoot amputations and skin grafting.


RESULTS
Though the patient suffered a protracted period of recovery he was discharged home well.


CONCLUSIONS
We have reported this complex case in order to familiarise cardiothoracic surgeons with the extreme characteristics of type II HIT and to emphasise that early diagnosis and treatment will facilitate a successful outcome.
Department of Cardiothoracic Surgery, North Staffordshire Royal Infirmary, Princes Road, Hartshill, Stoke-on-Trent, ST4 7LN, UK. udandekar@yahoo.co.uk
Uday
U
Dandekar
Jonathan
J
Young
Maninder
M
Kalkat
Christopher M R
CM
Satur