Heparin-induced thrombocytopenia in myeloproliferative disorders: a rare or under-diagnosed complication?
Patients with myeloproliferative disorders (MPD) are prone to develop thrombotic complications and thus frequently receive heparin. Surprisingly heparin-induced thrombocytopenia (HIT) has been rarely reported in MPD and is potentially under-diagnosed due to the relatively high platelet count. We report three patients with MPD who developed HIT; all presented with a relative fall of platelet counts (although without an absolute thrombocytopenia), thrombosis or skin necrosis and a positive test for HIT antibodies (particle gel immunoassay). Risk factors for developing HIT in our patients were exposure to unfractionated heparin, a recent surgical procedure and female gender. We review the literature on HIT in MPD and discuss the diagnosis of HIT in the absence of an absolute thrombocytopenia.
Spectre
Galia
G
Department of Hematology, Hadassah Medical Center, Jerusalem, Israel. galia.spectre@gmail.com
Kalish
Yossi
Y
Schliamser
Liliana
L
Varon
David
D
D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects* / Q000145:classification / Q000627:therapeutic use; D002277:Carcinoma / Q000150:complications / Q000601:surgery; D002405:Catheterization, Central Venous / Q000009:adverse effects; D005188:False Negative Reactions; D005260:Female; D006493:Heparin / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D010978:Platelet Factor 4 / Q000187:drug effects / Q000276:immunology; D011087:Polycythemia Vera / Q000097:blood / Q000150:complications*; D011183:Postoperative Complications / Q000097:blood / Q000139:chemically induced / Q000175:diagnosis; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000097:blood / Q000139:chemically induced* / Q000175:diagnosis; D012307:Risk Factors; D013920:Thrombocythemia, Essential / Q000097:blood / Q000150:complications*; D019851:Thrombophilia / Q000150:complications / Q000188:drug therapy / Q000235:genetics; D002583:Uterine Cervical Neoplasms / Q000150:complications / Q000601:surgery; D020246:Venous Thrombosis / Q000150:complications / Q000188:drug therapy
D000925:Anticoagulants; D010978:Platelet Factor 4; D006493:Heparin