Spontaneous heparin-induced thrombocytopenia presenting as bilateral adrenal hemorrhages and pulmonary embolism after total knee arthroplasty
Heparin-induced thrombocytopenia syndrome is an acquired potentially life-threatening prothrombotic disorder caused by antibodies that recognize complexes of platelet factor 4 bound to heparin or heparin-like molecules. It typically occurs after exposure to unfractionated heparin, to a lesser extent...
Main Authors: | , , , |
---|---|
Format: | Article |
Language: | English |
Published: |
Elsevier
2015-09-01
|
Series: | Arthroplasty Today |
Subjects: | |
Online Access: | http://www.sciencedirect.com/science/article/pii/S2352344115000539 |
id |
doaj-52bec89acce248ffa28aabf533a4e317 |
---|---|
record_format |
Article |
spelling |
doaj-52bec89acce248ffa28aabf533a4e3172020-11-25T01:25:43ZengElsevierArthroplasty Today2352-34412015-09-0113697110.1016/j.artd.2015.07.003Spontaneous heparin-induced thrombocytopenia presenting as bilateral adrenal hemorrhages and pulmonary embolism after total knee arthroplastyAmro Elshoury, MBChB0Maha Khedr, MBChB1Mostafa M. Abousayed, MD2Syed Mehdi, MD3Department of Internal Medicine, Albany Medical Center, Albany, NY, USADivision of Clinical Chemistry and Laboratory Medicine, Department of Clinical Pathology, Ain Shams University, Cairo, EgyptDepartment of Orthopedics, Albany Medical Center, Albany, NY, USADivision of Hematology-Oncology, Department of Internal Medicine, Stratton Veterans Affairs Medical Center, Albany, NY, USAHeparin-induced thrombocytopenia syndrome is an acquired potentially life-threatening prothrombotic disorder caused by antibodies that recognize complexes of platelet factor 4 bound to heparin or heparin-like molecules. It typically occurs after exposure to unfractionated heparin, to a lesser extent after exposure to low-molecular-weight heparins, and rarely after exposure to fondaparinux. Herein, we report the case of a 48-year-old woman who developed severe thrombocytopenia, bilateral pulmonary embolism, and bilateral adrenal hemorrhages after total knee arthroplasty without evidence of heparin exposure. Antibodies to the heparin-platelet factor 4 complex and serotonin-release assay were positive. Spontaneous heparin-induced thrombocytopenia syndrome should be considered in patients with unexplained thrombocytopenia after knee replacement surgery even without heparin exposure, and a high index of suspicion for adrenal hemorrhage is needed in patients with fever, abdominal pain, and shock.http://www.sciencedirect.com/science/article/pii/S2352344115000539Adrenal hemorrhageDeep venous thrombosisHeparin-induced thrombocytopeniaPulmonary embolismTotal knee arthroplasty |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Amro Elshoury, MBChB Maha Khedr, MBChB Mostafa M. Abousayed, MD Syed Mehdi, MD |
spellingShingle |
Amro Elshoury, MBChB Maha Khedr, MBChB Mostafa M. Abousayed, MD Syed Mehdi, MD Spontaneous heparin-induced thrombocytopenia presenting as bilateral adrenal hemorrhages and pulmonary embolism after total knee arthroplasty Arthroplasty Today Adrenal hemorrhage Deep venous thrombosis Heparin-induced thrombocytopenia Pulmonary embolism Total knee arthroplasty |
author_facet |
Amro Elshoury, MBChB Maha Khedr, MBChB Mostafa M. Abousayed, MD Syed Mehdi, MD |
author_sort |
Amro Elshoury, MBChB |
title |
Spontaneous heparin-induced thrombocytopenia presenting as bilateral adrenal hemorrhages and pulmonary embolism after total knee arthroplasty |
title_short |
Spontaneous heparin-induced thrombocytopenia presenting as bilateral adrenal hemorrhages and pulmonary embolism after total knee arthroplasty |
title_full |
Spontaneous heparin-induced thrombocytopenia presenting as bilateral adrenal hemorrhages and pulmonary embolism after total knee arthroplasty |
title_fullStr |
Spontaneous heparin-induced thrombocytopenia presenting as bilateral adrenal hemorrhages and pulmonary embolism after total knee arthroplasty |
title_full_unstemmed |
Spontaneous heparin-induced thrombocytopenia presenting as bilateral adrenal hemorrhages and pulmonary embolism after total knee arthroplasty |
title_sort |
spontaneous heparin-induced thrombocytopenia presenting as bilateral adrenal hemorrhages and pulmonary embolism after total knee arthroplasty |
publisher |
Elsevier |
series |
Arthroplasty Today |
issn |
2352-3441 |
publishDate |
2015-09-01 |
description |
Heparin-induced thrombocytopenia syndrome is an acquired potentially life-threatening prothrombotic disorder caused by antibodies that recognize complexes of platelet factor 4 bound to heparin or heparin-like molecules. It typically occurs after exposure to unfractionated heparin, to a lesser extent after exposure to low-molecular-weight heparins, and rarely after exposure to fondaparinux. Herein, we report the case of a 48-year-old woman who developed severe thrombocytopenia, bilateral pulmonary embolism, and bilateral adrenal hemorrhages after total knee arthroplasty without evidence of heparin exposure. Antibodies to the heparin-platelet factor 4 complex and serotonin-release assay were positive. Spontaneous heparin-induced thrombocytopenia syndrome should be considered in patients with unexplained thrombocytopenia after knee replacement surgery even without heparin exposure, and a high index of suspicion for adrenal hemorrhage is needed in patients with fever, abdominal pain, and shock. |
topic |
Adrenal hemorrhage Deep venous thrombosis Heparin-induced thrombocytopenia Pulmonary embolism Total knee arthroplasty |
url |
http://www.sciencedirect.com/science/article/pii/S2352344115000539 |
work_keys_str_mv |
AT amroelshourymbchb spontaneousheparininducedthrombocytopeniapresentingasbilateraladrenalhemorrhagesandpulmonaryembolismaftertotalkneearthroplasty AT mahakhedrmbchb spontaneousheparininducedthrombocytopeniapresentingasbilateraladrenalhemorrhagesandpulmonaryembolismaftertotalkneearthroplasty AT mostafamabousayedmd spontaneousheparininducedthrombocytopeniapresentingasbilateraladrenalhemorrhagesandpulmonaryembolismaftertotalkneearthroplasty AT syedmehdimd spontaneousheparininducedthrombocytopeniapresentingasbilateraladrenalhemorrhagesandpulmonaryembolismaftertotalkneearthroplasty |
_version_ |
1725112263079100416 |