Suspected heparin-induced thrombocytopenia in a COVID-19 patient on extracorporeal membrane oxygenation support: a case
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CASE REPORT
Open Access
Suspected heparin-induced thrombocytopenia in a COVID-19 patient on extracorporeal membrane oxygenation support: a case report Xuan T. Phan1, Tuan H. Nguyen2* , Tung T. Tran2, Thu-Hien T. Huynh1, Thuy-Ha T. Hoang2, Vinh-Chau V. Nguyen3 and Thao N. T. Pham1
Abstract Background: Extracorporeal membrane oxygenation (ECMO) support can be life-saving in critically ill COVID-19 patients. However, there are many complications associated with this procedure, including Heparin-induced thrombocytopenia (HIT.) Despite its rarity in ECMO cases, HIT can lead to devastating consequences and is difficult to manage. Case presentation: In this report, we present a case of a COVID-19 patient on ECMO support who was diagnosed with HIT and required intensive treatment. Initially, HIT was only suspected due to newly-developed thrombocytopenia and oxygenator dysfunction, with thrombi observed later. Regarding his treatment, since there was no recommended replacement to heparin available to us at the time of diagnosis, we decided to use rivaroxaban temporarily. No adverse events were recorded during that period. The patient was able to make a full recovery. Conclusion: HIT may jeopardize patient’s care during ECMO. As COVID-19 may bring about a surge in the number of patients requiring ECMO support, we need consented guidance to optimize treatment in this specific situation. Keywords: HIT, ECMO, Extracorporeal, COVID-19, Thrombocytopenia
Background Coronavirus disease 2019 (COVID-19), the disease caused by Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, is an ongoing medical problem worldwide [1]. Patients may have different severity levels, ranging from mild dyspnea or coughing to multiorgan failure [1]. For those with lifethreatening complications, intensive interventions may be requisite. Extracorporeal membrane oxygenation (ECMO) * Correspondence: [email protected] 2 Department of Hematology, Cho Ray Hospital, 201B Nguyen Chi Thanh Street, Ward 12, District 5, Ho Chi Minh City, Vietnam Full list of author information is available at the end of the article
is a potentially life-saving procedure, in which the patient’s blood is circulated through an oxygenator to provide oxygen to vital organs [2]. In ECMO, the tubing system is usually coated with heparin to reduce to risk of thrombosis due to widespread coagulation activation throughout the set [2]. However, this practice gives rise to an increased risk of Heparin-induced thrombocytopenia (HIT), a condition in which platelets are incessantly activated by anti-PF4/Heparin antibodies, leading to catastrophic thrombotic events [2]. In this report, we describe a case of a COVID-19 patient on ECMO with suspected HIT who was particularly difficult to manage due to our lack of resources.
© The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate cre
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