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Unusual Case of HIT With Cardiac Arrest During Hemodialysis.
[heparin-induced thrombocytopenia]
To
report
an
unusual
case
of
heparin-induced
thrombocytopenia
(
HIT
)
with
cardiac
arrest
during
hemodialysis
(
HD
)
.
An
88
-
year
-old
man
previously
treated
with
HD
under
enoxaparin
for
3
years
presented
with
dizziness
and
cyanosis
at
the
beginning
of
HD
on
3
consecutive
sessions
.
Even
though
the
dialyzer
membrane
was
changed
,
he
presented
with
cardiac
arrest
,
from
which
he
recovered
quickly
.
At
the
same
time
,
the
platelet
count
fell
,
and
HIT
was
suspected
.
No
thrombosis
was
found
.
Anti-
PF
4
/
H
,
IL
8
,
and
NAP
2
antibodies
were
negative
,
but
platelet
aggregation
tests
and
serotonin-release
assay
were
positive
.
After
implementing
HD
with
danaparoid
,
the
platelet
count
returned
to
normal
,
and
the
patient
remained
asymptomatic
.
Given
the
clinical
context
(
low
-molecular-weight
heparin
)
,
complications
(
cardiac
arrest
and
no
thrombosis
)
,
and
timing
(
3
years
)
,
this
was
an
unusual
case
of
HIT
.
According
to
the
Naranjo
probability
scale
,
the
causality
of
enoxaparin
was
evaluated
as
probable
.
In
most
reported
cases
,
time
to
onset
was
short
,
clotting
occurred
in
the
extracorporeal
system
,
and
biological
tests
,
including
ELISA
(
enzyme-linked
immunosorbent
assay
)
anti-
PF
4
/
heparin
,
were
positive
.
We
found
no
triggering
factor
in
this
case
,
and
given
the
biological
results
,
a
new
antigenic
target
may
be
involved
.
HIT
must
be
considered
when
acute
systemic
reactions
occur
at
the
beginning
of
HD
sessions
,
even
after
several
years
of
HD
and
with
no
change
of
anticoagulant
,
including
low
-molecular-weight
heparin
.
The
platelet
count
should
be
measured
immediately
after
the
reaction
.
The
diagnosis
is
important
because
of
possible
cardiac
arrest
in
this
context
.
Diseases
Validation
Diseases presenting
"cyanosis at the beginning of hd on 3 consecutive sessions"
symptom
heparin-induced thrombocytopenia
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