Abstract
Heparin-induced thrombocytopenia (HIT) has not been included as a possible cause of thrombocytopenia in Coronavirus Disease 2019 (COVID-19) patients. We report a case of HIT in a patient with COVID-19 treated with heparin. A 78-yearold man was admitted to our hospital for acute respiratory failure and acute renal failure due to SARS-CoV-2 infection; in intensive care unit, one 5000IU heparin dose (day 0, platelet count 305000/μL). On day 2, haemoglobin started to decrease and heparin was stopped. On day 10, platelet count was 153000/μL and 5000IU calcium heparin subcutaneously twice daily was started. The platelet further decreased, reaching 49000/μL on day 17, and the patient was investigated for suspected HIT: an IgG specific chemiluminescence test for heparin- PF4 antibodies was positive and a femoral DVT was found at ultrasound. Argatroban was started, platelet count increased without any bleeding and thrombosis complication. Our experience shows that HIT may develop in heparin treated COVID-19 patients and should be included among the possible cause of thrombocytopenia in such patients.
Highlights
Abstract antithrombotic regimens have been suggested in this population.[7]
We report a case of Heparin-induced thrombocytopenia thrombocytopenia (HIT) in a patient with COVID-19 treated with heparin
All authors approved the final version of the manuscript, and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy old man was admitted to our hospital for acute respiratory failure and acute renal ly failure due to SARS-CoV-2 infection; in intensive care unit, one 5000IU heparin dose n
Summary
A 78-year-old man (weight 76 Kg) with a history of chronic kidney disease, arterial hypertension and recurrent deep vein thrombosis was admitted to our hospital for acute respiratory and renal failure. The pretest clinical score (4 T’s)[12] for the diagnosis of HIT was 4 (viral pneumonia and tocilizumab as a possible cause for thrombocytopenia) pneumonia due to SARS-CoV-2 infection was confirmed. When he was discharged, serum creatinine was 6.14 mg/dL, sodium 137 mmol/L, kalium 5 mmol/L, INR 2.7. Despite the obvious limitations of a case report, our experience demonstrates that HIT may develop in patients with COVID-19 treated with heparin and it should be considered among the possible cause of thrombocytopenia in such patients.
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