• Brandon Z Lei, Joseph J Shatzel, and Merav Sendowski.
• Division of Hematology and Medical Oncology, Oregon Health and Science University, Knight Cancer Institute, Portland, Oregon.
• Transfusion. 2017 Apr 1; 57 (4): 919-923.

BackgroundHeparin-induced thrombocytopenia (HIT) results in platelet consumption and a virulent thrombotic state, which generally responds to cessation of heparin and initiation of anticoagulation. Rarely, delayed HIT can occur and/or persist after heparin is discontinued.Study Design And MethodsA 47-year-old male developed delayed HIT with severe thrombocytopenia and thrombosis after cardiac surgery. Thrombocytopenia developed and persisted after heparin cessation and did not improve despite sequential use of argatroban followed by bivalirudin. Treatment with intravenous immunoglobulin (IVIg) was well tolerated and resulted in rapid resolution of thrombocytopenia.ResultsThere are few case reports on the management of delayed HIT with severe and prolonged thrombocytopenia. The risk for thrombosis and bleeding in the setting of an undefined time course increases uncertainty in management.ConclusionThis case, along with others accumulating in the literature, suggest that IVIg may be effective in treating delayed HIT with persistent thrombocytopenia.© 2016 AABB.

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