Sartori Michelangelo, Cosmi Benilde
Division of Angiology and Blood Coagulation, IRCCS Azienda Ospedaliero-Universitaria di Bologna.
University of Bologna, Italy.
Hematol Rep. 2021 Mar 12;13(1):8857. doi: 10.4081/hr.2021.8857. eCollection 2021 Mar 5.
Heparin-induced thrombocytopenia (HIT) has not been included as a possible cause of thrombocytopenia in Coronavirus Disease 2019 (COVID-19) patients. We report a case of HIT in a patient with COVID-19 treated with heparin. A 78-yearold man was admitted to our hospital for acute respiratory failure and acute renal failure due to SARS-CoV-2 infection; in intensive care unit, one 5000IU heparin dose (day 0, platelet count 305000/μL). On day 2, haemoglobin started to decrease and heparin was stopped. On day 10, platelet count was 153000/μL and 5000IU calcium heparin subcutaneously twice daily was started. The platelet further decreased, reaching 49000/μL on day 17, and the patient was investigated for suspected HIT: an IgG specific chemiluminescence test for heparin- PF4 antibodies was positive and a femoral DVT was found at ultrasound. Argatroban was started, platelet count increased without any bleeding and thrombosis complication. Our experience shows that HIT may develop in heparin treated COVID-19 patients and should be included among the possible cause of thrombocytopenia in such patients.
肝素诱导的血小板减少症（HIT）未被列为2019冠状病毒病（COVID-19）患者血小板减少症的可能病因。我们报告了1例接受肝素治疗的COVID-19患者发生HIT的病例。一名78岁男性因严重急性呼吸综合征冠状病毒2感染导致急性呼吸衰竭和急性肾衰竭入住我院；在重症监护病房，给予一次5000IU肝素剂量（第0天，血小板计数305000/μL）。第2天，血红蛋白开始下降，肝素停用。第10天，血小板计数为153000/μL，开始每天两次皮下注射5000IU肝素钙。血小板进一步下降，在第17天降至49000/μL，患者因疑似HIT接受检查：肝素-PF4抗体的IgG特异性化学发光试验呈阳性，超声检查发现股静脉深静脉血栓形成。开始使用阿加曲班，血小板计数增加，未出现任何出血和血栓形成并发症。我们的经验表明，接受肝素治疗的COVID-19患者可能发生HIT，应将其列为此类患者血小板减少症的可能病因之一。
