Saleem Nasir, Khan Mahjabeen, Parveen Sanober, Balavenkatraman Arvind
Department of Internal Medicine, Presence St Joseph Hospital, Chicago, Illinois, USA.
BMJ Case Rep. 2016 Mar 10;2016:bcr2016214679. doi: 10.1136/bcr-2016-214679.
Heparin-induced thrombocytopaenia (HIT) is a life-threatening complication of exposure to heparin. It is mediated by autoantibodies to platelet factor-4 causing platelet activation, destruction and thrombosis. Given their rich arterial supply and a single central vein, the adrenal glands are particularly susceptible to congestive haemorrhage following venous thrombosis. We report a case of bilateral adrenal haemorrhage (BAH) associated with HIT following prophylactic use of unfractionated heparin for venous thromboembolism causing adrenal insufficiency. BAH is a life-threatening paradoxical complication associated with HIT, a prothrombotic state. The resulting adrenal insufficiency can lead to haemodynamic collapse if unrecognised. Early diagnosis, in the wake of vague symptoms, and prompt treatment primarily aimed at repletion of glucocorticoids and close monitoring of enlarging haemorrhage is of utmost importance. Likewise, early identification of HIT is important to prevent potential complications including adrenal haemorrhage.
肝素诱导的血小板减少症（HIT）是接触肝素后一种危及生命的并发症。它由针对血小板因子4的自身抗体介导，导致血小板活化、破坏和血栓形成。肾上腺因其丰富的动脉供应和单一的中央静脉，在静脉血栓形成后特别容易发生充血性出血。我们报告一例双侧肾上腺出血（BAH）病例，该病例与在预防性使用普通肝素治疗静脉血栓栓塞后发生的HIT相关，导致肾上腺功能不全。BAH是一种与HIT（一种血栓前状态）相关的危及生命的矛盾并发症。如果未被识别，由此导致的肾上腺功能不全可导致血流动力学崩溃。在出现模糊症状后进行早期诊断，并迅速进行主要旨在补充糖皮质激素和密切监测不断扩大的出血情况的治疗至关重要。同样，早期识别HIT对于预防包括肾上腺出血在内的潜在并发症很重要。
