Heparin‐induced thrombocytopenia due to heparin lock in a hemodialysis patient: A case report

Chan, Koon Ming; Cheung, ST; Chau, Kwong Wing

doi:10.1111/hdi.12137

Cited by 10 publications

(8 citation statements)

References 12 publications

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“…Second, the patients enrolled in the current study were taking various medications that might affect plasma XOR activity [ 40 ]; however, we could not take these differences into consideration owing to the relatively small sample size. Third, because XOR has affinity for heparin and can bind to vascular endothelial cells [ 41 ], administration of heparin before blood collection might increase XOR activity in the circulating blood; however, heparin injection was not performed before blood sampling in accordance with other investigators’ methods of XOR activity measurement [ 17 , 26 , 34 ], and also to avoid potential adverse effects [ 42 ].…”

Section: Discussionmentioning

confidence: 99%

Relationship between plasma xanthine oxidoreductase activity and left ventricular ejection fraction and hypertrophy among cardiac patients

Fujimura

Yamauchi

Murase³

et al. 2017

PLoS ONE

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Background and purposeXanthine oxidoreductase (XOR), which catalyzes purine catabolism, has two interconvertible forms, xanthine dehydrogenase and xanthine oxidase, the latter of which produces superoxide during uric acid (UA) synthesis. An association between plasma XOR activity and cardiovascular and renal outcomes has been previously suggested. We investigated the potential association between cardiac parameters and plasma XOR activity among cardiology patients.Methods and resultsPlasma XOR activity was measured by [13C2,15N2]xanthine coupled with liquid chromatography/triplequadrupole mass spectrometry. Among 270 patients who were not taking UA-lowering drugs, XOR activity was associated with body mass index (BMI), alanine aminotransferase (ALT), HbA1c and renal function. Although XOR activity was not associated with serum UA overall, patients with chronic kidney disease (CKD), those with higher XOR activity had higher serum UA among patients without CKD. Compared with patients with the lowest XOR activity quartile, those with higher three XOR activity quartiles more frequently had left ventricular hypertrophy. In addition, plasma XOR activity showed a U-shaped association with low left ventricular ejection fraction (LVEF) and increased plasma B-type natriuretic peptide (BNP) levels, and these associations were independent of age, gender, BMI, ALT, HbA1C, serum UA, and CKD stages.ConclusionsAmong cardiac patients, left ventricular hypertrophy, low LVEF, and increased BNP were significantly associated with plasma XOR activity independent of various confounding factors. Whether pharmaceutical modification of plasma XOR activity might inhibit cardiac remodeling and improve cardiovascular outcome should be investigated in future studies.

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Section: Discussionmentioning

confidence: 99%

Relationship between plasma xanthine oxidoreductase activity and left ventricular ejection fraction and hypertrophy among cardiac patients

Fujimura

Yamauchi

Murase³

et al. 2017

PLoS ONE

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“…Fourteen studies detailed the use of IVIG or TPE as initial therapy (see Table 2). Twelve studies included 13 case reports 46,[48][49][50][51][52][53][54][55][56][57][58] and one case series included four patients. 14 One case-controlled study of 44 patients reported aggregate data on 26 TPE-treated patients and is summarized separately.…”

Section: Treatment Indication 2: Initial Therapymentioning

confidence: 99%

Therapeutic plasma exchange and intravenous immune globulin in the treatment of heparin‐induced thrombocytopenia: A systematic review

et al. 2020

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Background: Immunomodulatory strategies in heparin-induced thrombocytopenia (HIT) include the use of intravenous immune globulin (IVIG) and therapeutic plasma exchange (TPE). The optimal application of these therapies is unknown and outcomes data are limited. We investigated treatment categories and laboratory and clinical outcomes of IVIG and/or TPE in HIT with a systematic literature review. Study Design and Methods: We searched MEDLINE, Embase, and Web of Science through December 2019 for studies combining controlled vocabulary and keywords related to thrombocytopenia, heparin, TPE, and IVIG. The primary outcome was treatment indication. Secondary outcomes were platelet recovery, HIT laboratory parameters, heparin re-exposure, and post-treatment course. Case-level data were analyzed by qualitative synthesis. Results: After 4241 references were screened, we identified 60 studies with four main categories of IVIG and/or TPE use as follows: (a) treatment of refractory HIT (n = 35; 31%); (b) initial therapy (n = 45; 40%); (c) cardiopulmonary bypass surgery (CPB; n = 30; 27%); and (d) other (n = 2; 2%). IVIG was most commonly used for the treatment of refractory HIT while TPE was primarily used to facilitate heparin exposure during CPB. Both IVIG and TPE were

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“…Heparin was then discontinued and argatroban was started. Additionally, Chan et al [10] presented a case of 58-year-old woman with acute kidney injury was initiated on heparin-free hemodialysis. Subsequent thrombocytopenia development and positive HIT antibodies led to HIT type II diagnosis, and patient was eventually put on plasmapheresis.…”

Section: Discussionmentioning

confidence: 99%

Rare heparin induced thrombocytopenia type I reaction in a hemodialysis patient

Liu¹,

Zhang²,

Bai

et al. 2018

Medicine

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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.

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Heparin‐induced thrombocytopenia due to heparin lock in a hemodialysis patient: A case report

Cited by 10 publications

References 12 publications

Relationship between plasma xanthine oxidoreductase activity and left ventricular ejection fraction and hypertrophy among cardiac patients

Relationship between plasma xanthine oxidoreductase activity and left ventricular ejection fraction and hypertrophy among cardiac patients

Therapeutic plasma exchange and intravenous immune globulin in the treatment of heparin‐induced thrombocytopenia: A systematic review

Rare heparin induced thrombocytopenia type I reaction in a hemodialysis patient

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