Persistent heparin-induced thrombocytopenia: danaparoid cross-reactivity or delayed-onset heparin-induced thrombocytopenia? A case report.
(2017) Blood Coagulation and Fibrinolysis — Vol. 28, n° 2, p. 193-197 (2017)
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- Abstract
- Clinical suspicion of immune heparin-induced thrombocytopenia (HIT) requires cessation of heparin and initiation of an alternative anticoagulant. The platelet count will subsequently recover. This case report describes the clinical course of a patient after a cardiovascular surgery. HIT was clinically and biologically confirmed. Unexpectedly, the platelet count did not recover despite the arrest of heparin. Danaparoid was initiated, and thrombocytopenia persisted. Danaparoid cross-reactivity was suspected, and laboratory assay was performed. Results were misinterpreted because no comparative buffer control was performed to ensure that the platelet aggregation was caused by danaparoid. Moreover, plasma/serum must be diluted to demonstrate this effect. Danaparoid cross-reactivity was incorrectly concluded, and the patient was switched to bivalirudin. The severe thrombocytopenia persisted. Plasmapheresis was started, and platelet count finally increased. The clinical course suggested a delayed-onset HIT. This case report illustrates the need for appropriate testing to differentiate drug cross-reactivity from delayed-onset HIT.
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Horlait, G., Minet, V., Mullier, F., & Michaux, I. (2017). Persistent heparin-induced thrombocytopenia: danaparoid cross-reactivity or delayed-onset heparin-induced thrombocytopenia? A case report. Blood Coagulation and Fibrinolysis, 28(2), 193-197. https://doi.org/10.1097/MBC.0000000000000566 (Original work published 2017)