title: Heparin-Induced Thrombocytopenia in a Patient with Essential Thrombocythemia: A Case Based Update.
abstract: Vascular thrombosis is a common clinical feature of both essential thrombocythemia (ET) and heparin-induced thrombocytopenia (HIT). The development of HIT in a patient with ET is rare and underrecognized. We report the case of a 77-year-old woman with preexisting ET, who was admitted with acute coronary syndrome, and IV heparin was started. She was exposed to unfractionated heparin (UFH) 5 days prior to this admission. Decrease in platelet count was noted, and HIT panel was sent. Heparin was discontinued. Patient developed atrial fibrillation, and Dabigatran was started. On day three, patient also developed multiple tiny cerebral infarctions and acute right popliteal DVT. On day ten of admission, HIT panel was positive, and Dabigatran was changed to Lepirudin. Two days later, Lepirudin was also discontinued because patient developed pseudoaneurysm on the right common femoral artery at the site of cardiac catheterization access. A progressive increase in the platelet count was noted after discontinuing heparin. Physicians should be aware of the coexistence of HIT and ET, accompanied challenges of the prompt diagnosis, and initiation of appropriate treatment.
authors.affiliation: Department of Medicine, Bronx Lebanon Hospital Center, 1650 Selwyn Avenue, Suite No. 15H, Bronx, NY 10457, USA.
authors.forename: Edva
authors.initials: E
authors.lastname: Noel
authors.affiliation: Department of Gastroenterology, Bronx Lebanon Hospital Center, 1650 Selwyn Avenue, Suite No. 10C, Bronx, NY 10457, USA.
authors.forename: Naeem
authors.initials: N
authors.lastname: Abbas
authors.affiliation: Department of Hematology, Bronx Lebanon Hospital Center, 1650 Selwyn Avenue, Suite No. 2C, Bronx, NY 10457, USA.
authors.forename: Yevegeniy
authors.initials: Y
authors.lastname: Skaradinskiy
authors.affiliation: Department of Hematology, Bronx Lebanon Hospital Center, 1650 Selwyn Avenue, Suite No. 2C, Bronx, NY 10457, USA.
authors.forename: Zwi
authors.initials: Z
authors.lastname: Schreiber