Heparin-induced thrombocytopenia as a cause of prolonged low platelet count in patient with thrombotic thrombocytopenic purpura treated with plasmapheresis

Agata Winiarska; Norbert Kwella; Tomasz Stompór

doi:10.18388/abp.2016_1428

Agata Winiarska Department of Nephrology, Hypertension and Internal Medicine University of Warmia and Mazury
Norbert Kwella Department of Nephrology, Hypertension and Internal Medicine University of Warmia and Mazury
Tomasz Stompór Department of Nephrology, Hypertension and Internal Medicine University of Warmia and Mazury

DOI: https://doi.org/10.18388/abp.2016_1428

Keywords: thrombotic thrombocytopenic purpura (TTP), heparin-induced thrombocytopenia (HIT), plasma exchange (PE)

Abstract

Thrombotic thrombocytopenic purpura (TTP) is a rare disorder belonging to thrombotic microangiopathies (TMA) and is caused by functional deficiency of metalloproteinase ADAMTS-13. Plasma exchange (PE) remains the treatment of choice in this disease. Here were describe the case of patient who apparently recovered from TTP following multiple sessions of PE, but remained thrombocytopenic. Careful analysis revealed the development of heparin-induced thrombocytopenia (HIT) that precluded platelet count (PLT) normalization. Full normalization of PLT followed discontinuation of PE and low-molecular weight heparin.

References

Tersteeg C, Verhenne S, Roose E, Schelpe AS, Deckmyn H, De Meyer SF, Vanhoorelbeke K. (2016) ADAMTS13 and anti-ADAMTS13 autoantibodies in thrombotic thrombocytopenic purpura - current perspectives and new treatment strategies. Expert Rev Hematol 9: 209 - 221. doi: 10.1586/17474086.2016.1122515

Warkentin TE (2015) Heparin-induced thrombocytopenia. Curr Opin Crit Care 21: 576 – 585. doi: 10.1097/MOH.0000000000000273.

Studt J-D, Binet I, Nair G, Schanz U (2013) Heparin - induced thrombocytopenia associated with thrombotic microangiopathy. Hamostaseologie 33: 160 – 163. doi: 10.5482/HAMO-13-03-0012

Benke S, Moltzan C (2005) Co-existence of heparin-induced thrombocytopenia and thrombotic thrombocytopenic purpura in a postoperative cardiac surgery patient. Am J Hematol 80: 288 – 291.

Takatsuka H, Nakajima T, Nomura K, Wakae T, Toda A, Itoi H, Okada M, Misawa M, Hara H (2005). Heparin-induced thrombocytopenia antibody and the pathogenesis of thrombotic microangiopathy after stem cell transplantation. Clin Transplant 19: 418 – 422.