A case of heparin-induced thrombocytopenia (HIT) triggered by methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia. Issue 1 (December 2016)

• Record Type: Journal Article
• Authors: Sugioka, Sayaka; Doi, Yohei; Ishihara, Takeshi; Arisato, Tetsuya; Osaki, Keisuke; Koga, Kenichi; Koshikawa, Masao; Sugawara, Akira
• Is Part Of: Renal replacement therapy. Volume 2:Issue 1(2016)
• Page Start: 1
• Page End: 5
• Publication Date: 2016-12
• Subjects: HIT -- Functional assay -- Antigen assay -- Hypercoagulable state -- MSSA bacteremia; Kidneys -- Diseases -- Periodicals; Acute renal failure -- Treatment -- Periodicals; Kidneys -- Transplantation -- Periodicals; Hemodialysis -- Periodicals; 616.61406
• DOI: 10.1186/s41100-016-0073-8
• Languages: English
• ISSNs: 2059-1381

Abstract

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-susceptibleStaphylococcus 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.