Heparin-induced skin lesions

Phlebologie ◽  
2010 ◽  
Vol 39 (01) ◽  
pp. 5-11 ◽  
Author(s):  
M. Schindewolf ◽  
B. Kahle ◽  
E. Lindhoff-Last ◽  
R. J. Ludwig
Keyword(s):  
Clinical Importance ◽  
Skin Lesions ◽  
Delayed Type Hypersensitivity ◽  
Medical Patients ◽  
Heparin Induced Thrombocytopenia ◽  
Immune Mediated ◽  
Prospective Epidemiological Study ◽  
Therapeutic Procedures ◽  
Life Threatening ◽  
Cutaneous Reactions

SummaryCutaneous reactions to subcutaneous heparin injections have been described first in 1952. These reactions may be caused by several mechanisms such as immediate or delayed-type hypersensitivity responses, or by life-threatening immune-mediated heparin-induced thrombocytopenia (HIT). In contrast to bleeding, induction of osteoporosis and hair loss, no data on the incidence and causes of heparin-induced skin lesions had been available until recently. In a large prospective epidemiological study, the incidence of heparin-induced skin lesions was as high as 7.5% in medical patients, far exceeding the expected incidence. As heparin-induced skin lesions may be the sole clinical manifestation of immune HIT, rapid and valid diagnosis of heparin-induced skin lesions is of utmost clinical importance. Therefore, we have reviewed all known causes of heparin-induced skin lesions, and propose diagnostic and therapeutic procedures.

Diagnosis of heparin-induced delayed type hypersensitivity

Phlebologie ◽  
2010 ◽  
Vol 39 (04) ◽  
pp. 226-231 ◽  
Author(s):  
M. Schindewolf ◽  
M. Wolter ◽  
K. Hardt ◽  
R. Kaufmann ◽  
E. Lindhoff-Last ◽  
...  
Keyword(s):  
Clinical Presentation ◽  
False Negative ◽  
Clinical Importance ◽  
Diagnostic Procedures ◽  
Skin Lesions ◽  
Delayed Type Hypersensitivity ◽  
Epidemiological Investigation ◽  
Heparin Induced Thrombocytopenia ◽  
Immune Mediated ◽  
Low Sensitivity

SummaryHeparin is commonly used for prevention and therapy of thromboembolic diseases. Recently, work from a prospective epidemiological investigation has indicated, that heparin-induced skin lesions may be more frequent, than expected. Commonly, delayed-type hypersensitivity reactions can be identified as the cause of heparin-induced skin lesions. Rarely, immediatetype hypersensitivity responses or immune-mediated heparin-induced thrombocytopenia (HIT) are diagnosed. It is of clinical importance to differentiate between those, as patient management is fundamentally different. Patients, methods: We evaluated diagnostic procedures used to identify causes of heparin-induced skin lesions. Based on clinical presentation, histology and/or allergologic testing in 32 patients, heparin-induced delayed-type hypersensitivity (HIHS) was diagnosed. Results: Sensitivity of histology and s.c. provocation was high, amounting to 100% or 78% respectively. All other tests were unspecific or had a low sensitivity: Immediate readings of prick tests were false negative in 81%. Patch, prick and i.c. testing had a sensitivity ranging from 3.1–15.6%. Conclusion: Based on these results and despite the limitations of histology we recommend performing a skin biopsy rather than allergologic testing for diagnosis of HIHS. Compared to allergologic testing, results from histology are sensitive, readily available and may allow a differentiation from other causes of heparin-induced skin lesions.

scholarly journals Bullous Hemorrhagic Dermatosis Induced By Heparin: An Indonesian Case Report

2021 ◽  
pp. 8-12
Author(s):  
Syahfori Widiyani ◽  
Irsalina Rahmawati ◽  
W. Yohannes Widodo ◽  
Dian Zamroni ◽  
Fajar L. Gultom ◽  
...  
Keyword(s):  
Skin Lesions ◽  
Low Molecular Weight ◽  
Heparin Induced Thrombocytopenia ◽  
Clinical Disorder ◽  
Heparin Treatment ◽  
Life Threatening ◽  
Topical Treatments ◽  
Lesion Regression ◽  
The Right ◽  
Related Reaction

Introduction: Bullous haemorrhagic dermatosis is a rare clinical disorder which is usually related to a treatment with unfractionated heparin (UFH) or low molecular weight heparin (LMWH), characterized by multiple intra-epidermal haemorrhages distant from the site of injection. Presentation of Case: A 62-year-old male patient with coronary heart disease who received heparin treatment experienced several tense, haemorrhagic bullae located on the right arm area, close to the injection site, and followed by the formation of several hematomas on his back trunk 2 days after he had received UFH. The lesions regressed after discontinuation of heparin and supportive topical treatments. Discussion: The lesions in this patient have similar characteristic with heparin-induced skin necrosis and demonstrate thrombocytopenia probably related to heparin. There are some proposed hypotheses of pathophysiology which include hypersensitivity reaction and idiosyncratic dose-related reaction. Given the clinically course, the discontinuation of heparin treatment was essential for lesion regression in addition other supportive measures. Conclusion: Heparin-induced skin lesions may indicate the presence of life-threatening heparin-induced thrombocytopenia. An early diagnosis is crucial to enable discontinuation of heparin if required.

Management of Heparin-Induced Thrombocytopenia and Heparin-Induced Thrombocytopenia and Thrombosis Syndrome

1997 ◽  
Vol 3 (1_suppl) ◽  
pp. S53-S63 ◽  
Author(s):  
Jeanine M. Walenga ◽  
Bruce E. Lewis ◽  
Debra A. Hoppensteadt ◽  
Jawed Fareed ◽  
Mamdouh Bakbos
Keyword(s):  
Antibody Titer ◽  
Platelet Factor 4 ◽  
Positive Patient ◽  
Platelet Factor ◽  
Heparin Induced Thrombocytopenia ◽  
Comprehensive Account ◽  
Immune Mediated ◽  
Life Threatening ◽  
Pros And Cons ◽  
Sensitivity Specificity

Summary: Heparin-induced thrombocytopenia (HIT) is an immune mediated response to heparin in which antibody driven thrombosis can have a dramatic life-threatening expression. There is much interest on this subject including studies on the pathophysiologic mechanism, the clinical managements of the initial stages of HIT versus the HIT-positive patient requiring continued anticoagulation versus the HIT patient with thrombosis, the pros and cons of available alterr~aci~~ anticoagulants, and the laboratory assays to aid in the diagnosis of HIT with particular reference to the sensitivity/specificity of the new heparin-platelet factor 4 antibody titer assay. A comprehensive account of these timely issues is given in this article.

Abstract 13476: Association of HLA-DRB3*01:01 With Heparin-Induced Thrombocytopenia

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Jason H Karnes ◽  
Joshua C Denny ◽  
Robert M Cronin ◽  
Christian M Shaffer ◽  
Jonathan D Mosley ◽  
...  
Keyword(s):  
Human Leukocyte ◽  
Serotonin Release ◽  
European Ancestry ◽  
Heparin Induced Thrombocytopenia ◽  
Hla Alleles ◽  
Hla Dr ◽  
Immune Mediated ◽  
Hla Dq ◽  
Long Read ◽  
Life Threatening

Introduction: Variation in the human leukocyte antigen (HLA) region is now used clinically to prevent immune-mediated adverse drug reactions. Heparin-induced thrombocytopenia (HIT) is an unpredictable, life-threatening, immune-mediated reaction to heparin treatment. Previous studies have implicated HLA-DR variants in HIT, but HLA alleles which predispose patients to HIT have not been identified. Hypothesis: Our hypothesis is that sequenced HLA alleles are associated with HIT. Methods: We identified HIT cases and heparin-exposed controls in an electronic medical record coupled to a DNA biobank. Cases were defined based on HIT antibody results, HIT risk scoring (4Ts score), and serotonin release assay results. Controls were matched to cases based on age, gender, and type of heparin exposure (unfractionated versus low molecular weight heparin). We performed high resolution, four-digit HLA sequencing for HLA-A, HLA-B, HLA-C, HLA-DR, HLA-DP, and HLA-DQ using long-read 454 FLX sequencing. We tested association of sequenced HLA alleles using conditional univariate logistic regression in a dominant model. Analysis was restricted to individuals with European ancestry and HLA alleles with a frequency greater than 0.01 (n=101). P values were corrected using a Bonferroni correction for 101 sequenced HLA alleles (alpha=4.95x10 -4 ). Results: We identified 77 HIT cases and 345 matched controls. No statistical differences were observed between cases and controls for baseline characteristics. The HLA-DRB3*01:01 allele was significantly associated with HIT (odds ratio 3.55, p=1.09x10 -4 ). No other alleles showed a significant association with HIT. Conclusions: We implicate the HLA-DRB3*01:01 allele as a risk factor for HIT. This allele represents a biologically plausible candidate for HIT, considering the previous literature implicating HLA-DR variation in HIT, the central role of HLA-DR in T cell-dependent antibody production, and the importance of T cells in HIT pathogenesis. Validation of HLA-DRB3*01:01 as a predictor of HIT pathogenesis would lead to preventive genotyping to reduce the risk of HIT.

scholarly journals Heparin-induced thrombocytopenia

Medicina ◽  
2008 ◽  
Vol 44 (9) ◽  
pp. 723
Author(s):  
Dagmara Reingardienė
Keyword(s):  
Platelet Count ◽  
Oral Anticoagulants ◽  
Thrombin Inhibitors ◽  
Direct Thrombin Inhibitors ◽  
Heparin Induced Thrombocytopenia ◽  
Immune Mediated ◽  
Laboratory Confirmation ◽  
Blood Clots ◽  
Life Threatening ◽  
Low Platelet Count

In clinical use for over 50 years, heparin is an important and widely used anticoagulant for the prophylaxis or treatment of thromboembolic disease as well as other numerous clinical situations. Ordinarily, heparin prevents clotting and does not affect the platelets, components of the blood that help to form blood clots. However, heparin can also cause heparin-induced thrombocytopenia. Two distinct types of heparininduced thrombocytopenia can occur: nonimmune and immune mediated. Nonimmune heparin-induced thrombocytopenia, which occurs most frequently, is characterized by a mild decrease in the platelet count and is not harmful. The second type, immune-mediated heparin-induced thrombocytopenia, occurs much less frequently but is dangerous. Immune-mediated heparin-induced thrombocytopenia causes much lower platelet count. Paradoxically, despite a very low platelet count, patients who suffer from heparin-induced thrombocytopenia are at risk for arterial or venous thrombosis. In this review article, there are discussed about pathogenesis of heparin-induced thrombocytopenia, other causes of thrombocytopenia, clinical features, laboratory confirmation of diagnosis, and management of patients (direct thrombin inhibitors, other therapies, duration of therapy, and use of oral anticoagulants). Prognosis and prophylaxis of this life-threatening disorder, which can develop from the use of unfractionated or (less commonly) low-molecular-weight heparin, are also discussed.

Review: Recent Advances in Argatroban-Warfarin Transition in Patients With Heparin-induced Thrombocytopenia

2008 ◽  
Vol 16 (1) ◽  
pp. 5-12 ◽  
Author(s):  
Ziad Taimeh ◽  
Babette Weksler
Keyword(s):  
Active Site ◽  
Thrombin Inhibitors ◽  
Direct Thrombin Inhibitors ◽  
Low Molecular Weight ◽  
Heparin Induced Thrombocytopenia ◽  
Prevention Of Thrombosis ◽  
Immune Mediated ◽  
Life Threatening ◽  
Comprehensive Manner ◽  
Synthetic Molecule

Heparin-induced thrombocytopenia is a devastating, life-threatening, immune-mediated complication of therapy with unfractionated heparin, and less frequently, with low molecular weight heparin. Direct thrombin inhibitors are now standard therapy for the prevention of thrombosis in heparin-induced thrombocytopenia. Argatroban, a small synthetic molecule that inhibits thrombin at its active site, is increasingly used as the direct thrombin inhibitors of choice. Transition to longer term oral anticoagulation needs to be instituted after the platelet count has risen, because of the persistent risk of thrombosis. Although guidelines available in the literature outline the management of heparin-induced thrombocytopenia, they are not presented in a concise and comprehensive manner easily followed by physicians. This article reviews current recommendations, relevant studies, and clinical management trials carried out on patients with heparin-induced thrombocytopenia and provides updated, detailed guidelines for treatment of heparin-induced thrombocytopenia with emphasis on a key part of the management, the argatroban—warfarin transition.

scholarly journals Autoimmune Hemolytic Anemia as a Complication of Congenital Anemias. A Case Series and Review of the Literature

2021 ◽  
Vol 10 (15) ◽  
pp. 3439
Author(s):  
Irene Motta ◽  
Juri Giannotta ◽  
Marta Ferraresi ◽  
Kordelia Barbullushi ◽  
Nicoletta Revelli ◽  
...  
Keyword(s):  
Hemolytic Anemia ◽  
Autoimmune Hemolytic Anemia ◽  
Case Series ◽  
Intravenous Immunoglobulins ◽  
Point Of View ◽  
First Line ◽  
Human Erythropoietin ◽  
Immune Mediated ◽  
Hemolytic Crisis ◽  
Life Threatening

Congenital anemias may be complicated by immune-mediated hemolytic crisis. Alloantibodies are usually seen in chronically transfused patients, and autoantibodies have also been described, although they are rarely associated with overt autoimmune hemolytic anemia (AIHA), a serious and potentially life-threatening complication. Given the lack of data on the AIHA diagnosis and management in congenital anemias, we retrospectively evaluated all clinically relevant AIHA cases occurring at a referral center for AIHA, hemoglobinopathies, and chronic hemolytic anemias, focusing on clinical management and outcome. In our cohort, AIHA had a prevalence of 1% (14/1410 patients). The majority were warm AIHA. Possible triggers were recent transfusion, infection, pregnancy, and surgery. All the patients received steroid therapy as the first line, and about 25% required further treatment, including rituximab, azathioprine, intravenous immunoglobulins, and cyclophosphamide. Transfusion support was required in 57% of the patients with non-transfusion-dependent anemia, and recombinant human erythropoietin was safely administered in one third of the patients. AIHA in congenital anemias may be challenging both from a diagnostic and a therapeutic point of view. A proper evaluation of hemolytic markers, bone marrow compensation, and assessment of the direct antiglobulin test is mandatory.

scholarly journals Inflammatory Skin Lesions in Three SARS-CoV-2 Swab-Negative Adolescents: A Possible COVID-19 Sneaky Manifestation?

2021 ◽  
Vol 13 (2) ◽  
pp. 181-188
Author(s):  
Giuseppe Ingravallo ◽  
Francesco Mazzotta ◽  
Leonardo Resta ◽  
Sara Sablone ◽  
Gerardo Cazzato ◽  
...  
Keyword(s):  
Electron Microscopy ◽  
Respiratory Symptoms ◽  
Clinical Manifestations ◽  
Skin Lesions ◽  
Sweat Glands ◽  
Histological Findings ◽  
Immune Mediated ◽  
Nodular Lesions ◽  
Immunohistochemical Evidence ◽  
Eccrine Sweat Glands

Coronavirus disease 19 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is associated with various clinical manifestations, including skin lesions. In particular, during the COVID-19 pandemic lock-down period numerous chilblain-like lesions, mainly located on the feet, were observed in adolescents. The latter were often asymptomatic or associated with very mild respiratory symptoms. Here, we report three cases of acral nodular lesions in SARS-CoV-2 swab-negative adolescents with histological findings of chronic immune-mediated inflammation and immunohistochemical evidence of SARS-CoV-2 spike glycoproteins in endothelial cells and eccrine sweat glands. In one of these cases, the virus presence was confirmed by electron microscopy.

scholarly journals Neonatal Birthmarks at the 4 Central Hospitals in Vientiane Capital, Lao PDR

2021 ◽  
Vol 8 ◽  
pp. 2333794X2199090
Author(s):  
Vilounna Sanaphay ◽  
Sourideth Sengchanh ◽  
Alongkone Phengsavanh ◽  
Anousavanh Sanaphay ◽  
Leelawadee Techasatian
Keyword(s):  
Sebaceous Gland ◽  
Neonatal Period ◽  
Lao Pdr ◽  
Skin Lesions ◽  
Medical Advice ◽  
Point Of View ◽  
Parental Anxiety ◽  
Skin Disorders ◽  
Clinical Point ◽  
Therapeutic Procedures

Newborn skin disorders are quite common and happen to occur during the neonatal period. Most of the birthmarks are transient; however, worried parents often seek medical advice from their child’s physician regarding skin lesions. Thus, it is important to differentiate the skin lesions from pathologic ones to avoid unnecessary diagnostic or therapeutic procedures. This is the first published study in Lao neonates that carried out the data from 4 central hospitals in Vientiane Capital, Lao PDR from September 2019 to February 2020. Among 500 neonates, Sebaceous gland hyperplasia (53%), Mongolian patches (46.6%), and Erythema toxicum neonatorum (30%) were the 3 most common cutaneous conditions found in the Lao newborns. From a clinical point of view, these findings are often a source of parental anxiety and medical concern for inexperienced clinicians.

Treatment of Heparin-Induced Thrombocytopenia

2002 ◽  
Vol 36 (3) ◽  
pp. 489-503 ◽  
Author(s):  
William E Dager ◽  
Richard H White
Keyword(s):  
Adverse Reaction ◽  
Treatment Options ◽  
Clinical Manifestations ◽  
Low Molecular Weight ◽  
National Library ◽  
Severe Adverse Reaction ◽  
Heparin Induced Thrombocytopenia ◽  
Immune Mediated ◽  
Study Selection ◽  
Clinical Conditions

OBJECTIVE: To describe heparin-induced thrombocytopenia (HIT or HIT-2), an immune-mediated adverse reaction to heparin or low-molecular-weight heparin. Available treatment options and considerations in developing a therapy approach are discussed. DATA SOURCES: A search of the National Library of Medicine (1992–June 2001) was done to identify pertinent literature. Additional references were reviewed from selected articles. STUDY SELECTION: Articles related to laboratory recognition and treatment options of HIT, including the use of agents in selected clinical conditions, were reviewed and included. CONCLUSIONS: HIT is a rare but potentially severe adverse reaction to heparin that was, until recently, poorly understood and had limited treatment options. Recent advances describing the recognition and clinical manifestations of immune-mediated HIT, including recently available antithrombotic treatment options, have dramatically changed outcomes for patients having this syndrome.

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