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. 2013:2013:849168.
doi: 10.1155/2013/849168. Epub 2013 Nov 3.

Low Molecular Weight Heparin Induced Skin Necrosis without Platelet Fall Revealing Immunoallergic Heparin Induced Thrombocytopenia

Thomas Godet  1 , Sébastien Perbet, Aurélien Lebreton, Guillaume Gayraud, Sophie Cayot, Aymeric Tremblay, Aurélie Ravinet, Sébastien Christophe, Renaud Guérin, Julien Pascal, Matthieu Jabaudon, Amr Hassan, Anne-Françoise Sapin, Jean-Etienne Bazin, Jean-Michel Constantin
Affiliations

Low Molecular Weight Heparin Induced Skin Necrosis without Platelet Fall Revealing Immunoallergic Heparin Induced Thrombocytopenia

Thomas Godet et al. Case Rep Hematol. 2013.

Abstract

Low molecular weight heparins (LMWH) are commonly used in the ICU setting for thromboprophylaxis as well as curative decoagulation as required during renal replacement therapy (RRT). A rare adverse event revealing immunoallergic LMWH induced thrombopenia (HIT) is skin necrosis at injection sites. We report the case of a patient presenting with skin necrosis witnessing an HIT after RRT, without thrombocytopenia. The mechanism remains unclear. Anti-PF4/heparin antibodies, functional tests (HIPA and/or SRA), and skin biopsy are of great help to evaluate differential diagnosis with a low pretest probability 4T's score.

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Figures

Figure 1
Figure 1
Skin necrosis lesion at injection sites of left thigh.
Figure 2
Figure 2
Timeline of platelets count and anticoagulant therapies. Skin necrosis appeared on day 15. Platelet count increased after danaparoid initiation. UFH: unfractionated heparin; LMWH: low molecular weight heparin; RRT: renal replacement therapy.
Figure 3
Figure 3
Skin biopsy showing leukocytoclastic vasculitis and intravascular microthrombi.
See this image and copyright information in PMC

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