title: Non-injection-site necrotic skin lesions complicating postoperative heparin thromboprophylaxis.
abstract: The patient case we present is a definite case of HIT from both clinical and serological perspectives. The 4Ts score was eventually 8/8 (maximum) based upon thrombocytopenia (88% platelet count fall to nadir of 58 × 109/L), appropriate timing (onset on Day 5 post-intraoperative UFH exposure), thrombosis (right lower limb DVTs, skin necrosis, anaphylactoid reaction to IV heparin, right hallux ischemic necrosis), and no plausible alternative explanation for thrombocytopenia. In addition, the patient had a strong positive SRA and PF4-dependent ELISA. Although necrotizing skin lesions distant from heparin injection sites are not a common consequence of HIT, their occurrence in this patient—along with previous supportive literature [11-13]—indicate that these lesions should be considered rare manifestations of HIT. Moreover, the distinct localization of the unusual necrotic skin rash to the right limb suggests that a low flow state due to the arterial obstruction or perhaps even as a result of an underlying venous thrombus, both of which were present in our patient, could play a key pathophysiological role in predisposing to this unusual complication of HIT.
authors: Department of Medicine, Saint Joseph Mercy Hospital, Ann Arbor, Michigan.
authors: Twylla
authors: T
authors: Tassava
authors: Department of Pathology and Molecular Medicine, Michael G, DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada.|Department of Medicine, Michael G, DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada.
authors: Theodore E
authors: TE
authors: Warkentin
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects*; D001011:Aorta / Q000601:surgery; D001792:Blood Platelets / Q000473:pathology; D003924:Diabetes Mellitus, Type 2 / Q000473:pathology / Q000601:surgery; D005263:Femoral Artery / Q000601:surgery; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D007866:Leg / Q000098:blood supply / Q000473:pathology* / Q000601:surgery; D008297:Male; D010976:Platelet Count; D011183:Postoperative Complications; D012307:Risk Factors; D012867:Skin / Q000187:drug effects / Q000473:pathology*; D013921:Thrombocytopenia / Q000139:chemically induced / Q000473:pathology*; D020246:Venous Thrombosis / Q000473:pathology / Q000517:prevention & control
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight