Key result
Immediate heparin interruption, argatroban, nafamostat, and plasma exchange successfully treated a rare case of heparin-induced thrombocytopenia that developed four years after starting maintenance hemodialysis.
Why the study?
HIT is known to be less prevalent in long-term maintenance dialysis compared to the induction phase, presenting a diagnostic challenge.
Case Report (n=1)
No
Heparin-induced thrombocytopenia should be considered in the differential diagnosis of thrombocytopenia even in patients on long-term maintenance hemodialysis.
HIT possible in long-term maintenance dialysis; extends temporal risk window but hypothesis-generating from a single case.
Heparin-induced thrombocytopenia type II (HIT) is a rare and serious complication of heparin exposure and is always a potential risk in hemodialysis patients who routinely receive heparin. It is particularly likely to occur during the induction phase of dialysis. However, it is known to be less prevalent in long-term maintenance dialysis. In the present study, we experienced a maintenance dialysis patient who developed HIT four years after starting dialysis. After careful diagnosis with antibodies assay and clinical scores, the patient was treated with immediate heparin interruption, argatroban administration followed by nafamostat, and simple plasma exchange, which resulted in remission. Therefore, even in the maintenance phase of hemodialysis, it is important to consider HIT in the differential diagnosis of thrombocytopenia.
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Nishiyama et al. (2024) conducted a case report in Heparin-induced thrombocytopenia (n=1). Argatroban, nafamostat, and plasma exchange was evaluated on Remission of thrombocytopenia. Immediate heparin interruption, argatroban, nafamostat, and plasma exchange successfully treated a rare case of heparin-induced thrombocytopenia that developed four years after starting maintenance hemodialysis.
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