Kommalapati Anuhya, Kallam Avyakta, Krishnamurthy Jairam, Tella Sri H, Koppala Jahnavi, Tandra Pavan Kumar
Internal Medicine, University of South Carolina, Columbia, USA.
Hematology and Oncology, University of Nebrask, Omaha, USA.
Cureus. 2018 Jun 21;10(6):e2853. doi: 10.7759/cureus.2853.
We present a case of a dialysis-dependent end-stage renal disease patient who originally presented with sepsis and later developed heparin-induced thrombocytopenia-related upper extremity deep venous thrombosis that rapidly progressed to phlegmasia. Argatroban, a direct thrombin inhibitor, was initiated without delay. Argatroban restored the venous patency completely but did not reverse his two gangrenous fingers. The patient finally underwent digital amputation. The management of this uncommon, but life-threatening, situation of upper limb phlegmasia cerulea dolens secondary to heparin-induced thrombocytopenia leading to gangrene is discussed in this case report.
我们报告一例依赖透析的终末期肾病患者，该患者最初表现为败血症，随后发生肝素诱导的血小板减少症相关的上肢深静脉血栓形成，并迅速发展为血栓性静脉炎。立即开始使用直接凝血酶抑制剂阿加曲班。阿加曲班完全恢复了静脉通畅，但未能使他的两根坏疽手指恢复正常。患者最终接受了手指截肢手术。本病例报告讨论了这种由肝素诱导的血小板减少症继发上肢蓝色疼痛性血栓形成并导致坏疽的罕见但危及生命情况的处理。
