Plasmapheresis May Be an Option in Urgent Management of Heparin-Induced Thrombocytopenia in the Setting of Acute Intracerebral Hemorrhage

We report a case of heparin-induced thrombocytopenia (HIT) that was complicated by acute intracerebral hemorrhage (ICH) and bilateral adrenal hemorrhage. In the setting of worsening thrombocytopenia, the risk of expansion of ICH and additional thrombotic events is concerning; hence, we employed plasmapheresis to reduce thrombotic risk. We followed serial daily heparin antibody enzyme-linked immunosorbent assay (ELISA) optical density measurements as well as heparin-induced platelet aggregation (HIPA) assays on both pre- and post-pheresis samples in order to objectively determine when thrombotic risk was sufficiently decreased. After four cycles of plasmapheresis, both heparin antibody ELISA and HIPA assays became negative. This case helps illustrate the utility of plasmapheresis in management of HIT when anticoagulation is contraindicated.