Heparin‐induced skin necrosis associated with thrombocytopenia and acquired protein C and protein S deficiency

Abstract

We have described a patient with colon cancer and liver metastases who developed heparin-induced thrombocytopenia and skin necrosis. We believe that the skin necrosis caused by the heparin/platelet factor 4 antibody was exacerbated by the acquired protein C and protein S deficiency. After the heparin was discontinued and infection treated, the skin necrosis and thrombocytopenia resolved. This case illustrates the fact that, in patients with heparin-induced skin necrosis, a search must be undertaken for an underlying pro-thrombotic state, which may precipitate the microthrombosis responsible for skin necrosis. We could not find any previous case reports of heparin-induced skin necrosis associated with isolated protein C deficiency, or combined protein C and protein S deficiency. Am. J. Hematol. 82:1116Hematol. 82: -1117Hematol. 82: , 2007

Thrombophilia: the dermatological clinical spectrum

“…The use of intravenous or subcutaneous heparin can also give rise to skin necrosis that is clinically and histopathologically similar to warfarin-induced necrosis [33,36,58].…”

Manifestações cutâneas das trombofilias

“…31,54 A necrose cutânea pela heparina surge entre o quinto e o 10 o dia do tratamento. 34 Os achados histopatológicos são similares aos da varfarina e outras síndromes de oclusão microvascular.…”