Blue Toe Syndrome Accompanied With Heparin-induced Thromboscutopenia:a Case Report

Objective:To improve understanding of low molecular weight heparin induced thrombocytopenia, and promote early diagnosis and treatment of heparin-induced thrombocytopenia (HIT).Methods:Report a case of low molecular weight heparin induced thrombocytopenia accompanied with blue toe syndrome (BTS) and deliver a literature review.Results:By blood cytology, serology, enzyme-linked immunosorbent assay (ELISA) and ultrasonography imaging techniques, we ruled out the diagnos of venous and arterial thromboembolis, and HIT with microcirculatory thromboembolis was clear, which manifestation was BTS. We maintained double antiplatelet therapy treatment of aspirin and clopidogrel. To improve of the micro-circulation of digits, Alprostadil was given. The sysptoms showned dramatic improvement in the patient after treatment.Conclusion:HIT has a higher mortality rate, especially combined with heparin-induced thrombocytopenia and thrombosis syndrome (HITTS). Therefore, early recognition and diagnosis and timely treatment for HIT is very important. When the patients after anticoagulant therapies occured an absolute drop in platelet count below the normal range or a relative decrease of50%from baseline counts, we should highly suspected HIT. The platelet count of the patient in the case decrease71.7%, compared with before anticoagulant therapies, and the diagnosis of HIT is makesured by4T scoring system and detection of PF4/H antibodies. The patient appeared blue, purple, and pain at the area of her serveral toes. The changes of the patient’s toes were consistented with the clinical manifestation of BTS, which was caused by HIT complicating with microcirculatory. Asprin, Clopidogrel and alprostadil are a safe and effective strategy for the treatment of HIT complicating with BTS.