Heparin-induced thrombocytopenia in a hemodialysis patient treated with fondaparinux: nephrologists between two fires.
Heparin-induced thrombocytopenia (HIT) is caused by heparin exposure and presents with reduced platelet count. Patients undergoing hemodialysis (HD) treatment have increased risk of developing HIT due to prolonged exposure to unfractionated heparin or low-molecular weight heparin. We report a 79-year-old male patient with end-stage renal disease who developed type-II HIT during maintenance HD. Platelet count of the patient decreased gradually and antiplatelet factor IV antibody was found to be positive. The patient was treated with fondaparinux and continued heparin-free HD. Unfortunately, despite favorable initial response without any thrombotic episodes, the patient died due to severe sepsis complicated by gastrointestinal hemorrhage.
Division of Nephrology, Department of Internal Medicine, Meram School of Medicine, Konya University, Konya, Turkey. yalcinsolakmd@gmail.com
Yalcin
Y
Solak
Sinan
S
Demircioglu
Ilker
I
Polat
Zeynep
Z
Biyik
Abduzhappar
A
Gaipov
Kadir
K
Acar
Suleyman
S
Turk
D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D017809:Fatal Outcome; D000077425:Fondaparinux; D006493:Heparin / Q000009:adverse effects*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000628:therapy; D008297:Male; D010976:Platelet Count; D011134:Polysaccharides / Q000627:therapeutic use*; D006435:Renal Dialysis / Q000009:adverse effects / Q000379:methods*; D013921:Thrombocytopenia / Q000097:blood / Q000139:chemically induced* / Q000188:drug therapy*
D000925:Anticoagulants; D011134:Polysaccharides; D006493:Heparin; D000077425:Fondaparinux