Repeated premature hemofilter clotting during regional citrate anticoagulation as indicator of heparin induced thrombocytopenia
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Repeated premature hemofilter clotting during regional citrate anticoagulation as indicator of heparin induced thrombocytopenia. / Lehner, Georg Franz; Schöpf, Marion; Harler, Ulrich; Pechlaner, Christoph; Joannidis, Michael.
in: BLOOD PURIFICAT, Jahrgang 38, Nr. 2, 2014, S. 127-30.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Repeated premature hemofilter clotting during regional citrate anticoagulation as indicator of heparin induced thrombocytopenia
AU - Lehner, Georg Franz
AU - Schöpf, Marion
AU - Harler, Ulrich
AU - Pechlaner, Christoph
AU - Joannidis, Michael
N1 - © 2014 S. Karger AG, Basel.
PY - 2014
Y1 - 2014
N2 - PURPOSE: Early clinical signs of heparin induced thrombocytopenia (HIT) are nonspecific and include a sudden drop in the number of platelets as well as formation of arterial and venous thromboses. Regional citrate anticoagulation (RCA) is increasingly used as a very effective modality to prevent filter clotting during renal replacement therapy (RRT). We report the first case where repeated premature filter clotting despite RCA indicated a manifestation of HIT.MATERIALS AND METHODS: A 71-year old woman admitted to the ICU for a compartment syndrome of the leg developed septic shock with acute kidney injury requiring continuous veno-venous hemodialysis (CVVHD). Because of unexpected and repeated premature filter clotting during CVVHD using RCA, HIT was suspected.RESULTS: The diagnosis of HIT was confirmed by the presence of IgG antibodies against heparin and platelet factor (PF) 4 complexes and six points in the 4T score. Discontinuation of heparin administration and initiation of systemic anticoagulation with danaparoid sodium resulted in the normalization of platelet count and hemofilter lifetime.CONCLUSION: RCA does not seem to be sufficient to prevent hemofilter clotting during HIT. Thus, in case of repeated premature filter clotting despite RCA, one should suspect HIT and prompt diagnostic workup as well as a switch to alternative anticoagulation.
AB - PURPOSE: Early clinical signs of heparin induced thrombocytopenia (HIT) are nonspecific and include a sudden drop in the number of platelets as well as formation of arterial and venous thromboses. Regional citrate anticoagulation (RCA) is increasingly used as a very effective modality to prevent filter clotting during renal replacement therapy (RRT). We report the first case where repeated premature filter clotting despite RCA indicated a manifestation of HIT.MATERIALS AND METHODS: A 71-year old woman admitted to the ICU for a compartment syndrome of the leg developed septic shock with acute kidney injury requiring continuous veno-venous hemodialysis (CVVHD). Because of unexpected and repeated premature filter clotting during CVVHD using RCA, HIT was suspected.RESULTS: The diagnosis of HIT was confirmed by the presence of IgG antibodies against heparin and platelet factor (PF) 4 complexes and six points in the 4T score. Discontinuation of heparin administration and initiation of systemic anticoagulation with danaparoid sodium resulted in the normalization of platelet count and hemofilter lifetime.CONCLUSION: RCA does not seem to be sufficient to prevent hemofilter clotting during HIT. Thus, in case of repeated premature filter clotting despite RCA, one should suspect HIT and prompt diagnostic workup as well as a switch to alternative anticoagulation.
KW - Acute Kidney Injury
KW - Aged
KW - Anticoagulants
KW - Chondroitin Sulfates
KW - Citrates
KW - Dermatan Sulfate
KW - Equipment Failure
KW - Female
KW - Heparin
KW - Heparitin Sulfate
KW - Humans
KW - Immunoglobulin G
KW - Platelet Factor 4
KW - Renal Dialysis
KW - Shock, Septic
KW - Thrombocytopenia
KW - Thrombosis
KW - Case Reports
KW - Journal Article
U2 - 10.1159/000366125
DO - 10.1159/000366125
M3 - SCORING: Journal article
C2 - 25412655
VL - 38
SP - 127
EP - 130
JO - BLOOD PURIFICAT
JF - BLOOD PURIFICAT
SN - 0253-5068
IS - 2
ER -