PMID- 17828468
OWN - NLM
STAT- MEDLINE
DCOM- 20090107
LR  - 20181113
IS  - 0929-5305 (Print)
IS  - 0929-5305 (Linking)
VI  - 26
IP  - 2
DP  - 2008 Oct
TI  - Clinical challenge: heparin-induced thrombocytopenia type II (HIT II) or 
      pseudo-HIT in a patient with antiphospholipid syndrome.
PG  - 142-6
AB  - Treatment of patients with heparin-induced thrombocytopenia type II (HIT II) and 
      thrombosis in some cases that represents a clinical challenge, which, if 
      unrecognized, may lead to treatment delay or disease progression with potentially 
      lethal outcome. We present a case of a 19-year-old patient with antiphospholipid 
      syndrome, factor V (FV) Leiden mutation in heterozygous state, and venous 
      thromboembolism. The patient was subjected to intravenous infusions of 
      unfractionated heparin (UFH), and 16 days after the beginning of the treatment, 
      his condition worsened, with thrombocytopenia and extension of thrombosis. 
      Whereas the patient had a high clinical score for HIT II, functional and 
      antigenic assays for the presence of HIT antibodies were negative. After repeated 
      negative functional and antigenic assays, pseudo-HIT was suspected and nadroparin 
      was introduced, which resulted in further worsening of the clinical presentation. 
      Disease remission, along with complete normalization of platelet count, was 
      finally accomplished with the introduction of lepirudin. The presence of multiple 
      comorbid states, such as antiphospholipid syndrome, can potentially make 
      laboratory confirmation of disease more difficult in patients with HIT II. In our 
      opinion, it is of great importance that HIT II diagnosis be primarily clinical 
      and that laboratory test results are carefully interpreted, especially when HIT 
      is indicated by high clinical score values.
FAU - Perunicic, Jovan
AU  - Perunicic J
AD  - Institute of Cardiovascular Diseases, University Clinical Center of Serbia, 
      Pasterova 2, Belgrade, 11000, Serbia.
FAU - Antonijevic, Nebojsa M
AU  - Antonijevic NM
FAU - Miljic, Predrag
AU  - Miljic P
FAU - Djordjevic, Valentina
AU  - Djordjevic V
FAU - Mikovic, Danijela
AU  - Mikovic D
FAU - Kovac, Mirjana
AU  - Kovac M
FAU - Djokic, Milan
AU  - Djokic M
FAU - Mrdovic, Igor
AU  - Mrdovic I
FAU - Nikolic, Aleksandra
AU  - Nikolic A
FAU - Vasiljevic, Zorana
AU  - Vasiljevic Z
LA  - eng
PT  - Case Reports
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20070909
PL  - Netherlands
TA  - J Thromb Thrombolysis
JT  - Journal of thrombosis and thrombolysis
JID - 9502018
RN  - 0 (Antibodies)
RN  - 0 (Anticoagulants)
RN  - 0 (Hirudins)
RN  - 0 (Nadroparin)
RN  - 0 (Recombinant Proteins)
RN  - 0 (factor V Leiden)
RN  - 9001-24-5 (Factor V)
RN  - 9005-49-6 (Heparin)
RN  - Y43GF64R34 (lepirudin)
SB  - IM
MH  - Administration, Oral
MH  - Adult
MH  - Antibodies/blood
MH  - Anticoagulants/administration & dosage/*adverse effects/immunology
MH  - Antiphospholipid Syndrome/blood/*complications/immunology
MH  - Diagnosis, Differential
MH  - Factor V/*genetics
MH  - Heparin/administration & dosage/*adverse effects/immunology
MH  - Hirudins/administration & dosage
MH  - Humans
MH  - Infusions, Intravenous
MH  - Male
MH  - Mutation
MH  - Nadroparin/adverse effects
MH  - Platelet Count
MH  - Recombinant Proteins/administration & dosage
MH  - Thrombocytopenia/blood/*chemically induced/drug therapy/immunology
MH  - Venous Thromboembolism/blood/complications/*drug therapy
EDAT- 2007/09/11 09:00
MHDA- 2009/01/08 09:00
CRDT- 2007/09/11 09:00
PHST- 2007/03/23 00:00 [received]
PHST- 2007/06/29 00:00 [accepted]
PHST- 2007/09/11 09:00 [pubmed]
PHST- 2009/01/08 09:00 [medline]
PHST- 2007/09/11 09:00 [entrez]
AID - 10.1007/s11239-007-0076-y [doi]
PST - ppublish
SO  - J Thromb Thrombolysis. 2008 Oct;26(2):142-6. doi: 10.1007/s11239-007-0076-y. Epub 
      2007 Sep 9.