Profound thrombocytopenia and transient leucoerythroblastosis following hip fracture surgery
- 1Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- 2Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, Ontario, Canada
- 3Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
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.
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BibTeX
@article{eshaghpour2026profound,
title = {{Profound thrombocytopenia and transient leucoerythroblastosis following hip fracture surgery}},
author = {Ali Eshaghpour and Conor Bell and Ishac Nazy and Theodore Earl Warkentin},
journal = {BMJ Case Reports},
year = {2026},
month = oct,
doi = {10.1136/bcr-2026-275907},
url = {https://doi.org/10.1136/bcr-2026-275907},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Profound thrombocytopenia and transient leucoerythroblastosis following hip fracture surgery
AU - Ali Eshaghpour
AU - Conor Bell
AU - Ishac Nazy
AU - Theodore Earl Warkentin
PY - 2026
DA - 2026/10/23
JO - BMJ Case Reports
DO - 10.1136/bcr-2026-275907
UR - https://doi.org/10.1136/bcr-2026-275907
AB - 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.
SN - 1757-790X
ER -