Heparin-induced thrombocytopenia presenting as splenic hemorrhage following cardiac surgery: a case report.

BACKGROUND: Heparin-induced thrombocytopenia with thrombosis (HITT) is a paradoxical prothrombotic complication of anticoagulant therapy. As many as 3% of patients undergoing cardiac surgery develop clinical HIT presenting as thrombocytopenia with or without thrombosis within 5-10 days of heparin exposure. Thrombotic complications associated with HIT carry a mortality rate of 5-10%. CASE PRESENTATION: We report a case of atraumatic splenic hemorrhage due to splenic vein thrombosis as the main indicator of HIT following cardiac surgery in a 62-year-old woman. She presented to the emergency department on day nine following coronary artery bypass graft surgery with acute weakness, dizziness, and malaise. Her evaluation in the emergency department found anemia and thrombocytopenia. A coagulation profile revealed a markedly elevated d-dimer. She underwent a computed tomography scan of the chest, abdomen and pelvis for suspected bleed and was found to have splenic vein thrombosis, right atrial filling defects consistent with atrial thrombus and mild to moderate hemoperitoneum. Surgical consultation was obtained due to splenic hemorrhage. Hematology was consulted on post-operative day 10, however, she unfortunately developed left sided weakness concerning for stroke. A magnetic resonance imaging scan of the brain demonstrated infarct involving distribution of the right anterior cerebral artery. A transesophageal echocardiogram demonstrated a large immobile thrombus within the right atrium with a second, mobile thrombus arising from the left tricuspid valve annulus. Due to a 4Ts score of 7 and markedly positive platelet factor 4 (PF4) IgG antibody a serotonin release assay was not performed given the high probability of HIT. She was cautiously treated with bivalirudin and was transitioned to warfarin anticoagulation. In the following days her platelet count recovered and 3 months later a transthoracic echocardiogram revealed solution of the intracardiac thrombi. CONCLUSIONS: Atraumatic splenic hemorrhage is an unusual presentation of HIT that is reminiscent of the rare bilateral adrenal hemorrhage due to adrenal necrosis that also occurs in HIT. Alternative anticoagulation is the mainstay of therapy for HIT despite hemorrhage, given the underlying acquired hypercoagulability. Despite similarities of the presentation between splenic hemorrhage and bilateral adrenal hemorrhage, splenic hemorrhage is rarely described in the literature. HIT should be considered in patients presenting with thrombocytopenia following cardiac surgery

PLACENTAL TRANSFER OF SULFAMETHAZINE IN MICE AND RATS

Abstract SimunekJ., A. B. Siddique, E. Hegerova: Placental Transfer of Suljamethazine in Mice and Rats. Acta Vet. Brno, 47,1978: 145-151. Placental transfer of sulfamethazine in mice was investigated in the second half of their pregnancy. The transfer was not free but only a part of the drug administered to mothers was found to pass from the maternal circulation to the fetus. Placental transfer of sulfamethazine in rats was investigated at two stages of gestation -early (8th to 10th day) and late (18th to 20th day of gestation). Ther~ was free and rapid passage of the drug from the maternal circulation to the fetus at the early stage of gestation. But the passage was found to be greatly reduced at the late stage of gestation. The drug also appeared in the amniotic fluid. Mice, rat, placenta, fetus, transfer, suljamethazine~· The placenta in unique is its function. Its life time is short relative to the fetus, and its size and function change continually during the course of gestation Sulfonamides have been reported to easily pass through both human and animal placenta (Lee, The present paper reports on the placental transfer of sulfamethazine in mice in their second half of pregnancy and in rats at two stages of pregnancy. Materials and Methods White mice and Wistar rats were obtained from the Biological Research Center, Konarovice near Prague. Sulfamethazine used was a product of Czechoslovak national pharmaceutical enterprise, Spofa. Procedure for mice 13 mice which were 15 to 18 days pregnant were divided into two groups and injected intramuscularly a freshly prepared 2 % solution of sodium-sulfamethazine at the dose of 0.2 g/kg body mass. One group of mice was killed after 2 hours and the other group after 24 hours of drug administration. Samples of blood, placenta and fetus of each group of mice were collected and their sulfamethazine concentrations measured. In all there were 70 fetal samples. Simultaneous control experiment with 5 nonpregnant adult female mice was carried out. Procedure for rats Two independent experiments were done. In both cases, transfer was studied at two stages of gestation