Heparin‐induced thrombocytopenia with multiple organized thrombi accompanied by unusual cholesterin deposition: Autopsy case after long‐term follow up

Abstract

Heparin-induced thrombocytopenia (HIT) is characterized by a reduction in the platelet count and systemic thromboembolism during heparin therapy. Herein is reported a case of HIT with characteristic thrombus formation. A 68-year-old man who had been treated for hypertension for 27 years suffered a brain infarction and was treated with heparin. After this treatment, other new infarctions occurred in multiple organs. Because serum antibodies against heparin/PF4 complex were detected, he was diagnosed as having HIT, and warfarin and argatroban were administered instead of heparin. He died, however, 119 days after the first onset. At autopsy infarction due to organized thrombi with cholesterin deposition in multiple organs were found, similar to usual atherosclerotic emboli, but different to them with regard to clinical course and distribution of thrombi. This case in which organization and frequent cholesterin deposition were found in thromboembolized lesions of multiple organs after relatively long-term follow up, is unusual. The findings suggest that HIT accompanied by marked hypercholesterolemia of long duration contributes to a characteristic form of thromboembolism that needs careful management.

Histopathologically TMA-like distribution of multiple organ thromboses following the initial dose of the BNT162b2 mRNA vaccine (Comirnaty, Pfizer/BioNTech): an autopsy case report

“…Moreover, thrombosis at the hepatic vein is characteristic in PNH [27] and haemosiderin deposition is observed in the renal tubular endothelium in chronic cases [28,29]. Among the few autopsy case reports that include histopathological analysis of HIT [30][31][32][33], the lung and gastrointestinal tract are reported as the main thrombosis sites in HIT. TTS/VITT, which is suspected to be associated with autoimmune HIT, develops 4 to 28 days after vaccination and causes thrombosis characteristically in atypical sites such as the cerebral venous sinus, hepatic vein, and splenic vein [34][35][36][37][38][39][40].…”