Low Molecular Weight Heparin Induced Skin Necrosis without Platelet Fall Revealing Immunoallergic Heparin Induced Thrombocytopenia

Low molecular weight heparins (LMWH) are commonly used in the ICU setting for thromboprophylaxis as well as curative decoagulation as required during renal replacement therapy (RRT). A rare adverse event revealing immunoallergic LMWH induced thrombopenia (HIT) is skin necrosis at injection sites. We...

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Detalles Bibliográficos
Autores principales: Godet, Thomas, Perbet, Sébastien, Lebreton, Aurélien, Gayraud, Guillaume, Cayot, Sophie, Tremblay, Aymeric, Ravinet, Aurélie, Christophe, Sébastien, Guérin, Renaud, Pascal, Julien, Jabaudon, Matthieu, Hassan, Amr, Sapin, Anne-Françoise, Bazin, Jean-Etienne, Constantin, Jean-Michel
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Hindawi Publishing Corporation 2013
Materias:
Case Report
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3835902/
https://www.ncbi.nlm.nih.gov/pubmed/24307958
http://dx.doi.org/10.1155/2013/849168
Descripción
Sumario:Low molecular weight heparins (LMWH) are commonly used in the ICU setting for thromboprophylaxis as well as curative decoagulation as required during renal replacement therapy (RRT). A rare adverse event revealing immunoallergic LMWH induced thrombopenia (HIT) is skin necrosis at injection sites. We report the case of a patient presenting with skin necrosis witnessing an HIT after RRT, without thrombocytopenia. The mechanism remains unclear. Anti-PF4/heparin antibodies, functional tests (HIPA and/or SRA), and skin biopsy are of great help to evaluate differential diagnosis with a low pretest probability 4T's score.

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