A case report on heparin-induced thrombocytopenia associated with the anti-PF4-heparin complex antibody in a diabetic hemodialysis patient

Abstract

Thrombocytopenia is one of the complications in the use of heparin associated with acute thrombosic events. We report here a case of heparin-induced thrombocytopenia in a patient treated with hemodialysis. Progressive thrombocytopenia with clot formation in the A-V fistula occurred in a 56-year-old diabetic man after the onset of hemodialysis treatment using heparin. After we substituted nafamostat mesilate for heparin as an anticoagulant, the platelet count began to recover. After acetyl salicylic acid (ASA) 0.33g p.o. was coadministered with heparin instead of nafamostat mesilate, thrombocytopenia never occurred. Heparin-induced thrombocytopenia was suspected and the anti-PF4-heparin complex antibody was found to be strongly positive. We propose that it may be productive to study the possible contribution of this disease to idiopathic thrombocytopenia or thrombosis.