[A case of thrombocytopenia due to heparin therapy for a progressing ischemic stroke]

A 44-year-old man was admitted, complaining of weakness of his left limbs. On admission, he was oriented and cooperative. He showed positive Barré sign only on the left leg. Deep tendon reflexes were unremarkable; pathological reflexes were negative. There was no cerebellar ataxia or sensory deficit. Immediately after admission, monoplegia of the left leg progressed. He was started on heparin infusion therapy. His paralysis had been resolved by the 5th day. MRI of the brain demonstrated an infarction involving the body of the corpus callosum, the right cingulate gyrus, and the right paracentral lobule. Neuropsychologic examination demonstrated a disturbance of interhemispheric transfer of position. On the 10th day he developed Klebsiella ozaenae bacteremia. On the 11th day, platelet count was 9.2 x 10(4)/microliter. Antithrombin III, thrombin antithrombin III complex, D-dimer, and FDP levels were unremarkable, which is quite atypical for DIC associated with bacterial infection. Platelet factor 4 and beta-thromboglobulin levels were remarkably high, suggesting activated platelet aggregation. We made a diagnosis of heparin-induced thrombocytopenia and discontinued heparin infusion. Three days later, platelet count began to increase and creatinine levels returned normal. All patients receiving heparin should be monitored for platelet count.