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Plasmapheresis May Be an Option in Urgent Management of Heparin-Induced Thrombocytopenia in the Setting of Acute Intracerebral Hemorrhage.
[heparin-induced thrombocytopenia]
We
report
a
case
of
heparin-induced
thrombocytopenia
(
HIT
)
that
was
complicated
by
acute
intracerebral
hemorrhage
(
ICH
)
and
bilateral
adrenal
hemorrhage
.
In
the
setting
of
worsening
thrombocytopenia
,
the
risk
of
expansion
of
ICH
and
additional
thrombotic
events
is
concerning
;
hence
,
we
employed
plasmapheresis
to
reduce
thrombotic
risk
.
We
followed
serial
daily
heparin
antibody
enzyme-linked
immunosorbent
assay
(
ELISA
)
optical
density
measurements
as
well
as
heparin-induced
platelet
aggregation
(
HIPA
)
assays
on
both
pre-
and
post-pheresis
samples
in
order
to
objectively
determine
when
thrombotic
risk
was
sufficiently
decreased
.
After
four
cycles
of
plasmapheresis
,
both
heparin
antibody
ELISA
and
HIPA
assays
became
negative
.
This
case
helps
illustrate
the
utility
of
plasmapheresis
in
management
of
HIT
when
anticoagulation
is
contraindicated
.
