Thromb Haemost 2013; 109(04): 669-675
DOI: 10.1160/TH12-11-0865
Platelets and Blood Cells
Schattauer GmbH

Adrenal haemorrhage due to heparin-induced thrombocytopenia

Siva Ketha
1   Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
,
Patrick Smithedajkul
2   Division of Hospital Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
,
Adrian Vella
3   Division of Endocrinology and Metabolism, Mayo Clinic, Rochester, Minnesota, USA
,
Rajiv Pruthi
4   Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
,
Waldemar Wysokinski
1   Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
,
Robert McBane
1   Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
4   Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
› Author Affiliations
Further Information

Publication History

Received: 27 November 2012

Accepted after minor revision: 09 January 2013

Publication Date:
22 November 2017 (online)

Summary

Adrenal haemorrhage (AH) is a rare but potentially devastating complication of heparin-induced thrombocytopenia (HIT). Neither the prevalence nor the natural history of AH due to HIT are known. The objectives of this study were to identify the spectrum of AH causes, to characterise the frequency of AH due to HIT and determine the natural history of HIT-associated AH. All patients with incident adrenal haemorrhage from January 2002 through June 2012 seen at the Mayo Clinic were identified. Over this time frame, there were a total of 115 patients with AH of which 11 cases (10%; mean age 67 ± 8 years; 73% female) were associated with HIT. Of these, all but one occurred in the postoperative setting and involved both adrenal glands (89%) with acute adrenal insufficiency at the time of diagnosis. Cases were found incidentally during an evaluation for fever, shock, abdominal pain or mental status changes. All HIT patients experienced venous thrombosis at other locations including deep venous thromboses (n=14), pulmonary emboli (n= 4) and arterial thrombosis (n=2). Four patients undergoing total knee arthroplasty had “spontaneous HIT” with AH in the absence of identifiable heparin exposure. Other causes of AH included trauma (29%), sepsis (15%), antiphospholipid antibody syndrome (10%), and metastatic disease (12%). In conclusion, AH is an important but seldom recognised presumed thrombotic complication of HIT, which usually occurs in the postoperative period, especially after orthopaedic procedures. This syndrome can occur in the apparent absence of heparin exposure, especially following major joint replacement surgery.

 
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