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Rapid and durable response to intravenous immunoglobulin in delayed heparin‐induced thrombocytopenia: a case report
Author(s) -
Lei Brandon Z.,
Shatzel Joseph J.,
Sendowski Merav
Publication year - 2017
Publication title -
transfusion
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.045
H-Index - 132
eISSN - 1537-2995
pISSN - 0041-1132
DOI - 10.1111/trf.13960
Subject(s) - heparin induced thrombocytopenia , medicine , argatroban , heparin , bivalirudin , thrombosis , antibody , platelet , surgery , anesthesia , immunology , percutaneous coronary intervention , myocardial infarction , thrombin
BACKGROUND Heparin‐induced thrombocytopenia (HIT) results in platelet consumption and a virulent thrombotic state, which generally responds to cessation of heparin and initiation of anticoagulation. Rarely, delayed HIT can occur and/or persist after heparin is discontinued. STUDY DESIGN AND METHODS A 47‐year‐old male developed delayed HIT with severe thrombocytopenia and thrombosis after cardiac surgery. Thrombocytopenia developed and persisted after heparin cessation and did not improve despite sequential use of argatroban followed by bivalirudin. Treatment with intravenous immunoglobulin (IVIg) was well tolerated and resulted in rapid resolution of thrombocytopenia. RESULTS There are few case reports on the management of delayed HIT with severe and prolonged thrombocytopenia. The risk for thrombosis and bleeding in the setting of an undefined time course increases uncertainty in management. CONCLUSION This case, along with others accumulating in the literature, suggest that IVIg may be effective in treating delayed HIT with persistent thrombocytopenia.