Journal List > Korean J Hematol > v.42(1) > 1032765

Lee, Kim, Song, and Song: A Case of Heparin Induced Thrombocytopenia with Circulating Anti-PF4/Heparin Antibody

Abstract

Heparin-induced thrombocytopenia (HIT) is usually caused by anti-platelet factor 4 (PF4)/heparin antibodies, leading to intravascular platelet activation. Circulating anti-PF4/heaprin antibody (IgG, IgA and IgM) was detected by ELISA (Asserachrom HPIA, Diagnostia Stago, Asnieres, France) in a 61-year-old man with coronary artery disease and dyspnea on exercise. He had undergone a coronoary angiography using 2,000 unit of heparin before a procedure. On admission, laboratory testing revealed a platelet count of 296×109/L and aPTT (activated partial thromboplastin time) of 38.1 sec. The fall in the platelet count was progressive, resulting in 42% and 53% of platelet counts on the 6th and 12th days after intravenous heparin administration, respectively. He was discharged after coronary artery bypass graft. On discharge, platelet count was normalized to be 212×109/L. On the 7th day after dischage, anti-PF4/heaprin antibody was detected by ELISA (Asserachrom HPIA, Diagnostia Stago, Asnieres, France).

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Table 1.
Laboratory findings
HOD∗ Heparin (unit) WBC (×109/L) RBC (×1012/L) Hb (g/dL) Hct (%) Platelet (×109/L) aPTT (sec) Remark
#1   6.5 3.3 6.6 22.2 296 38.1  
#2 2,000 6.3 3.5 7.5 25.4 238   Coronary angiography
#3   5.5 3.9 8.1 28.1 233    
#4   6.2 4.4 10.4 32.6 212    
#5   6.0 4.8 11.0 36.6 226 41.5  
#8   5.3 4.3 10.0 32.8 171    
#14 (AM)   10.0 3.0 7.1 22.4 141 53.7  
#14 (PM)   13.6 3.6 9.1 27.8 139    
#15   17.6 3.7 9.4 29.1 144    
#16   18.8 3.6 9.5 28.8 146    
#17   17.5 3.8 9.6 31.3 155 40.4  
#18   8.8 3.4 8.8 28.4 159    
#19   7.7 3.8 9.6 31.4 212 39.4  
7th days after discharge 8.7 3.8 9.6 31.1 295 53.1 ELISA (anti-PF4/ heparin antibody)

∗HOD: hospital day.

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