title: Heparin-induced thrombocytopenia with thrombosis syndrome managed with plasmapheresis.
abstract: Heparin-induced thrombocytopenia with thrombosis syndrome is an antibody-mediated disorder that has a high mortality in cardiac surgical patients in spite of early diagnosis and management with direct thrombin inhibitors. Plasmapheresis, an extracorporeal technique that has been designed for the removal of large molecular weight substances from the plasma, can remove the offending antibodies from these desperately ill patients. We describe a case of a postoperative cardiac surgery patient with heparin-induced thrombocytopenia with thrombosis syndrome and multi-system failure who was dependent upon a left ventricular assist device. He was treated successfully with plasmapheresis with recovery of his platelet count from 25,000/microl to over 200,000/microl, along with multi-organ recovery. This patient survived because of plasmapheresis. Removing the antibodies to the heparin-platelet factor four complex with plasmapheresis is an effective strategy to treat these patients. We believe that the use of plasmapheresis as a bail-out procedure in these often desperately ill post-operative cardiac surgical patients who have heparin-induced thrombocytopenia with thrombosis syndrome could be lifesaving.
authors.affiliation: Division of Cardiothoracic Surgery, Maine Medical Center, Portland, ME 04102, USA. kramer@mmc.org
authors.forename: Robert
authors.initials: R
authors.lastname: Kramer
authors.forename: Payson
authors.initials: P
authors.lastname: Oberg-Higgins
authors.forename: Louis
authors.initials: L
authors.lastname: Russo
authors.forename: John H
authors.initials: JH
authors.lastname: Braxton
mesh_terms: D000906:Antibodies / Q000097:blood; D000925:Anticoagulants / Q000009:adverse effects* / Q000276:immunology; D001026:Coronary Artery Bypass; D006353:Heart-Assist Devices; D006493:Heparin / Q000009:adverse effects* / Q000276:immunology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000139:chemically induced / Q000628:therapy; D010956:Plasmapheresis; D013577:Syndrome; D013921:Thrombocytopenia / Q000139:chemically induced / Q000276:immunology / Q000628:therapy*; D013927:Thrombosis / Q000139:chemically induced / Q000276:immunology / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D000906:Antibodies; D000925:Anticoagulants; D006493:Heparin