Authors:

Shaghayegh Habibi , Tien-Chan Hsieh , Shrinkhala Khanna

1Department of Internal Medicine, Lucy Curci Cancer Center, Eisenhower Health, Rancho Mirage, CA, USA ,

Abstract:

Background : An extremely dangerous side effect of heparin that might result in a prothrombotic state is heparin-induced thrombocytopenia (HIT). In the case of HIT, prompt heparin withdrawal and non-heparin anticoagulant initiation are the recommended courses of action. Still, there may be difficulties with the treatment, especially in patients who are resistive to HIT, have contraindications to anticoagulation, or need immediate surgery. Furthermore, there are rare instances in which standard anticoagulation medication fails to provide the desired results, requiring the use of alternative therapies including intravenous immunoglobulin (IVIG) and plasma exchange (PLEX).
Case Report : Following liver transplant surgery, a 57-yearold male patient experienced mild acute cellular rejection, refractory HIT, and disseminated intravascular coagulation. Heparin was discontinued, and argatroban was started as a thromboembolism treatment; nonetheless, transplant failure resulted from hepatic artery thrombosis that happened in the context of refractory HIT. One month following the initial procedure, the patient had a second liver transplant. He had one IVIG dose prior to the operation and one during it, along with two PLEX sessions. The refractory HIT continued even after receiving extensive therapy with PLEX and IVIG. Even with catheter-directed intra-arterial thrombolysis and argatroban treatment, hepatic artery thrombosis returned in two weeks, and the transplant failed once more.
Conclusions : Refractory HIT has recently been treated with perioperative PLEX and IVIG on a few occasions. This therapy strategy was used on the first known case of a liver transplant patient with resistant HIT. Particularly in liver transplant recipients with HIT, more research is necessary to ascertain the effectiveness and safety of PLEX and IVIG therapy both before and after surgery
Keywords:
Liver Transplantation • Plasma Exchange • Thrombocytopenia • Immunoglobulins, Intravenous • Heparin

Citation:

Shaghayegh Habibi. Refractory Heparin-Induced Thrombocytopenia in a Liver Transplant Recipient: Intravenous Immunoglobulin Use and Perioperative Plasma Exchang.. Clinical Imaging and Case Reports 2023.