Profound thrombocytopenia and transient leucoerythroblastosis following hip fracture surgery
Year: 2026
Type: article
Study design: Case Report
Abstract: An elderly man underwent hip fracture surgery with pre-/postoperative heparin anticoagulation; the platelet count fell to 5×109/L (nadir); haematopathology blood film review identified leucoerythroblastosis (circulating normoblasts, leucocyte left-shift) and schistocytosis (red cell fragments). Although screening platelet factor 4 (PF4)/heparin enzyme-immunoassay for heparin-induced thrombocytopenia (HIT) antibodies yielded a strong-positive result, the confirmatory serotonin-release assay gave an atypical profile (strong serum-induced serotonin-release but only partial inhibition by platelet Fc receptor-blocking monoclonal antibody). Bilateral lower-limb deep-vein thrombosis prompted treatment with therapeutic-dose fondaparinux and high-dose intravenous immunoglobulin (IVIG) for presumptive ‘autoimmune HIT’ (aHIT), that is, HIT featuring both heparin-dependent and heparin-independent platelet-activating anti-PF4/heparin antibodies. Persistent thrombocytopenia, recurrent fibrinogen decrease and d-dimer increase indicated refractoriness to IVIG, with pulmonary embolism also identified; ultimately, additional IVIG was followed by complete recovery. Further laboratory evaluation confirmed a diagnosis of severe aHIT. A novel finding was the transient appearance of leucoerythroblastosis, compatible with overt disseminated intravascular complicating severe aHIT.
Source: BMJ Case Reports
Institution: McMaster University
Language: English
Subfield: Hematology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W7223262095