Upper Limb Phlegmasia Cerulea Dolens Secondary to Heparin-induced Thrombocytopenia: A Case Study.

Abstract

Introduction:Phlegmasia cerulea dolens (PCD) is a rare pathology with a very high morbidity and mortality rate, which usually occurs in the lower limb. There is very little literature available to aid management.Case Report:We present a case of upper limb PCD in a 67-year-old female secondary to heparin-induced thrombocytopenia caused by warfarin bridging. She presented to the orthopedic team with upper limb compartment syndrome from a bleed around a peripherally inserted central catheter, for which she was urgently taken to the theater for fasciotomies. Postoperatively, the patient’s platelets dropped and the upper limb pain and swelling continued; after conservative management and anticoagulation failed the patient had an upper limb amputation of her right arm.Conclusion:With limited guidelines and management options restricted by the large fasciotomy wounds, we believe amputation was the patients’ best option.