直腸癌術後にヘパリン起因性血小板減少症II型を発症した1例

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  • Heparin-induced thrombocytopenia type II in a patient who underwent rectal cancer surgery

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A case of heparin induced thrombocytopenia (HIT) type II that developed after rectal cancer surgery is presented with a literature review. A 53-year-old woman was given unfractionated heparin for prophylaxis of venous thromboembolism during the postoperative period of rectal cancer surgery. On the 9th postoperative day (POD), serum platelet decreased to 4.8×104/μl and the body CT scan revealed multiple thrombi in the pulmonary artery, left femoral vein, portal vein and so forth. Because HIT type II was strongly suspected as the cause of thrombus formation, heparin administration was stopped, argatroban and urokinase were initiated, and an inferior vena cava filter was placed. The serological test for HIT antibody was positive for the same day's blood sample. Platelet gradually increased after a transitory fall to 2.0×104/μl. On the 22nd POD, a CT scan showed that all thrombi had completely vanished from the pulmonary artery. However, newly administrated warfarin again caused a slight platelet decrease and a new thrombus formation in the right lower leg. She recovered again with warfarin and was discharged from the hospital on the 49th POD.

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