ISSN:
1432-2307
Keywords:
Key words Heparin
;
Thrombocytopenia
;
Thrombosis
;
Pathomorphology
;
Immunohistochemistry
Source:
Springer Online Journal Archives 1860-2000
Topics:
Medicine
Notes:
Abstract The therapeutic use of heparin results in thrombocytopenia in 5–30% of patients. In 0.1–1% of patients treated with heparin, the platelet count decreases to between 100 × 109/l and 50 × 109/l and leads to severe synchronous central arterial and venous thrombosis with a mortality of 18–36%. This is known as ”white-clot syndrome” or heparin-induced thrombocytopenia II (HIT-II syndrome). Whilst the clinical aspects and the central type of thrombosis in HIT-II syndrome are well documented, the histomorphology and differential diagnosis of thrombosis are not. We report three cases of HIT-II syndrome with thrombosis of the central arteries and veins. The HIT-II thrombi could be differentiated from thrombi of other origins, particularly from mural thrombi. Heparin-induced thrombi were seen on microscopical examination to be like onion skin in structure, and immunohistochemistry showed that they had a markedly reduced content of fibrin and clearly enhanced amounts of IgG and IgM. The layered structure thus implied appositional growth. The thrombi in HIT-II syndrome do not seem to be induced by activation of the coagulation cascade, but by platelet aggregation mediated by anti-platelet antibodies.
Type of Medium:
Electronic Resource
URL:
http://dx.doi.org/10.1007/s004280050203
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