Catastrophic Complications of Intravenous Line Flushing with Unfractionated Heparin英文文献资料.docVIP

International Journal of Clinical Medicine, 2012, 3, 36-39 /10.4236/ijcm.2012.31007 Published Online January 2012 (http://www.SciRP.org/journal/ijcm) Catastrophic Complications of Intravenous Line Flushing with Unfractionated Heparin Giuseppe Colucci , Maximilian Jahns , Tobias Silzle , Lorenzo Alberio 1* 1 2 1 1 Department of Haematology and Central Haematology Laboratory, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland; Department of Haematology and Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland. Email: { giuseppe.colucci, maximilian.jahns, lorenzo.alberio}@insel.ch, Tobias.Silzle@sec.kssg.ch 2 * Received October 6 , 2011; revised November 19 , 2011; accepted December 16 , 2011 th th th ABSTRACT Heparin-induced thrombocytopenia (HIT) is a clinicopathologic syndrome because diagnosis is based on both clinical symptoms and laboratory data. We report a patient with multiple thromboembolic complications after daily flushing of intravenous line with small amounts of unfractionated heparin (UFH). At day 7 bilateral hemorrhagic infarction of the adrenal gland was misdiagnosed as adrenal adenoma. On day 10 thrombocytopenia was noted and the next day a myo- cardial infarction complicated by a left ventricular thrombus was diagnosed. On day 12, HIT was suspected. The pre-test probability for HIT according to the 4T-score was high (8/8 points) and detection of antibodies directed against the PF4/heparin-complex by particle gel immunoassay (Titer 1:1024) and ELISA (O.D. 2.784) was strongly positive. HIT can be induced by iv-line flushes with UFH. Arterial and venous thrombotic complications can be present before a