Abstract
We report a case of heparin-induced thrombocytopenia (HIT) complicated by anaphylaxis in a patient undergoing chronic hemodialysis. A 58-year-old man with polycystic kidney disease had received maintenance hemodialysis since 2001 using heparin without any complications. On Jan. 11, 2006, he had sweating, dyspnea and abdominal pain immediately after initiating hemodialysis. Since his arterial pressure and pO2 was decreased, hemodialysis was discontinued. Hematology test showed decreased platelet count from 36.8×104/mm3 to 11.4×104/mm3. There was blood coagulation in both arterial and venous chambers of circuit. Similar episode occurred when low-molecular heparin but not nafamostat mesilate was used as an anticoagulant during hemodialysis. HIT was highly suspected from these clinical manifestations. However, Anti-PF4/heparin antibodies were not detected and heparin-induced platelet activation assay was negative. Regarding the heparin allergy, the open patch test with heparin was positive. We diagnosed with HIT complicated with anaphylaxis induced by heparin on the basis of clinical symptoms. This is a rare case of HIT since it suddenly develops with anaphylaxis after long term use of heparin without the detection of HIT antibodies.
