scholarly journals Heparin-Induced Thrombocytopenia in a Patient with Essential Thrombocythemia: A Case Based Update

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Edva Noel ◽  
Naeem Abbas ◽  
Yevegeniy Skaradinskiy ◽  
Zwi Schreiber
Keyword(s):  
Platelet Count ◽  
Essential Thrombocythemia ◽  
Common Femoral Artery ◽  
Progressive Increase ◽  
Clinical Feature ◽  
Heparin Induced Thrombocytopenia ◽  
Coronary Syndrome ◽  
Appropriate Treatment ◽  
The Right ◽  
Prompt Diagnosis

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.

scholarly journals Spontaneous Heparin-Induced Thrombocytopenia and COVID-19 Infection

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 4216-4216
Author(s):  
Suneetha Amara
Keyword(s):  
Platelet Count ◽  
Conflicts Of Interest ◽  
Hospitalized Patients ◽  
Target Range ◽  
Low Grade ◽  
Primary Therapy ◽  
Platelet Factor ◽  
Heparin Induced Thrombocytopenia ◽  
The Right ◽  
D Dimer

Abstract Background and Objective: Heparin-induced thrombocytopenia (HIT) can develop if immune responses to infections become pathologic in the presence of heparins. Low molecular weight heparin or unfractionated heparin are recommended for prophylaxis and treatment of venous thromboembolic disease in hospitalized patients with Covid-19 infection but may trigger HIT. Our aim is to alert clinicians that HIT occurs in association with Covid-19 infections even in the absence of prior exposure and may not be easily recognized without a high index of suspicion. Case Summary: A 33-year-old previously healthy male was initially evaluated for low grade fever, dyspnea without hypoxia and cough. A Covid-19 PCR swab was negative despite a recent exposure. He was treated with azithromycin. However, his symptoms did not improve, he then developed right leg swelling and hypoxia, so he was re-evaluated. CTA of the chest showed bilateral pulmonary emboli and ground-glass opacities at the lung bases. Venous Duplex Ultrasound showed non-occlusive thrombus in the deep veins of right lower extremity. He was hospitalized and placed on oxygen and heparin. Covid-19 swab was negative again. Laboratory tests before heparin showed a decreased platelet count of 64,000 k/ul, elevated prothrombin time of 16.4 seconds, normal aPTT at 30.8 seconds, decreased serum fibrinogen at 120 mg/dl and markedly elevated D-dimer at 59,966 ng/ml. Lupus anticoagulant and anti-phospholipid antibody tests were negative. On heparin at the desired therapeutic aPTT target range, the right leg became significantly swollen and painful by day five. Platelet count had decreased further to 39,000 k/ul. Repeat doppler examination of the right leg now showed more severe and extensive deep venous thrombosis. D-dimer had increased to 125,133 ng/ml. The HIT 4T score was 4, suggesting intermediate probability. Rapid HIT immunoassays on 2 separate samples were positive. Heparin was discontinued and he was placed on argatroban. Serotonin release assays on 2 separate samples came back positive. Suspicion for Covid-19 infection remained high and so a Covid-19 serology sample was obtained which was positive for IgG. A repeat nasopharyngeal swab at this time turned positive. He did not receive any COVID specific treatments. As viability of his leg appeared threatened, he underwent right iliofemoral vein thrombectomy with arteriovenous fistula creation. He improved on argatroban and was transitioned to apixaban with gradual normalization of hemostasis laboratory parameters, improvement in hypoxemia and fading clinical symptoms, he was discharged home on day 15. Conclusion: Current consensus guidelines for thromboprophylaxis and treatment of thromboembolism in hospitalized patients with Covid-19 infection recommend heparins as primary therapy to reduce morbidity and mortality. However, our report in addition to the two previous reports of HIT in Covid-19 patients illustrate that HIT can be a complication in the setting of Covid-19 infection. Further, our report also highlights that HIT with thrombosis can occur in a spontaneous manner in the absence of prior heparin exposure, which has been so far studied only in bacterial infection with the hypothesis that Platelet factor 4 (PF4) can bind to negatively charged polysaccharides on the surface of bacteria, triggering an immune response. Disclosures No relevant conflicts of interest to declare.

scholarly journals Epirubicin-induced Kounis syndrome

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Hui-zhu Liang ◽  
Hong Zhao ◽  
Jian Gao ◽  
Cheng-fu Cao ◽  
Wei-min Wang
Keyword(s):  
Troponin I ◽  
Coronary Artery Spasm ◽  
Elevated Troponin ◽  
Kounis Syndrome ◽  
Case Presentation ◽  
Coronary Syndrome ◽  
Systemic Allergic Reaction ◽  
Appropriate Treatment ◽  
Prompt Diagnosis ◽  
Recurrent Bladder Cancer

Abstract Background Kounis syndrome is an acute coronary syndrome that appears in the setting of anaphylactic reaction or hypersensitivity. Many drugs and environmental exposures have been identified as potential offenders, and diagnosis and treatment can be challenging. Case presentation A 62-year-old man with recurrent bladder cancer underwent an intra-iliac artery epirubicin injection. After the injection, he developed chest pain and a systemic allergic reaction, with electrocardiographic alterations and elevated troponin-I levels. Emergent coronary angiography showed right coronary artery spasm and no stenosis of the other coronary arteries. This reaction was considered compatible with an allergic coronary vasospasm. A diagnosis of Kounis syndrome was made. Conclusions Kounis syndrome is common, but a prompt diagnosis is often not possible. This case is the first to suggest that an intraarterial epirubicin injection could potentially be one of its triggers. All physicians should be aware of the pathophysiology of this condition to better recognize it and start appropriate treatment; this will prevent aggravation of the vasospastic cardiac attacks and yield a better outcome.

scholarly journals Cystic Adventitial Disease of the Common Femoral Artery: A Rare-Case Report

2022 ◽  
Vol 8 ◽  
Author(s):  
Qilong Wang ◽  
Zhihua Cheng ◽  
Liang Tang ◽  
Qi Wang ◽  
Ping Zhang ◽  
...  
Keyword(s):  
Femoral Artery ◽  
Limb Ischemia ◽  
Common Femoral Artery ◽  
Acute Limb Ischemia ◽  
Appropriate Treatment ◽  
Contrast Enhanced ◽  
Rare Case Report ◽  
The Right ◽  
Enhanced Computed Tomography

Herein, we report the case of a 59-year-old man with intermittent claudication of ~100 m, who complained of resting pain in his lower right extremity. A pelvic, contrast-enhanced, computed tomography scan showed the presence of cystic density in the lower segment of the right common femoral artery. Faced with the risk of acute limb ischemia, we navigated a challenging diagnostic procedure to choose an appropriate treatment for him. Additionally, we performed a pathological investigation of the excised common femoral artery following the excision bypass. On postoperative day 5, the patient was discharged from the hospital. During the 2-year follow-up, no new cysts were discovered, and the patient had favorable prognosis.

scholarly journals Heparin-Induced Thrombocytopenia Associated with Massive Intracardiac Thrombosis: A Case Report

2012 ◽  
Vol 2012 ◽  
pp. 1-4 ◽  
Author(s):  
Atheer Ahmed ◽  
Hamid AL-Mondhiry ◽  
Truman J. Milling ◽  
David Campbell
Keyword(s):  
Platelet Count ◽  
Medical Records ◽  
Serotonin Release ◽  
University Hospital ◽  
Heparin Induced Thrombocytopenia ◽  
Heparin Administration ◽  
Elisa Testing ◽  
Perfusion Scan ◽  
The Right ◽  
The University

A 60-years old patient was admitted to a community hospital with septic arthritis. He was treated with antibiotics and subcutaneous unfractionated heparin (UH) was used for venous thromboprophylaxis. After three days, he developed leg deep venous thrombosis and was treated with IV heparin. One day later, the patient developed pulmonary emboli, which was found using ventilation/perfusion scan. He was transferred to the University Hospital for further management. Upon arrival, antibiotic and intravenous UH were continued. Trans-Esophageal Echocardiogram showed a thrombus in the right atrium, a small portion of which extended to the left atrium through a patent foramen ovale. Another large thrombus was noted in the right ventricle, which extended to the pulmonary artery. Review of the patient’s medical records revealed a halving of his platelet count three days following the heparin administration. Therefore, HIT seemed very likely. Intravenous UH was stopped and an emergency thrombectomy was performed. ELISA testing of HIT antibodies camenegative. This made HIT diagnosis unlikely and the patient received dalteparin. A week later, as the platelet count declined again, HIT antibodies’ testing using ELISA and C-14 serotonin release was repeated, and both assays werepositive. Argatroban was restarted and the platelet count normalized.

Heparin-Induced Thrombocytopenia in Patients with Coronary Artery Disease: A Common but Underdiagnosed Syndrome.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 3940-3940
Author(s):  
Min Ju Kim ◽  
Se Hoon Park ◽  
Tae Hoon Ahn ◽  
Eak Kyun Shin ◽  
Soo-Mee Bang ◽  
...  
Keyword(s):  
Platelet Count ◽  
Low Frequency ◽  
Laboratory Evaluation ◽  
Heparin Induced Thrombocytopenia ◽  
Baseline Platelet Count ◽  
Coronary Syndrome ◽  
Immune Mediated ◽  
Common Causes ◽  
Artery Disease ◽  
Complete Blood Counts

Abstract Heparin-induced thrombocytopenia (HIT) is occurring in a relatively low frequency but is sometimes problematic clinically. The aims of this study were to know the epidemiology of HIT in Korean population and to gain some insight of the physicians’ awareness of this syndrome. We obtained the records of all patients treated with unfractionated heparin (UFH) for their acute coronary syndrome at the Gachon Medical School Gil Heart Center during 2002–2003. Eligible patients were required to have checked complete blood counts at least twice in their hospital courses and to have normal baseline platelet count. Patients who had unexplained (absence of all common causes) thrombocytopenia were considered to have clinical HIT. We also reviewed the medical record of all patients with thrombocytopenia to determine whether the treating-physicians have thought and/or ordered any laboratory evaluation for immune-mediated HIT. Among 874 consecutive patients treated with UFH, 272 (31.1%) had never followed their platelet count after admission and 58 (6.6%) had baseline thrombocytopenia. Thus, 554 patients had protocol-compliant data and were included in the study. Median duration of UFH administration was 6 days (range 1 to 41) and 62 (11.1%) patients developed thrombocytopenia. Among the 442 patients who received UFH for > 96 hours, 51 (11.5%) developed thrombocytopenia. In these patients with prolonged UFH administration, 16 had a hematology consult, 30 had suspected to have clinical HIT, and only one had a diagnosis of HIT in their medical records. In 21 patients, possible other causes for thrombocytopenia were evident. Even though this is a tertiary academic hospital, serologic tests for HIT was never ordered. Keeping in mind the limitations of retrospective analyses, the present study shows that thrombocytopenia is common in patients treated with UFH and that physician’s awareness of this syndrome is limited.

scholarly journals An experience with Foot Macrodactyly: A case report and review of literature

2022 ◽  
Vol 7 (2) ◽  
pp. 87-89
Author(s):  
Anupam Kaur ◽  
Amandeep Kaur
Keyword(s):  
Congenital Malformation ◽  
Positive Family History ◽  
Clinical Manifestations ◽  
Progressive Increase ◽  
Health Issues ◽  
Psychological Issues ◽  
Ambulatory Ability ◽  
Appropriate Treatment ◽  
One Year ◽  
The Right

Macrodactyly is a rare congenital malformation with clinical manifestations such as enlargement of soft tissue and osseous elements. It causes various health issues such as pain, difficulty in wearing shoes, impairment in ambulatory ability and gait development, aesthetic problem, and psychological issues. The aetiology of macrodactyly is ambiguous; however, its association with PIK3CA /AKT1 genes has been reported recently. In the present study, a rare congenital macrodactyly of second and third toe of right foot along with deformed leg in 16-year-old girl has been reported. A progressive increase in the size of the second and third toe of the right foot and deformed reddish swollen area on the same lower leg below knee was seen in the patient. The malformation was present at the time of birth and at the age of one year the patient was operated for macrodactyly, but again the toe progressively increased to the previous size. She was presented with multiple health problems. There was no positive family history and/or other congenital malformation. Thus, it was suggested that due to variable phenotypic manifestations, appropriate treatment should be chosen for the patient individually.

Increased Thromboxane Biosynthesis in Essential Thrombocythemia

1995 ◽  
Vol 74 (05) ◽  
pp. 1225-1230 ◽  
Author(s):  
Bianca Rocca ◽  
Giovanni Ciabattoni ◽  
Raffaele Tartaglione ◽  
Sergio Cortelazzo ◽  
Tiziano Barbui ◽  
...  
Keyword(s):  
Platelet Count ◽  
Platelet Activation ◽  
Essential Thrombocythemia ◽  
Therapeutic Strategy ◽  
Low Dose ◽  
Thrombotic Risk ◽  
Dose Aspirin ◽  
Gender And Age ◽  
Low Dose Aspirin

SummaryIn order to investigate the in vivo thromboxane (TX) biosynthesis in essential thromboeythemia (ET), we measured the urinary exeretion of the major enzymatic metabolites of TXB2, 11-dehydro-TXB2 and 2,3-dinor-TXB2 in 40 ET patients as well as in 26 gender- and age-matched controls. Urinary 11-dehydro-TXB2 was significantly higher (p <0.001) in thrombocythemic patients (4,063 ± 3,408 pg/mg creatinine; mean ± SD) than in controls (504 ± 267 pg/mg creatinine), with 34 patients (85%) having 11-dehydro-TXB2 >2 SD above the control mean. Patients with platelet number <1,000 × 109/1 (n = 25) had significantly higher (p <0.05) 11 -dehydro-TXB2 excretion than patients with higher platelet count (4,765 ± 3,870 pg/mg creatinine, n = 25, versus 2,279 ± 1,874 pg/mg creatinine, n = 15). Average excretion values of patients aging >55 was significantly higher than in the younger group (4,784 ± 3,948 pg/mg creatinine, n = 24, versus 2,405 ± 1,885 pg/mg creatinine, n = 16, p <0.05). Low-dose aspirin (50 mg/d for 7 days) largely suppressed 11-dehydro-TXB2 excretion in 7 thrombocythemic patients, thus suggesting that platelets were the main source of enhanced TXA2 biosynthesis. The platelet count-corrected 11-dehydro-TXB2 excretion was positively correlated with age (r = 0.325, n = 40, p <0.05) and inversely correlated with platelet count (r = -0.381, n = 40, p <0.05). In addition 11 out of 13 (85%) patients having increased count-corrected 11-dehydro-TXB2 excretion, belonged to the subgroup with age >55 and platelet count <1,000 × 1099/1. We conclude that in essential thrombocythemia: 1) enhanced 11-dehydro-TXB2 excretion largely reflects platelet activation in vivo;2) age as well as platelet count appear to influence the determinants of platelet activation in this setting, and can help in assessing the thrombotic risk and therapeutic strategy in individual patients.

Acute Type-A Aortic Dissection with Obstruction of the Right Coronary Artery

2014 ◽  
Vol 17 (4) ◽  
pp. 196
Author(s):  
Erhan Kaya ◽  
Halit Yerebakan ◽  
Daniel Spielman ◽  
Omer Isik ◽  
Cevat Yakut
Keyword(s):  
Coronary Artery ◽  
Aortic Dissection ◽  
Right Coronary Artery ◽  
Type A ◽  
Sudden Onset ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
Coronary Syndrome ◽  
Bentall Procedure ◽  
The Right

Occlusion of a coronary artery by an acute type A aortic dissection presents a life-threatening emergency that is rarely seen and easy to misdiagnose. We present the case of a 75-year-old male who experienced sudden onset of severe left-sided chest pain due to an acute type A aortic dissection that obstructed the right coronary artery. Following an initial misdiagnosis of acute coronary syndrome, imaging revealed the presence of an aortic dissection. An emergency modified Bentall procedure was performed, in which the damaged aorta and aortic valve were replaced.

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