Heparin

Abstract

S HeparinAnaphylactoid reaction associated with thrombocytopenia: case report A 56-year-old woman developed an anaphylactoid reaction associated with thrombocytopenia while receiving heparin.The woman had undergone a total abdominal hysterectomy and salpingo-oophorectomy, during which she had received prophylactic postoperative SC heparin for 2 days [dosage not stated]. Fourteen days later, she presented with progressive dyspnoea, and she was diagnosed with acute pulmonary venous thromboembolism. She started receiving an IV heparin bolus and drip [dosage not stated]. Approximately 5 minutes after starting the infusion, she became acutely flushed with rapidly worsening dyspnoea. Her systolic BP decreased into the 90s.Heparin was withdrawn; however, the woman developed agonal respirations and went into cardiorespiratory arrest. She received advanced cardiac life support and rapid sequence intubation with return of spontaneous circulation. Her BP was maintained with epinephrine [adrenaline], dopamine and norepinephrine [noradrenaline]. Her laboratory results were significant for a decreased platelet count of 57 × 10 9 /L. She started receiving argatroban and was admitted to an ICU. Enzyme-linked immunosorbent and serotonin release assays confirmed the presence of heparin antibody, and she was diagnosed with heparin-induced anaphylactoid reaction associated with thrombocytopenia. She was extubated, and she subsequently developed transient global amnesia. She recovered all memory function early in her hospital stay, and she was discharged with a platelet count of 358 × 10 9 /L.Author comment: "[S]he was diagnosed as having had a heparin-induced anaphylactoid reaction associated with thrombocytopenia."