doiSerbia

Heparin induced thrombocytopenia type ii and myocardial infarction: Two case reports

Antonijević Nebojša (Institut za kardiovaskularne bolesti, Klinički centar Srbije, Beograd)
Stanojević Milica (Institut za kardiovaskularne bolesti, Klinički centar Srbije, Beograd)
Peruničić Jovan (Institut za kardiovaskularne bolesti, Klinički centar Srbije, Beograd)
Đokić Milan R. (Institut za transfuziju krvi Srbije, Beograd)
Miković Danijela (Institut za transfuziju krvi Srbije, Beograd)
Kovač Mirjana (Institut za transfuziju krvi Srbije, Beograd)
Miljić Predrag (Institut za hematologiju, Klinički centar Srbije, Beograd)
Milošević Rajko (Institut za hematologiju, Klinički centar Srbije, Beograd)
Terzić Branka (Institut za kardiovaskularne bolesti, Klinički centar Srbije, Beograd)
Vasiljević Zorana M. (Institut za kardiovaskularne bolesti, Klinički centar Srbije, Beograd)

Heparin-induced thrombocytopenia (HIT) type II is an acquired thrombophylic state and life-threatening immune complication of a heparin treatment mainly clinically manifested by marked thrombocytopenia, frequently by arterial and venous thrombosis, and sometimes by skin changes. Functional assay as heparin aggregation test and 14C-serotonin release assays are used in diagnostics as well as antigen assays of which detection tests for heparin-platelet factor 4 antibodies are most frequently used. Considering the fact that there is no single reliable assays for HIT II detection available, sometimes it is necessary to combine both of the above-mentioned types of assays. We present the case of a 57-year-old patient with an acute anterior myocardial infarction with cardiac insufficiency of III and IV degree according to Killip, recurrent ventricular fibrillation and diabetes mellitus type II developing thrombocytopenia to 37x10 9/l accompanied with typical skin changes. The diagnosis was confirmed by the heparin aggregation test. The second patient aged 70 undergoing the treatment for anteroseptal myocardial infarction and reinfarction of the inferior wall complicated by a cardiogenic shock and acute right bundle branch block developed thrombocytopenia 59x10 9/I on the third day of the heparin therapy, with the remark that he had received a heparin therapy during the first infarction as well. Antibodies against heparin-platelet factor 4 were detected by particle gel ID-HPF4 immunoassay. In both patients, the disease had a lethal outcome despite all then available therapeutic measures applied. Further on we discuss advantages of certain types of tests, a therapy doctrine, need for urgent therapeutic measures, inclusive of the administration of anitithrombins, avoidance of harmful procedures like low-molecular-weight heparins administration and prophylactic platelet transfusion as well as preventive measures.

Keywords: heparin, thrombocytopenia, diagnosis, treatment