title: [Heparin-induced thrombocytopenia developed during the acute phase after left upper lobectomy for lung cancer].
abstract: Heparin-induced thrombocytopenia (HIT) is a serious adverse effect of heparin administration. This must not be rarely encountered but is not often reported in Japan compared to Western countries. A 68-year-old woman underwent left upper lobectomy for lung cancer. Low-dose unfractionated heparin was administrated to prevent thromboembolism after the operation. Two days later, sudden dyspnea appeared and ultracardiosonography showing an extensive thromboembolus from the main trunk to both main branches of pulmonary artery indicated pulmonary embolization. After the establishment of percutaneous cardiopulmonary support (PCPS) support, the embolus was removed by emergent open heart surgery. However, despite further unfractionated heparin administration following embolization surgery, other thrombus was identified in both the bi-lateral internal jagular veins and inferior vena cava by ultrasonography and contrast computed tomography( CT). Her platelet count was decreased gradually despite platelet transfusion. Plate factor 4( PF4) antibody against heparin in her blood examination was found, and HIT II was diagnosed. Discontinuation of unfractionated heparin and administration of antithrombin agent improved platelet count, and no additional embolization was identified.
authors.affiliation: Department of Thoracic Surgery, Tohoku Pharmaceutical University Hospital, Sendai,Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Mitomo
authors.forename: Akira
authors.initials: A
authors.lastname: Miyamoto
authors.forename: Toshiharu
authors.initials: T
authors.lastname: Tabata
authors.forename: Takafumi
authors.initials: T
authors.lastname: Sugawara
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yabuki
authors.forename: Shigefumi
authors.initials: S
authors.lastname: Fujimura
mesh_terms: D000368:Aged; D005260:Female; D006493:Heparin / Q000009:adverse effects*; D006801:Humans; D008175:Lung Neoplasms / Q000601:surgery*; D010976:Platelet Count; D013510:Pulmonary Surgical Procedures; D013921:Thrombocytopenia / Q000139:chemically induced* / Q000000981:diagnostic imaging; D014463:Ultrasonography
chemical_list: D006493:Heparin