Injection Site Erythema in a Patient on Therapeutic Anticoagulation with Low Molecular Weight Heparin after Mechanical Aortic Valve Replacement: A Rare Presentation of Heparin- and Protamine-Induced Thrombocytopenia

Injection Site Erythema in a Patient on Therapeutic Anticoagulation with Low Molecular Weight Heparin after Mechanical Aortic Valve Replacement: A Rare Presentation of Heparin- and Protamine-Induced Thrombocytopenia

Previous exposition to heparin and protamine in patients undergoing cardiopulmonary bypass and postoperative therapeutic anticoagulation with LMWH may lead to the development of heparin-induced thrombocytopenia (HIT) and/or protamine-induced thrombocytopenia (PIT). This case deals with a rare clinic...

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Main Authors: Caroline Holaubek, Paul Simon, Sabine Eichinger-Hasenauer, Franz Gremmel, Barbara Steinlechner
Format: Article
Language:English
Published: Hindawi Limited 2020-01-01
Series:Case Reports in Immunology
Online Access:http://dx.doi.org/10.1155/2020/4503598
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spelling doaj-7f4b55e7d13c47aa84b90d8c4bae63412020-11-25T03:01:47ZengHindawi LimitedCase Reports in Immunology2090-66092090-66172020-01-01202010.1155/2020/45035984503598Injection Site Erythema in a Patient on Therapeutic Anticoagulation with Low Molecular Weight Heparin after Mechanical Aortic Valve Replacement: A Rare Presentation of Heparin- and Protamine-Induced ThrombocytopeniaCaroline Holaubek0Paul Simon1Sabine Eichinger-Hasenauer2Franz Gremmel3Barbara Steinlechner4Division of Cardiothoracic and Vascular Anesthesia and Intensive Care, Medical University of Vienna, Vienna, AustriaDivision of Cardiac Surgery, Medical University of Vienna, Vienna, AustriaDivision of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, AustriaDivision of Cardiac Surgery, Medical University of Vienna, Vienna, AustriaDivision of Cardiothoracic and Vascular Anesthesia and Intensive Care, Medical University of Vienna, Vienna, AustriaPrevious exposition to heparin and protamine in patients undergoing cardiopulmonary bypass and postoperative therapeutic anticoagulation with LMWH may lead to the development of heparin-induced thrombocytopenia (HIT) and/or protamine-induced thrombocytopenia (PIT). This case deals with a rare clinical presentation of circulating IgG antibodies against heparin/platelet factor 4 complexes and heparin/protamine complexes after cardiac surgery. Ensuing purpura and skin necrosis (blisters) at the injection sites of LMWH and clinical symptoms improved rapidly after replacement of LMWH by an alternative anticoagulant. The aim of this report is to draw attention to the several different clinical manifestations of heparin- and/or protamine-induced thrombocytopenia and shows a possible course of treatment and recovery.http://dx.doi.org/10.1155/2020/4503598
collection DOAJ
language English
format Article
sources DOAJ
author Caroline Holaubek
Paul Simon
Sabine Eichinger-Hasenauer
Franz Gremmel
Barbara Steinlechner
spellingShingle Caroline Holaubek
Paul Simon
Sabine Eichinger-Hasenauer
Franz Gremmel
Barbara Steinlechner
Injection Site Erythema in a Patient on Therapeutic Anticoagulation with Low Molecular Weight Heparin after Mechanical Aortic Valve Replacement: A Rare Presentation of Heparin- and Protamine-Induced Thrombocytopenia
Case Reports in Immunology
author_facet Caroline Holaubek
Paul Simon
Sabine Eichinger-Hasenauer
Franz Gremmel
Barbara Steinlechner
author_sort Caroline Holaubek
title Injection Site Erythema in a Patient on Therapeutic Anticoagulation with Low Molecular Weight Heparin after Mechanical Aortic Valve Replacement: A Rare Presentation of Heparin- and Protamine-Induced Thrombocytopenia
title_short Injection Site Erythema in a Patient on Therapeutic Anticoagulation with Low Molecular Weight Heparin after Mechanical Aortic Valve Replacement: A Rare Presentation of Heparin- and Protamine-Induced Thrombocytopenia
title_full Injection Site Erythema in a Patient on Therapeutic Anticoagulation with Low Molecular Weight Heparin after Mechanical Aortic Valve Replacement: A Rare Presentation of Heparin- and Protamine-Induced Thrombocytopenia
title_fullStr Injection Site Erythema in a Patient on Therapeutic Anticoagulation with Low Molecular Weight Heparin after Mechanical Aortic Valve Replacement: A Rare Presentation of Heparin- and Protamine-Induced Thrombocytopenia
title_full_unstemmed Injection Site Erythema in a Patient on Therapeutic Anticoagulation with Low Molecular Weight Heparin after Mechanical Aortic Valve Replacement: A Rare Presentation of Heparin- and Protamine-Induced Thrombocytopenia
title_sort injection site erythema in a patient on therapeutic anticoagulation with low molecular weight heparin after mechanical aortic valve replacement: a rare presentation of heparin- and protamine-induced thrombocytopenia
publisher Hindawi Limited
series Case Reports in Immunology
issn 2090-6609
2090-6617
publishDate 2020-01-01
description Previous exposition to heparin and protamine in patients undergoing cardiopulmonary bypass and postoperative therapeutic anticoagulation with LMWH may lead to the development of heparin-induced thrombocytopenia (HIT) and/or protamine-induced thrombocytopenia (PIT). This case deals with a rare clinical presentation of circulating IgG antibodies against heparin/platelet factor 4 complexes and heparin/protamine complexes after cardiac surgery. Ensuing purpura and skin necrosis (blisters) at the injection sites of LMWH and clinical symptoms improved rapidly after replacement of LMWH by an alternative anticoagulant. The aim of this report is to draw attention to the several different clinical manifestations of heparin- and/or protamine-induced thrombocytopenia and shows a possible course of treatment and recovery.
url http://dx.doi.org/10.1155/2020/4503598
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