Spontaneous heparin-induced thrombocytopenia syndrome without any proximate heparin exposure, infection, or inflammatory condition: Atypical clinical features with heparin-dependent platelet activating antibodies.

[heparin-induced thrombocytopenia]

Abstract Recent studies suggest that a thromboembolic disorder resembling heparin-induced thrombocytopenia (HIT ), so -called spontaneous HIT syndrome , can occur in patients without any history of heparin exposure . It is likely due to anti-platelet factor 4 (PF 4 )/polyanion antibodies induced by other polyanions , such as bacterial surfaces and nucleic acids . We describe an atypical case of spontaneous HIT syndrome . A 70 -year -old man suddenly presented with acute cerebral sinus thrombosis (CST ). Soon after the initiation of unfractionated heparin (UFH ) for the treatment of CST , his platelet count fell precipitously and he developed deep vein thrombosis , a clinical picture consistent with rapid-onset HIT but without any proximate episodes of heparin exposure , infection , trauma , surgery , or other acute illness . Antigen assays and a washed platelet activation assay indicated that the patient already possessed anti-PF 4 /heparin IgG antibodies with heparin-dependent platelet activation properties on admission . Cessation of UFH and initiation of argatroban resulted in prompt recovery of his platelet count without further thromboembolic events . We identified two similar cases in the literature . However , these patients do not meet the recently proposed criteria for spontaneous HIT syndrome . Even in atypical cases , however , inappropriate or delayed diagnosis of HIT appears to be associated with worse outcomes . We propose that these atypical cases should be included in the category of spontaneous HIT syndrome .

Diseases
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Diseases presenting "further thromboembolic events" symptom

heparin-induced thrombocytopenia

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