title: Fatal anaphylactoid reaction associated with heparin-induced thrombocytopenia.
abstract: Acute systemic (anaphylaxis and anaphylactoid) reactions have been well described in patients with heparin-induced thrombocytopenia (HIT). Both necrotizing and non-necrotizing skin lesions at heparin injection sites have been reported and may occur in 10-20% of patients with HIT. We report herein a patient treated with subcutaneous enoxaparin sodium who developed non-necrotizing erythematous skin lesions at enoxaparin sodium injection sites. A subsequent intravenous bolus of unfractionated heparin produced a fatal anaphylactoid reaction. This suggests that caution should be exercised in the administration of intravenous heparin to patients with non-necrotizing erythematous skin lesions at prior heparin injection sites.
authors.affiliation: Division of Cardiovascular Medicine, University of Missouri School of Medicine, Columbia, Missouri 65212, USA.
authors.forename: Atul
authors.initials: A
authors.lastname: Singla
authors.forename: Mohammad R
authors.initials: MR
authors.lastname: Amini
authors.forename: Martin A
authors.initials: MA
authors.lastname: Alpert
authors.forename: Heather L
authors.initials: HL
authors.lastname: Gornik
mesh_terms: D000707:Anaphylaxis / Q000139:chemically induced*; D000925:Anticoagulants / Q000009:adverse effects*; D017809:Fatal Outcome; D006493:Heparin / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012871:Skin Diseases / Q000139:chemically induced*; D013921:Thrombocytopenia / Q000139:chemically induced*
chemical_list: D000925:Anticoagulants; D006493:Heparin
keywords: heparin; low-molecular weight heparin; skin