title: Low Molecular Weight Heparin Induced Skin Necrosis without Platelet Fall Revealing Immunoallergic Heparin Induced Thrombocytopenia.
abstract: Low molecular weight heparins (LMWH) are commonly used in the ICU setting for thromboprophylaxis as well as curative decoagulation as required during renal replacement therapy (RRT). A rare adverse event revealing immunoallergic LMWH induced thrombopenia (HIT) is skin necrosis at injection sites. We report the case of a patient presenting with skin necrosis witnessing an HIT after RRT, without thrombocytopenia. The mechanism remains unclear. Anti-PF4/heparin antibodies, functional tests (HIPA and/or SRA), and skin biopsy are of great help to evaluate differential diagnosis with a low pretest probability 4T's score.
authors.affiliation: CHU Clermont-Ferrand, CHU Estaing, Réanimation Adultes & Unité de Soins Continus, 1 Place Lucie et Raymond Aubrac, 63003 Clermont-Ferrand Cedex 1, France.
authors.forename: Thomas
authors.initials: T
authors.lastname: Godet
authors.forename: Sébastien
authors.initials: S
authors.lastname: Perbet
authors.forename: Aurélien
authors.initials: A
authors.lastname: Lebreton
authors.forename: Guillaume
authors.initials: G
authors.lastname: Gayraud
authors.forename: Sophie
authors.initials: S
authors.lastname: Cayot
authors.forename: Aymeric
authors.initials: A
authors.lastname: Tremblay
authors.forename: Aurélie
authors.initials: A
authors.lastname: Ravinet
authors.forename: Sébastien
authors.initials: S
authors.lastname: Christophe
authors.forename: Renaud
authors.initials: R
authors.lastname: Guérin
authors.forename: Julien
authors.initials: J
authors.lastname: Pascal
authors.forename: Matthieu
authors.initials: M
authors.lastname: Jabaudon
authors.forename: Amr
authors.initials: A
authors.lastname: Hassan
authors.forename: Anne-Françoise
authors.initials: AF
authors.lastname: Sapin
authors.forename: Jean-Etienne
authors.initials: JE
authors.lastname: Bazin
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Constantin