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Non-immune mediated thrombocytopenia caused by thromboprophylaxis for the perioperative care of urological surgery: A case report and review of the literature

INTRODUCTION: Heparin-induced thrombocytopenia (HIT) is a rare but serious condition due to heparin use for treating thromboprophylaxis, regardless of the dosage. Here, we present a case of non-immune thrombocytopenia caused by thromboprophylaxis for urological surgery, which is sometimes difficult...

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Autores principales: Hata, Kenichi, Kimura, Takahiro, Ishii, Gen, Suzuki, Masayasu, Egawa, Shin
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4987503/
https://www.ncbi.nlm.nih.gov/pubmed/27522399
http://dx.doi.org/10.1016/j.ijscr.2016.07.049
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author Hata, Kenichi
Kimura, Takahiro
Ishii, Gen
Suzuki, Masayasu
Egawa, Shin
author_facet Hata, Kenichi
Kimura, Takahiro
Ishii, Gen
Suzuki, Masayasu
Egawa, Shin
author_sort Hata, Kenichi
collection PubMed
description INTRODUCTION: Heparin-induced thrombocytopenia (HIT) is a rare but serious condition due to heparin use for treating thromboprophylaxis, regardless of the dosage. Here, we present a case of non-immune thrombocytopenia caused by thromboprophylaxis for urological surgery, which is sometimes difficult to discriminate from immune-mediated thrombocytopenia. PRESENTATION OF CASE: A 55-year-old man with renal cancer underwent portless endoscopic radical nephrectomy through a single small incision and was subsequently administered unfractionated heparin as well as mechanical devices to prevent venous thromboembolism. On postoperative day 2, a subcutaneous hemorrhage developed around the surgical site and the lower abdomen, and the platelet count simultaneously decreased to 50% of the baseline value. We suspected HIT and immediately conducted the 4Ts score examination. The 4Ts score was 3 points (low probability), and the result of the platelet factor 4-heparin complex antibody assay was negative. The patient was diagnosed with non-immune mediated thrombocytopenia. We took precaution by discontinuing heparin, which fortunately did not result in any adverse effects, and this led to platelet count normalization. DISCUSSION: Due to the rarity of HIT, it is difficult to distinguish HIT from non-immune mediated thrombocytopenia. CONCLUSION: This article emphasizes that early and accurate diagnosis of postoperative thrombocytopenia is important for accurate therapy. Hence, all surgeons should know that the HIT diagnosis is based on clinical and serologic findings.
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spelling pubmed-49875032016-08-23 Non-immune mediated thrombocytopenia caused by thromboprophylaxis for the perioperative care of urological surgery: A case report and review of the literature Hata, Kenichi Kimura, Takahiro Ishii, Gen Suzuki, Masayasu Egawa, Shin Int J Surg Case Rep Case Report INTRODUCTION: Heparin-induced thrombocytopenia (HIT) is a rare but serious condition due to heparin use for treating thromboprophylaxis, regardless of the dosage. Here, we present a case of non-immune thrombocytopenia caused by thromboprophylaxis for urological surgery, which is sometimes difficult to discriminate from immune-mediated thrombocytopenia. PRESENTATION OF CASE: A 55-year-old man with renal cancer underwent portless endoscopic radical nephrectomy through a single small incision and was subsequently administered unfractionated heparin as well as mechanical devices to prevent venous thromboembolism. On postoperative day 2, a subcutaneous hemorrhage developed around the surgical site and the lower abdomen, and the platelet count simultaneously decreased to 50% of the baseline value. We suspected HIT and immediately conducted the 4Ts score examination. The 4Ts score was 3 points (low probability), and the result of the platelet factor 4-heparin complex antibody assay was negative. The patient was diagnosed with non-immune mediated thrombocytopenia. We took precaution by discontinuing heparin, which fortunately did not result in any adverse effects, and this led to platelet count normalization. DISCUSSION: Due to the rarity of HIT, it is difficult to distinguish HIT from non-immune mediated thrombocytopenia. CONCLUSION: This article emphasizes that early and accurate diagnosis of postoperative thrombocytopenia is important for accurate therapy. Hence, all surgeons should know that the HIT diagnosis is based on clinical and serologic findings. Elsevier 2016-07-30 /pmc/articles/PMC4987503/ /pubmed/27522399 http://dx.doi.org/10.1016/j.ijscr.2016.07.049 Text en © 2016 The Authors http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Case Report
Hata, Kenichi
Kimura, Takahiro
Ishii, Gen
Suzuki, Masayasu
Egawa, Shin
Non-immune mediated thrombocytopenia caused by thromboprophylaxis for the perioperative care of urological surgery: A case report and review of the literature
title Non-immune mediated thrombocytopenia caused by thromboprophylaxis for the perioperative care of urological surgery: A case report and review of the literature
title_full Non-immune mediated thrombocytopenia caused by thromboprophylaxis for the perioperative care of urological surgery: A case report and review of the literature
title_fullStr Non-immune mediated thrombocytopenia caused by thromboprophylaxis for the perioperative care of urological surgery: A case report and review of the literature
title_full_unstemmed Non-immune mediated thrombocytopenia caused by thromboprophylaxis for the perioperative care of urological surgery: A case report and review of the literature
title_short Non-immune mediated thrombocytopenia caused by thromboprophylaxis for the perioperative care of urological surgery: A case report and review of the literature
title_sort non-immune mediated thrombocytopenia caused by thromboprophylaxis for the perioperative care of urological surgery: a case report and review of the literature
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4987503/
https://www.ncbi.nlm.nih.gov/pubmed/27522399
http://dx.doi.org/10.1016/j.ijscr.2016.07.049
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