Thrombotic microangiopathy mimicking a heparin-induced thrombocytopenia

• Published in: Annales de biologie clinique (Paris) Vol. 71; no. 1; p. 113
• Main Authors: Huynh-Moynot, Sophie, Eyrieux, Sandrine, Moynot, Jean-Clair, Commandeur, Diane, Fourel, Didier, Ould-Ahmed, Mehdi, Drouillard, Isabelle
• Format: Journal Article
• Language: French
• Published: France 01-01-2013
• Subjects: Diagnosis, Differential; Female; Hematology - methods; Heparin - adverse effects; Humans; Middle Aged; Thrombocytopenia - chemically induced; Thrombocytopenia - diagnosis; Thrombotic Microangiopathies - diagnosis; heparin; haemolytic uraemic syndrome; thrombotic thrombocytopenic purpura; thrombotic microangiopathies; heparin induced thrombocytopenia
• ISSN: 1950-6112
• DOI: 10.1684/abc.2012.0786

We report a case of a 47 years old woman. In her case of medical history, there were vein thrombosis and an allergic to tinzaparin. The patient entered in critical care unit under medical supervision for a multivisceral infarction due to an arterial mesenteric, renal and splenic thrombosis. An heparinotherapy was introduced. A laparotomy was realized because of an occlusion. Small intestine necrozed was removed. 8 days after the introduction of the heparin, there was a thrombocytopenia. Considering the background and the initiale situation, an heparin-induced thrombocytopenia of type II (HTI) was suspected. Whereas the heparinotherapy was stopped, the thrombocytopenia maked worse. Biological tests infirmed HIT's diagnosis. A recurrent anemia in spite transfusions associated to a renal failure suggest a thrombotic microangiopathy which was secondary confirmed. The intensivist is sensibilized to evoke an heparin induced thrombocytopenia when there is a thrombocytopenia under heparin. However, he must not forget diagnosis of thrombocytopenia which required specific investigations and emergency treatment such as thrombotic microangiopathy.