Medicine · 2025
Type II heparin-induced thrombocytopenia in a maintenance hemodialysis patient: A case report and literature review.
СтатьяКлинический случайОбзорНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Zhang Xiaming, Zhou Mi, Wu Ping, Chen Yingji, Yan Juzhen
Аннотация
RATIONALE: Heparin-induced thrombocytopenia (HIT) is a rare but severe immunologically mediated drug reaction characterized by a significant decrease in platelet count following exposure to heparin, accompanied by hypercoagulability or thrombosis. Severe cases can present as acute allergic reactions, which can be life-threatening. We report a rare case of type II HIT in a hemodialysis patient, initially presenting with arteriovenous fistula thrombosis, and review the literature to share strategies for early recognition and management.
PATIENT CONCERNS: We present a case involving a 69-year-old female patient who experienced significant thrombocytopenia, thrombosis of an arteriovenous fistula, and an acute hypersensitive reaction after being exposed to low molecular weight heparin during the initiation of dialysis.
DIAGNOSES: She scored 8 points on the 4T scoring system, and her HIT immunoglobulin G-specific antibody test returned positive, confirming a diagnosis of HIT.
INTERVENTIONS: All heparin-based anticoagulants were discontinued, and argatroban was introduced as a substitute.
OUTCOMES: The patient's platelet count recovered to near baseline levels within approximately 1 week after stopping heparin, and no further symptoms related to acute systemic reactions occurred. The patient was eventually transitioned to novel oral anticoagulants and then discontinued argatroban. Her dialysis has been proceeding smoothly so far, and there have been no further occurrences of arteriovenous fistula thrombosis.
LESSONS: Our experience emphasizes the importance of closely monitoring clinical manifestations and platelet count changes during the first 1 to 2 weeks following the initiation of dialysis. If there is a significant drop in platelet count, it is crucial to consider the possibility of HIT in conjunction with the patient's medical history and clinical presentation. In addition, hemodialysis can be safely performed using only oral rivaroxaban.
PATIENT CONCERNS: We present a case involving a 69-year-old female patient who experienced significant thrombocytopenia, thrombosis of an arteriovenous fistula, and an acute hypersensitive reaction after being exposed to low molecular weight heparin during the initiation of dialysis.
DIAGNOSES: She scored 8 points on the 4T scoring system, and her HIT immunoglobulin G-specific antibody test returned positive, confirming a diagnosis of HIT.
INTERVENTIONS: All heparin-based anticoagulants were discontinued, and argatroban was introduced as a substitute.
OUTCOMES: The patient's platelet count recovered to near baseline levels within approximately 1 week after stopping heparin, and no further symptoms related to acute systemic reactions occurred. The patient was eventually transitioned to novel oral anticoagulants and then discontinued argatroban. Her dialysis has been proceeding smoothly so far, and there have been no further occurrences of arteriovenous fistula thrombosis.
LESSONS: Our experience emphasizes the importance of closely monitoring clinical manifestations and platelet count changes during the first 1 to 2 weeks following the initiation of dialysis. If there is a significant drop in platelet count, it is crucial to consider the possibility of HIT in conjunction with the patient's medical history and clinical presentation. In addition, hemodialysis can be safely performed using only oral rivaroxaban.