Kidney Week

Abstract: TH-PO233

Unusual Presentation of Type II Heparin-Induced Thrombocytopenia Successfully Managed with Predilution Online Hemodiafiltration

Session Information

• Hemodialysis, Hemodiafiltration, and Frequent Dialysis
  October 24, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• Pascoal, Felipe, Centro Brasiliense de Nefrologia Ltda, Brasilia, Distrito Federal, Brazil

Felipe Pascoal, MD

• Simon, Adolfo, Centro Brasiliense de Nefrologia Ltda, Brasilia, Distrito Federal, Brazil

Adolfo Simon, MD

• Pascoal, Istenio, Centro Brasiliense de Nefrologia Ltda, Brasilia, Distrito Federal, Brazil

Istenio Pascoal, MD

• Lauar, Juliane, Centro Brasiliense de Nefrologia Ltda, Brasilia, Distrito Federal, Brazil

Juliane Lauar, MD

• Xavier, Kelia, Centro Brasiliense de Nefrologia Ltda, Brasilia, Distrito Federal, Brazil

Kelia Xavier, MD

• Bello, Vilber, Centro Brasiliense de Nefrologia Ltda, Brasilia, Distrito Federal, Brazil

Vilber Bello, MD

Introduction

Type II heparin-induced thrombocytopenia (HIT) is portrayed by antibody production against PF4/Heparin complex. While it typically presents with thrombocytopenia and thrombosis, allergic features have also been reported. Predilution Online hemodiafiltration (OL-HDF) can dismiss heparin and is safely used when this anticoagulant is contraindicated. Herein, we present a rare case of type II HIT with wheezing, elevated IgE levels and thrombocytopenia in a dialysis patient effectively handled with predilution OL-HDF.

Case Description

An 83-year-old male with unresolved obstructive uropathy was referred to our clinic for dialysis initiation. After four uneventful sessions, he experienced wheezing, 88% oxygen saturation and high filter transmembrane pressures half an hour into the next therapies, despite switch of filter and line brands. Bloodwork revealed 108 k/μL platelets (from 223k/μL), 4Ts score was 6 (high probability) and Anti-PF4/Heparin assay yielded 1.2 U/mL (RR: < 0,6 U/mL), confirming the diagnosis of type II HIT. IgE levels were also elevated at 716 kU/L. Since equipment clotting persisted despite intermitent saline flushes and Apixaban prescription, dialysis therapy was shifted to short daily heparin free predilution OL-HDF. Sessions resumed uneventfully ever since and, six months later, IgE decreased to 296 kU/L, platelets increased to 264k/μL and Anti-PF4/Heparin levels were undetectable, as shown in the graphs attached.

Discussion

Type II HIT may display with thrombocytopenia, hypercoagulability and unusual allergic features in a manifold fashion. As management for this condition relies on heparin cessation and clot-preventing strategies, predilution OL-HDF presents a safe and effective dialysis modality in this group of patients.