Heparin-Induced Thrombocytopenia in a Chronic Hemodialysis Patient with End-Stage Renal Disease / 대한신장학회지

Hemodialysis (HD) patients continually exposed to heparin are at risk of developing heparin-induced thrombocytopenia (HIT). However, HIT is very rare in chronic HD patients with end-stage renal disease (ESRD). The authors report the case of a chronic HD patient with ESRD who developed HIT complicated by recurrent thrombocytopenia and significant bleeding episodes. A 67-year-old man with diabetic ESRD on chronic HD suddenly developed recurrent acute bleeding episodes and severe thrombocytopenia (platelet count <1.0x10(3)/uL) 2 months prior to presentation. These bleeding episodes and the thrombocytopenia always occurred 1 week after initiating HD with heparin, and improved within 1 week of discontinuing heparin. HIT was confirmed by ELISA for anti-heparin/platelet factor 4 antibody. HD was conducted successfully and thrombocytopenia did not occur after switching argatroban for heparin. This case report suggests that clinicians must consider HIT in the differential diagnosis of thrombocytopenia during maintenance HD.

Bone Marrow Expression and Plasma Concentration of Basic Fibroblast Growth Factor in Patient with Idiopathic Thrombocytopenic Purpura / 대한진단검사의학회지

BACKGROUND: Basic Fibroblast Growth Factor (bFGF) is known to be closely related to myelofibrosis and hematopoiesis including magakaryopoiesis. The main bone marrow finding in patients with idiopathic thrombocytopenic purpura (ITP) is an increased megakaryopoiesis without myelofibrosis. Purposes of this study are to evaluate the changes in bFGF expression pattern in the bone marrow of patients with ITP and to correlate them with the plasma concentrations of bFGF. METHODS: Paraffin-sections of bone marrow biopsies from 17 cases ITP and 7 cases normal controls, without pathological alterations, were investigated by immunohistochemistry for bFGF and CD68. The plasma levels of bFGF were evaluated by enzyme immunoassay in 7 cases of ITP and controls. RESULTS: The bFGF was strongly expressed in stromal cells and weakly in megakaryocytes in normal controls. The density of the bFGF-expressing stromal cells was decreased in 70% (12/17) of the patients with ITP, compared with none in the other controls. The number of stromal cells in patients with ITP was similar to those in the control groups. The bFGF plasma levels were significantly lower in almost all the ITP patients compared to the control group. CONCLUSIONS: The results indicate that concentrations of bFGF in plasma and bone marrow stromal cells of ITP were decreased. Although the mechanism of low cellular and plasma concentrations of bFGF needs to be elucidated, these findings may complement the serologic and morphological diagnosis of ITP.