Aslam, Jonaid, MD

Brewster, Nathan, DO

Godil, Kareem, MD

Holahan, Brian J, DO

English

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health Network LVHN Scholarly Works Department of Medicine Concurrent Catastrophic Antiphospholipid Syndrome and Heparin-Induced Thrombocytopenia Brian J. Holahan DO Lehigh Valley Health Network, Brian.Holahan@lvhn.org Kareem Godil MD Lehigh Valley Health Network, Kareem.Godil@lvhn.org Nathan Brewster DO Lehigh Valley Health Network, Nathan.Brewster@lvhn.org Jonaid Aslam MD Lehigh Valley Health Network, Jonaid.Aslam@lvhn.org Follow this and additional works at: https://scholarlyworks.lvhn.org/medicine  Part of the Internal Medicine Commons Published In/Presented At Holahan, B.J. Godil, K. Brewster, N. Aslam, J. (2019, October 19-23). Concurrent Catastrophic Antiphospholipid Syndrome and Heparin-Induced Thrombocytopenia. Poster Presented at: Chest Annual Meeting, New Orleans, LA. This Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by an authorized administrator. For more information, please contact LibraryServices@lvhn.org. © 2019 Lehigh Valley Health NetworkLVHN.orgConclusion•  It is unclear whether APS may predispose a patient to HIT. The concurrence of both disease processes is possible and should  be considered in patients with either diagnosis who are not improving with treatment.•  The presence of severe thrombocytopenia in CAPS is  not common and should raise  the suspicion for HIT.Concurrent Catastrophic Antiphospholipid Syndrome and  Heparin-Induced ThrombocytopeniaBrian J. Holahan, DO, Kareem Godil, MD, Nathan Brewster, DO, Jonaid Aslam, MDLehigh Valley Health Network, Allentown, Pa.Discussion•  CAPS and HIT are rare thrombotic disorders with high risk for morbidity and mortality.•		It	is	estimated	that	CAPS	affects	1%	of	patients diagnosed with APS1 and HIT occurs	in	5%	of	patients	exposed	to	heparin.2•		The	mortality	rate	is	estimated	to	be	37%	for CAPS1	and	30%	for	HIT.2•  Both disease processes are driven by autoantibodies and it is possible that this pathogenic similarity may create a rare overlapping presentation.References1 Espinosa G, Rodriguez-Pinto I, Cervera R. Catastrophic antiphospholipid syndrome: an update. Panminerva Med. 2017 Sep; 59(3):254-268.2 Nicolas D, Reed M. Heparin Induced Thrombocytopenia (HIT) [Updated 2018 Oct 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2018 Jan-. Available from:  https://www.ncbi.nlm.nih.gov/books/NBK482330/3 Adediran S and Agostino N. Coexistence of Antiphospholipid Syndrome and Heparin-Induced Thrombocytopenia in a Patient with recurrent venous thromboembolism. Case Reports in Hematology. 2017.Adrenal HemorrhagePlatelet trendCase Presentation•  64-year-old female with history of APS on coumadin and remote ischemic stroke secondary to APS presented with worsening encephalopathy.•  On recent prior hospitalization, coumadin was held because of traumatic SAH and SDH. Coumadin was re-started one week later by neurosurgery after CT showed near resolution.•  Initial workup was negative for new intracranial bleeds, but CT abdomen/pelvis demonstrated bilateral adrenal hemorrhages. Labs showed worsening AKI and elevated transaminases.•		These	findings	indicated	probable	CAPS (3 of 4 criteria) and she was subsequently started on plasma exchange.•  Anticoagulation was initially held in the setting of her adrenal hemorrhages. Heparin drip was later started on day  four of the hospitalization. •  Because of persistent thrombocytopenia and	prior	exposure	to	subcutaneous	heparin, HAPA was sent and resulted positive. SRA was also positive, confirming	HIT.	Heparin	drip	was	switched to argatroban.•  Subsequent brain MRI noted numerous acute to subacute infarctions throughout both the cerebral and cerebellar hemispheres consistent with embolic phenomenon. The etiology of these emboli was not discovered. The patient was placed on comfort measures and died shortly thereafter.050100150200250300350400Platelet Count (High)       Platelet Count       Platelet Count (Low)

Concurrent Catastrophic Antiphospholipid Syndrome and Heparin-Induced Thrombocytopenia

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Concurrent Catastrophic Antiphospholipid Syndrome and Heparin-Induced Thrombocytopenia

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