Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
BMJ Case Rep. 2021 Nov 29;14(11):e245385. doi: 10.1136/bcr-2021-245385.
A 68-year-old woman was admitted to the hospital for elective total knee arthroplasty in both knees without preceding heparin exposure. She developed adrenal haemorrhage and thrombocytopaenia on postoperative day 12, followed by right leg arterial occlusion and multiple venous intra-abdominal sites thrombosis. After given unfractionated heparin to treat arterial occlusion, platelet count was gradually declined. Spontaneous heparin-induced thrombocytopaenia was diagnosed by heparin-induced platelet activation test with light transmission aggregometry. The patient was successfully treated with fondaparinux and intravenous immunoglobulin. Apixaban was given after recovery of platelet count. Resolution of both thrombus along aorta and adrenal haemorrhage were shown by CT of whole abdomen after 2 months of treatment. Our case demonstrates that this serious complication is important but seldom recognised early.
一位 68 岁女性因双侧膝关节择期行全膝关节置换术入院，既往无肝素暴露史。术后第 12 天，患者出现肾上腺出血和血小板减少症，随后出现右下肢动脉闭塞和多处腹部静脉内血栓形成。在给予普通肝素治疗动脉闭塞后，血小板计数逐渐下降。通过光传输聚集法进行肝素诱导血小板活化试验诊断为自发性肝素诱导血小板减少症。患者成功接受了磺达肝癸钠和静脉注射免疫球蛋白治疗。血小板计数恢复后给予阿哌沙班。治疗 2 个月后，全腹部 CT 显示主动脉和肾上腺出血处血栓均已溶解。本病例表明，这种严重并发症虽然重要，但早期常常不易被识别。
