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Heparin‐induced skin necrosis associated with thrombocytopenia and acquired protein C and protein S deficiency
Author(s) -
Prasad H. Keshava,
Govindarajan Rangaswamy
Publication year - 2007
Publication title -
american journal of hematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.456
H-Index - 105
eISSN - 1096-8652
pISSN - 0361-8609
DOI - 10.1002/ajh.21026
Subject(s) - heparin induced thrombocytopenia , necrosis , heparin , medicine , tumor necrosis factor alpha , protein s deficiency , protein c , protein c deficiency , anticoagulant , platelet , immunology , protein s , gastroenterology , thrombosis , venous thrombosis
We have described a patient with colon cancer and liver metastases who developed heparin‐induced thrombocytopenia and skin necrosis. We believe that the skin necrosis caused by the heparin/platelet factor 4 antibody was exacerbated by the acquired protein C and protein S deficiency. After the heparin was discontinued and infection treated, the skin necrosis and thrombocytopenia resolved. This case illustrates the fact that, in patients with heparin‐induced skin necrosis, a search must be undertaken for an underlying pro‐thrombotic state, which may precipitate the microthrombosis responsible for skin necrosis. We could not find any previous case reports of heparin‐induced skin necrosis associated with isolated protein C deficiency, or combined protein C and protein S deficiency. Am. J. Hematol., 2007. © 2007 Wiley‐Liss, Inc.