A case of heparin-induced thrombocytopenia (HIT) triggered by methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia

Abstract

Background: Heparin-induced thrombocytopenia (HIT) is a potentially life-threatening complication of heparin anticoagulation. Recently, infection has been implicated in the development of HIT. Case presentation: We herein present a case of HIT diagnosed by a repeated functional assay. A 67-year-old female with diabetic nephropathy was admitted to our hospital with hypoxemia caused by volume overload. Due to her diuretic-resistant condition, dialysis therapy anticoagulated with low-molecular-weight heparin (LMWH) was initiated. The coagulation of the whole extracorporeal blood circuit occurred on day 13. Methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia derived from a catheter-related bloodstream infection (CRBSI) was detected on day 15. Based on the hypercoagulable state due to infection, we increased the heparin dose during dialysis therapy; however, coagulation of the dialysis circuit persisted. We suspected HIT on day 17 in spite of a normal platelet count and performed a functional assay, which was negative. Since thrombocytopenia subsequently developed, the functional assay was repeated and a positive result was obtained on day 27, which definitely established a diagnosis of HIT. Conclusions: Based on the present clinical course, MSSA bacteremia appears to have contributed to the pathogenesis of HIT.

Spontaneous HIT syndrome: Knee replacement, infection, and parallels with vaccine-induced immune thrombotic thrombocytopenia

“…A study by Grigorian and colleagues [78] found a higher frequency of HIT in patients who had bacterial infection, including the subsets of patients with urinary tract infection and pneumonia. One group presented a case of thrombocytopenia in the setting of heparin exposure and bacteremia with methicillin-susceptible Staphylococcus aureus, arguing that the bacteremia may have contributed to the clinical picture of HIT [79]. Sartori et al [80] found somewhat increased levels of anti-PF4/PVS antibodies in septic patients versus controls, although there was no difference in IgGspecific antibodies.…”