Журнал травм и лечения

Bilateral Adrenal Hemorrhage Secondary to Heparin Induced Thrombocytopenia in a Trauma Patient

Abstract

Yuki Yoshioka and Akihiro Hamanaka

We report a case of a trauma patient with Bilateral Adrenal Hemorrhage (BAH) associated with Heparin Induced Thrombocytopenia (HIT). An 80-year-old man was brought to our hospital after falling from a height of 3 m. His vital signs were stable, and whole body Computed Tomography (CT) showed that he had right multiple rib fractures, hemothorax, and pelvic fracture. The patient subsequently underwent Transcatheter Arterial Embolization (TAE) for the pelvic fracture hemorrhage treatment. Then, the patient was admitted to the intensive care unit and was transfused 2 units of red cell concentrate and 2 units of fresh frozen plasma.

On Day 3, we started with the subcutaneous injection of unfractionated heparin (15,000 units per day) to prevent Deep Vein Thrombosis (DVT). On Day 6, the patient vomited and had fever (39°C) with a confused mental status. His systolic blood pressure suddenly dropped to 90 mmHg. Abdominal CT scan demonstrated BAH (Figure 1) and laboratory findings exhibited a platelet count of 50 × 103 mm−3 (which was 160 × 103 mm−3 5 days earlier). We suspected HIT leading to BAH and stopped heparin injection; we subsequently started anticoagulation therapy with argatrovan (continuous infusion: 0.5 μg/BW kg/min) and checked heparin antibody. As the patient was in a shock status, we diagnosed adrenal insufficiency and started the administration of steroids. Subsequently, the patient gained consciousness, his other symptoms regressed, and his platelet count gradually increased. Later, heparin antibody was found to be positive, and the diagnosis of HIT was confirmed.