Heparinom indukovana trombocitopenija tip II usled primene niskomolekularnog heparina kod dece

Abstract

Heparin-induced thrombocytopenia (HIT) type II is a very rare complication of heparin use which is associated with high risk of developing life-threatening thrombosis. Clinical criteria for diagnosis of heparin-induced thrombocytopenia type II are: platelet ten days after the application of low-molecular-weight heparin for more than 50% of the initial number, the appearance of silent thrombosis, erythematous changes in the skin, normalization of platelet count within ten days after the exclusion of heparin, unproven other causes of thrombocytopenia, a positive finding of specific antibodies to the complex of heparin-TF4 based on agglutination test. The aim of this paper is to present a case of 12 years old girl with thrombocytopenia occurrence of type 2 after administration of anticoagulant therapy, low-molecular heparin (Fraxiparin ®) in the cubital vein thrombosis. In order to prevent occurrence of recurrent thrombosis and thromboembolic complications of anticoagulant therapy was administered nonheparin anticoagulants, direct thrombin inhibitor - danaparoid sodium. Due to the development of chemophagocytes syndrome, and to suppress the reaction between antibodies and heparin-TF4 complex, also were ordained an intravenous immunoglobulins. The measures applied leads to normalization of clinical status and laboratory parameters. In the case of heparin-induced thrombocytopenia type II, the use of heparin should be stopped and it is necessary to apply an alternative anticoagulant therapy to normalize platelet counts. Use of danaparoid has significant anticoagulant effect and leads to clinical improvements of heparin-induced thrombocytopenia type II.