A rare case of heparin-induced thrombocytopenia following long-term chronic hemodialysis

Abstract

 A 58-year-old man had been treated with hemodialysis using heparin as an anticoagulant since December 1991. Eosinophilia appeared in November 2005 without changes in other clinical and laboratory findings. In August 2006 (15 years after the start of dialysis), blood coagulation in the dialyzer and extracorporeal circuit began to occur during hemodialysis. Blood coagulation gradually worsened, despite an increase in the dose of heparin and change of the dialysis membrane, which was then accompanied by chest discomfort and severe hypotension just after the commencement of dialysis. Both blood coagulation and shock during hemodialysis were improved by the administration of aspirin. However, aspirin administration ceased because of skin itching, after which the above symptoms recurred. Laboratory data disclosed an extreme decrease in platelet count after hemodialysis and specific immunoglobulin G antibodies to platelet factor 4-heparin complex. Accordingly, the patient was diagnosed with heparin-induced thrombocytopenia (HIT) and heparin was changed to nafamostat mesilate as an anticoagulant. Clotting in dialysis equipment, thrombocytopenia, shock during hemodialysis, and eosinophilia were all improved following the use of nafamostat mesilate. The present case was a rare case of HIT characterized by late occurrence following long-term hemodialysis for 15 years, complication of shock during dialysis, and eosinophilia preceding the onset of HIT.