Rare heparin induced thrombocytopenia type I reaction in a hemodialysis patient: Case report

Abstract

Rationale: Heparin-induced thrombocytopenia (HIT) is a common antibody-mediated adverse reaction that occurs after heparin exposure. However, few case reports exist regarding nonantibody-mediated HIT.

Patient concerns and diagnoses: An 81-year-old female diagnosed with rapidly progressive glomerulonephritis (RPGN) presented with atypical presentation of non antibody-meditated HIT after using heparin during hemodialysis.

Interventions and outcomes: Patient was initiated on hemodialysis and presented with thrombocytopenia following administration of heparin during dialysis. After ruling out all other causes of thrombocytopenia, HIT was suspected to be the cause. Patient's 4Ts score was 6 points, and Naranjo adverse drug reaction probability scale was a score of 10. However, enzyme-linked immunoassay for platelet factor 4 (PF4)/heparin antibodies was negative, indicating non-antibody mediated HIT. Patient eventually continued hemodialysis without heparin.

Lessons: This patient case presented a rare presentation of HIT type I reaction due to heparin and demonstrated the importance of timely recognition of thrombocytopenia, appropriate diagnosis and management, and possible existence of a new atypical or subtype of HIT reaction.

Figure 1

Platelet count change time course. Plate count change timeline during hospital admission with platelet count decrease occurred after receiving heparin during hemodialysis with nadir on day 12. Heparin was discontinued afterwards and re-introduced on day 20. Thrombocytopenia occurred again following heparin re-exposure with nadir on day 28.