title: [Heparin-induced thrombocytopenia occurring after surgical treatment of atrial myxoma--a case report].
abstract: BACKGROUND
  Heparin-induced thrombocytopenia (HIT) is an acquired, prothrombotic disorder, caused by antibodies to a complex of heparin and platelet factor 4 (PF4) that activates platelets, resulting in the release of procoagulant microparticles, thrombocytopenia occurrence, generation of thrombin, and frequent thromboses.
  
  
  METHODS
  We present a case of severe HIT in a 68-year-old female, which occurred after cardiosurgery of the left atrial myxoma with the aim to point out the importance of differential diagnosis of thrombocytopenia in patients recently exposed to heparin. Platelet count dropped on the eleventh postoperative day, six days after unfractioned heparin and enoxaparine threatment, to 4x10(9)/I.The correct diagnosis failed to be made at first. Since thrombocytopenia remained refractory to a corticosteroid treatment and platelet transfusion, the patient was hospitalized on the 13th postoperative day at the Institute of Haematology. The diagnosis of HIT was confirmed with the high-probability clinical score (4T's) and strongly positive anti-heparin-PF4 (PaGIA) test as well as positive platelet aggregation test. The treatment started with a smaller therapeutic doses of danaparoid than recommended of 750 U intravenous bolus and was followed by continuous infusions of 100 U per 1 h and intravenous gammaglobulins in full dosage for four days. The platelet count started to rise on the third day and it was completely normalized on the 5th day of the therapy.
  
  
  CONCLUSIONS
  Treatment of severe HIT with small doses of danaparoid supplemented by intravenous gamma globulin was successful. Additional awareness of heparin-induced thrombocytopenia is needed, especially of HIT in differential diagnosis of thrombocytopenia in patients recently exposed to heparin.
authors: Irena
authors: I
authors: Djunić
authors: Dragica
authors: D
authors: Tomin
authors: Nebojsa
authors: N
authors: Antonijević
authors: Sinisa
authors: S
authors: Gradinac
authors: Mirjana
authors: M
authors: Kovac
authors: Ana
authors: A
authors: Vidović
authors: Vladislava
authors: V
authors: Djurasinović
authors: Ivo
authors: I
authors: Elezović
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects*; D002809:Chondroitin Sulfates / Q000008:administration & dosage; D003871:Dermatan Sulfate / Q000008:administration & dosage; D003937:Diagnosis, Differential; D005260:Female; D006325:Heart Atria; D006338:Heart Neoplasms / Q000601:surgery*; D006493:Heparin / Q000009:adverse effects*; D006497:Heparan Sulfate / Q000008:administration & dosage; D006801:Humans; D009232:Myxoma / Q000601:surgery*; D011183:Postoperative Complications; D013921:Thrombocytopenia / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy
chemical_list: D000925:Anticoagulants; D002809:Chondroitin Sulfates; D003871:Dermatan Sulfate; D006493:Heparin; D006497:Heparan Sulfate; C035838:danaparoid