Gan Weh Kiat
Dermatology, Royal Bolton Hospital NHS Foundation Trust, Bolton, UK.
BMJ Case Rep. 2017 Nov 3;2017:bcr-2017-221388. doi: 10.1136/bcr-2017-221388.
An uncommon case of delayed-onset dalteparin-induced skin necrosis in an 83-year-old Caucasian female patient associated with heparin-induced thrombocytopaenia (HIT) presenting on day 30 following dalteparin therapy is reported. Investigations revealed mild thrombocytopaenia with normal protein C, protein S, coagulation screen and positive test for heparin-platelet factor-4 antibody. Clinical diagnosis of heparin-induced skin necrosis with HIT was made. Dalteparin injection was discontinued promptly and substituted with fondaparinux therapy. The patient achieved good recovery following cessation of dalteparin therapy and was subsequently discharged.
报告了一例罕见的延迟发作的达肝素诱导的皮肤坏死病例，该病例发生在一名83岁的白种女性患者身上，与肝素诱导的血小板减少症（HIT）相关，在达肝素治疗后第30天出现。检查发现轻度血小板减少，蛋白C、蛋白S、凝血筛查正常，肝素-血小板因子4抗体检测呈阳性。做出了肝素诱导的皮肤坏死合并HIT的临床诊断。立即停用达肝素注射，改用磺达肝癸钠治疗。停用达肝素治疗后患者恢复良好，随后出院。
