TITLE:
Catastrophic Complications of Intravenous Line Flushing with Unfractionated Heparin
AUTHORS:
Giuseppe Colucci, Maximilian Jahns, Tobias Silzle, Lorenzo Alberio
KEYWORDS:
Heparin-Induced Thrombocytopenia, Adrenal Haemorrhagic Necrosis, 4T Score, PF4/Heparin-Antibodies
JOURNAL NAME:
International Journal of Clinical Medicine,
Vol.3 No.1,
January
5,
2012
ABSTRACT: Heparin-induced thrombocytopenia (HIT) is a clinicopathologic syndrome because diagnosis is based on both clinical symptoms and laboratory data. We report a patient with multiple thromboembolic complications after daily flushing of intravenous line with small amounts of unfractionated heparin (UFH). At day 7 bilateral hemorrhagic infarction of the adrenal glands was misdiagnosed as adrenal adenoma. On day 10 thrombocytopenia was noted and the next day a myocardial infarction complicated by a left ventricular thrombus was diagnosed. On day 12, HIT was suspected. The pre-test probability for HIT according to the 4T-score was high (8/8 points) and detection of antibodies directed against the PF4/heparin-complex by particle gel immunoassay (Titer 1:1024) and ELISA (O.D. 2.784) was strongly positive. HIT can be induced by iv-line flushes with UFH. Arterial and venous thrombotic complications can be present before a clear platelet drop can be recognised.