Heparin-induced thrombocytopenia with thrombosis
10.3760/cma.j.issn.1008-5734.2015.02.025
- VernacularTitle:肝素诱导的血小板减少伴血栓形成
- Author:
Ying HUANG
1
;
Chunmei WANG
1
;
Jianxin LI
1
;
Libing WEI
1
;
Yachan NING
1
Author Information
1. 首都医科大学宣武医院血管外科监护室,北京,100053
- Publication Type:Journal Article
- Keywords:
Heparin;
Thrombocytopenia;
Thrombosis
- From:
Adverse Drug Reactions Journal
2015;(2):152-154
- CountryChina
- Language:Chinese
-
Abstract:
A 73-year-old male patient underwent stent implanting of left iliac artery and recanalization of left superficial femoral artery due to atherosclerotic obliterans of artery of lower extremity and received IV push of 4 000 U unfractionated heparin( UFH)during the operation. On the operation day,the patient was transferred into Intensive Care Unit due to acute renal insufficiency caused by left perirenal hematoma and acute cardiac insufficiency. Laboratory examination showed the following values:hemoglobin 147 g/L,platelet count 113 × 109/L,serum creatinine 247 μmol/L,blood urea nitrogen 10. 6 mmol/L. On day 2 postoperation,he received non-heparin continuous renal replacement therapy on bed( the tubes were rinsed with UFH before hemodiafiltration and deep venous catheters were sealed with UFH during the hemodiafiltration). On day 3 postoperation, the patient's PLT dropped to 73 × 109/L. On day 5 postoperation,the temperature of his left foot decreased and the pulse of dorsal artery of his left foot disappeared. UFH was given intravenously at the rate of 500-625 U per hour. On day 7 postoperation,the patient's PLT suddenly dropped to 16 × 109/L,he developed skin cyanosis on his left lower limb and cyanoderma on his plantar. Vascular ultrasonography examination showed that thrombosis occurred on his left femoral vein and right internal jugular vein,occlusion appeared on his left superficial femoral artery. Heparin-induced thrombocytopenia with thrombosis was considered. UFH was stopped immediately and intravenous argatroban was given and tube rinsing and sealing with UFH was replaced with saline in continuous renal replacement therapy. On day 12 postoperation,the PLT count increased to 121 × 109/L. However,the patient died of multiple organ failure at last.
