[The therapy of the heparin-induced thrombosis-thrombocytopenia syndrome with immunoglobulins].

A 51-year-old obese woman who had just undergone a second osteotomy for arthrosis of the hip joint was given unfractionated heparin, 7,500 IU subcutaneously three times daily, as thrombosis prophylaxis. Signs of fulminant pulmonary embolism occurred on the 16th postoperative day with a platelet count of 33,000/microliters. Suspected heparin-induced thrombocytopenia and thrombosis (HITT) was confirmed by platelet tests. When heparin had been discontinued immunoglobulin G was administered, seven times 5 g intravenously, in view of the immunological genesis of HITT. In addition thrombolysis treatment with streptokinase combined with phenprocoumon was undertaken, until satisfactory anticoagulation was achieved after 4 days. Platelet count rose to 136,000/microliters within 20 hours of the first immunoglobulin dose. Complete clinical normality was restored, scintigraphy showed no perfusion deficit in the lungs.