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H. Stricker, et al., “Heparin-Dependent in Vitro Aggregation of Normal Platelets by Plasma of a Patient with Heparin-Induced Skin Necrosis: Specific Diagnostic Test for a Rare Side Effect,” The American Journal of Medicine, Vol. 85, No. 5, 1988, pp. 721-724. doi:10.1016/S0002-9343(88)80250-X

has been cited by the following article:

• TITLE: Catastrophic Complications of Intravenous Line Flushing with Unfractionated Heparin

  AUTHORS: Giuseppe Colucci, Maximilian Jahns, Tobias Silzle, Lorenzo Alberio

  KEYWORDS: Heparin-Induced Thrombocytopenia, Adrenal Haemorrhagic Necrosis, 4T Score, PF4/Heparin-Antibodies

  JOURNAL NAME: International Journal of Clinical Medicine, Vol.3 No.1, January 5, 2012

  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 glands was misdiagnosed as adrenal adenoma. On day 10 thrombocytopenia was noted and the next day a myocardial 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 clear platelet drop can be recognised.