Alternative diagnosis to heparin-induced thrombocytopenia in two critically ill patients despite a positive PF4/heparin-antibody test |
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Authors: | Gregor Hron Folke Knutson Thomas Thiele Karina Althaus Christoph Busemann Sigrun Friesecke Andreas Greinacher Norbert Lubenow |
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Institution: | 1.Abteilung für Transfusionsmedizin, Institut für Immunologie und Transfusionsemedizin, Ernst-Moritz-Arndt University Greifswald, Germany;2.Department of Clinical Immunology and Transfusion Medicine, Uppsala University Hospital, Uppsala, Sweden;3.Klinik für Innere Medizin C, Ernst-Moritz-Arndt University Greifswald, Germany;4.Klinik für Innere Medizin B, Ernst-Moritz-Arndt University Greifswald, Germany |
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Abstract: | AbstractThrombocytopenia can cause diagnostic challenges in patients who have received heparin. Heparin-induced thrombocytopenia (HIT) is often considered in the differential diagnosis, and a positive screening can be mistaken as confirmation of the disorder. We present two patients who both received low-molecular-weight heparin for several days. In the first patient, clinical judgment rejected the suspicion of HIT despite a positive screening assay, and treatment for the alternative diagnosis of post-transfusion purpura was correctly initiated. In the second patient, the inaccurate diagnosis HIT was pursued due to a positive screening assay, while the alternative diagnosis of drug-dependent thrombocytopenia caused by piperacillin/tazobactam was rejected. This resulted in re-exposure to piperacillin/tazobactam which caused a second episode of severe thrombocytopenia. A positive screening assay for platelet factor 4/heparin-antibody should be verified by a functional assay, especially in patients with low pretest probability for HIT. |
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Keywords: | Drug-induced thrombocytopenia heparin-induced thrombocytopenia HIT piperacillin-induced thrombocytopenia post-transfusions purpura PTP |
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