A Case of Heparin-Induced Thrombocytopenia With Sepsis and Congestive Heart Failure-First Autopsy Report in Japan-

Sawaki, Daigo; Otani, Yoshitaka; Kobayakawa, Naoshi; Sekita, Gaku; Fukushima, Kazuyuki; Takeuchi, Hiroaki; Ogawa, Takafumi; Takemura, Tamiko; Aoyagi, Takaaki

doi:10.1253/circj.68.1215

Cited by 4 publications

(5 citation statements)

References 18 publications

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“…There are exceptions, however, as demonstrated by the present case. As histopathological findings in HIT, thrombi composed of platelets and fibrin have been emphasized (the typical ‘white clots’) 5,7,8 . In the present patient, however, thromboembolisms were organized with cholesterin deposition, and mainly found in medium‐sized arteries.…”

Section: Discussionmentioning

confidence: 47%

“…In previous HIT cases, distribution of thrombi occurred not only in the large artery, but also in medium–small arteries such as the small pulmonary artery and intestinal wall 5 . In HIT patients, venous thrombosis was predominant, but in post‐cardiovascular surgery patients, arterial thrombosis was predominant 14 .…”

Section: Discussionmentioning

confidence: 91%

“…Autopsy cases of HIT, however, have been rare. In some reports, fibrin thrombi were the common finding 3–5 . Recently, we had a patient suffering from HIT‐II with relatively long‐term follow up, for whom organized thrombi with cholesterin deposit were observed in multiple organs, accompanied by marked atherosclerotic change and an aneurysm of the aorta.…”

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confidence: 94%

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Heparin‐induced thrombocytopenia with multiple organized thrombi accompanied by unusual cholesterin deposition: Autopsy case after long‐term follow up

Ichinoe¹,

Mikami²,

Ujiie

et al. 2009

Pathology International

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Heparin-induced thrombocytopenia (HIT) is characterized by a reduction in the platelet count and systemic thromboembolism during heparin therapy. Herein is reported a case of HIT with characteristic thrombus formation. A 68-year-old man who had been treated for hypertension for 27 years suffered a brain infarction and was treated with heparin. After this treatment, other new infarctions occurred in multiple organs. Because serum antibodies against heparin/PF4 complex were detected, he was diagnosed as having HIT, and warfarin and argatroban were administered instead of heparin. He died, however, 119 days after the first onset. At autopsy infarction due to organized thrombi with cholesterin deposition in multiple organs were found, similar to usual atherosclerotic emboli, but different to them with regard to clinical course and distribution of thrombi. This case in which organization and frequent cholesterin deposition were found in thromboembolized lesions of multiple organs after relatively long-term follow up, is unusual. The findings suggest that HIT accompanied by marked hypercholesterolemia of long duration contributes to a characteristic form of thromboembolism that needs careful management.

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Section: Discussionmentioning

confidence: 47%

Section: Discussionmentioning

confidence: 91%

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Heparin‐induced thrombocytopenia with multiple organized thrombi accompanied by unusual cholesterin deposition: Autopsy case after long‐term follow up

Ichinoe¹,

Mikami²,

Ujiie

et al. 2009

Pathology International

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“…Moreover, thrombosis at the hepatic vein is characteristic in PNH [27] and haemosiderin deposition is observed in the renal tubular endothelium in chronic cases [28,29]. Among the few autopsy case reports that include histopathological analysis of HIT [30][31][32][33], the lung and gastrointestinal tract are reported as the main thrombosis sites in HIT. TTS/VITT, which is suspected to be associated with autoimmune HIT, develops 4 to 28 days after vaccination and causes thrombosis characteristically in atypical sites such as the cerebral venous sinus, hepatic vein, and splenic vein [34][35][36][37][38][39][40].…”

Section: Discussionmentioning

confidence: 99%

Histopathologically TMA-like distribution of multiple organ thromboses following the initial dose of the BNT162b2 mRNA vaccine (Comirnaty, Pfizer/BioNTech): an autopsy case report

et al. 2022

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Background Coronavirus disease 2019 (COVID-19) has spread worldwide. Vaccination is now recommended as one of the effective countermeasures to control the pandemic or prevent the worsening of symptoms. However, its adverse effects have been attracting attention. Here, we report an autopsy case of multiple thromboses after receiving the first dose of the BNT162b2 mRNA vaccine (Comirnaty, Pfizer/BioNTech) in an elderly woman. Case presentation A 72-year-old woman with a history of diffuse large B-cell lymphoma in the stomach and hyperthyroidism received the first dose of the BNT162b2 mRNA vaccine and died 2 days later. The autopsy revealed multiple microthrombi in the heart, brain, liver, kidneys, and adrenal glands. The thrombi were CD61 and CD42b positive and were located in the blood vessels primarily in the pericardial aspect of the myocardium and subcapsular region of the adrenal glands; their diameters were approximately 5–40 μm. Macroscopically, a characteristic myocardial haemorrhage was observed, and the histopathology of the characteristic thrombus distribution, which differed from that of haemolytic uraemic syndrome and disseminated intravascular coagulation, suggested that the underlying pathophysiology may have been similar to that of thrombotic microangiopathy (TMA). Conclusion This is the first report on a post-mortem case of multiple thromboses after the BNT162b2 mRNA vaccine. The component thrombus and characteristic distribution of the thrombi were similar to those of TMA, which differs completely from haemolytic uraemic syndrome or disseminated intravascular coagulation, after vaccination. Although rare, it is important to consider that fatal adverse reactions may occur after vaccination and that it is vital to conduct careful follow-up.

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“…Because of the significantly increased pressure in the RA, part of the clot protruded through an otherwise closed interatrial septum orifice to the left atrium. Cardiac thrombosis is uncommon in HIT, and such massive thrombosis is distinctly rare only few cases have been reported [5, 6]. …”

Section: Discussionmentioning

confidence: 99%

Heparin-Induced Thrombocytopenia Associated with Massive Intracardiac Thrombosis: A Case Report

Ahmed

Al‐Mondhiry

Milling

et al. 2012

Case Reports in Hematology

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A 60-years old patient was admitted to a community hospital with septic arthritis. He was treated with antibiotics and subcutaneous unfractionated heparin (UH) was used for venous thromboprophylaxis. After three days, he developed leg deep venous thrombosis and was treated with IV heparin. One day later, the patient developed pulmonary emboli, which was found using ventilation/perfusion scan. He was transferred to the University Hospital for further management. Upon arrival, antibiotic and intravenous UH were continued. Trans-Esophageal Echocardiogram showed a thrombus in the right atrium, a small portion of which extended to the left atrium through a patent foramen ovale. Another large thrombus was noted in the right ventricle, which extended to the pulmonary artery. Review of the patient's medical records revealed a halving of his platelet count three days following the heparin administration. Therefore, HIT seemed very likely. Intravenous UH was stopped and an emergency thrombectomy was performed. ELISA testing of HIT antibodies came negative. This made HIT diagnosis unlikely and the patient received dalteparin. A week later, as the platelet count declined again, HIT antibodies' testing using ELISA and C-14 serotonin release was repeated, and both assays were positive. Argatroban was restarted and the platelet count normalized.

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A Case of Heparin-Induced Thrombocytopenia With Sepsis and Congestive Heart Failure-First Autopsy Report in Japan-

Cited by 4 publications

References 18 publications

Heparin‐induced thrombocytopenia with multiple organized thrombi accompanied by unusual cholesterin deposition: Autopsy case after long‐term follow up

Heparin‐induced thrombocytopenia with multiple organized thrombi accompanied by unusual cholesterin deposition: Autopsy case after long‐term follow up

Histopathologically TMA-like distribution of multiple organ thromboses following the initial dose of the BNT162b2 mRNA vaccine (Comirnaty, Pfizer/BioNTech): an autopsy case report

Heparin-Induced Thrombocytopenia Associated with Massive Intracardiac Thrombosis: A Case Report

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