Heparin-Induced Thrombocytopenia Presenting as Splenic Hemorrhage Following Cardiac Surgery: A Case Report

Ferry J,Youssef S,Hegerova L,Wu P

doi:10.23937/2469-5696/1410049

Abstract

Heparin induced thrombocytopenia with thrombosis (HIT) is a paradoxical prothrombotic complication of anticoagulant therapy. We report a case of atraumatic splenic hemorrhage due to splenic vein thrombosis as main indicator to diagnosis of HIT. The presentation is reminiscent of the rare bilateral adrenal hemorrhage due to adrenal necrosis that occurs in HIT. Alternative anticoagulation is mainstay of therapy for HIT despite hemorrhage, given the underlying acquired hypercoagulability.

Highlights

Heparin-induced thrombocytopenia (HIT) is a complication of heparin therapy which occurs more commonly in postoperative than medical patients [1]
One increasingly recognized and unusual thrombotic complication seen in Heparin induced thrombocytopenia with thrombosis (HIT) is adrenal vein thrombosis with tissue necrosis leading to bilateral adrenal hemorrhage (BAH)
We present a case of splenic vein thrombosis post-cardiac surgery complicated hemorrhagic infarct, reminiscent of that seen in BAH, that led to diagnosis of HIT

Summary

Introduction

Heparin-induced thrombocytopenia (HIT) is a complication of heparin therapy which occurs more commonly in postoperative than medical patients [1]. Her complete blood count (CBC) was normal prior to CABG including platelet count of 268 × 103/μL (normal 150-379 × 103/μL) and at hospital discharge was 174 × 103/μL with post-operative hematocrit of 36% (normal 37.5%-51%) On physical examination she was afebrile, hypotensive with systolic blood pressure in the 70s, and in rapid atrial fibrillation with heart rate 120-130s. To evaluate for bleeding, a computed tomography (CT) angiogram of the chest, abdomen and pelvis was ordered and demonstrated filling defects suggestive of right atrial thrombus, splenic vein thrombosis with splenic infarct, and mild to moderate associated hemoperitoneum.

Findings

Discussion

Conclusion