Suspected heparin-induced thrombocytopenia in patients with advanced hepatocellular carcinoma following hepatic arterial infusion chemotherapy

Abstract

A 72-year-old male patient was admitted to our hospital with a low platelet count. A full blood count revealed remarkable thrombocytopenia (0.3 × 104/|xL), but not anemia or leukopenia. He had been diagnosed with hepatocellular carcinoma (HCC) with tumor thrombus of the main trunk of the portal vein (Vp4) and underwent hepatic arterial infusion chemotherapy (HAIC) with low-dose cisplatin and 5-fluorouracil 16 days prior to admission. Bone marrow biopsy examination revealed normocellular bone marrow accompanied by a mild increase in megakaryocyte number, indicating peripheral platelet consumption. Although 4T’s score for the diagnosis of heparin-induced thrombocytopenia (HIT) was low to medium, the finding of a positive HIT antibody led us to suspend heparin administration and initiate argatroban administration (20 mg/day). In addition, the removal of the heparin-coated catheter for HAIC resulted in a gradual increase in platelet count. However, the patient died of HCC progression 39 days after starting the systemic chemotherapy.