Circulating heparin‐like anticoagulants: Case report and review of literature

We report a case of a 56‐year‐old woman with a history of idiopathic thrombocytopenic purpura (ITP) following splenectomy on mycophenolate mofetil (MMF), who developed moderate bleeding after stopping MMF. Her laboratory testing suggested the presence of an abnormal circulating heparin‐like anticoag...

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Bibliographic Details
Published in:Transfusion (Philadelphia, Pa.) Pa.), 2021-03, Vol.61 (3), p.968-973
Main Authors: Hou, Chenchen, Moffat, Karen A., Gangji, Azim S., Ning, Shuoyan
Format: Article
Language:English
Subjects:
activated partial thromboplastin time
Anticoagulants
Antifibrinolytic agents
Bleeding
Case reports
Coagulation
coagulopathy
Hemorrhage
Heparin
heparin‐like anticoagulants
Idiopathic thrombocytopenic purpura
immunosuppression
Intravenous administration
Laboratory tests
Literature reviews
Malignancy
Mycophenolate mofetil
Mycophenolic acid
Splenectomy
Thrombocytopenic purpura
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Summary:We report a case of a 56‐year‐old woman with a history of idiopathic thrombocytopenic purpura (ITP) following splenectomy on mycophenolate mofetil (MMF), who developed moderate bleeding after stopping MMF. Her laboratory testing suggested the presence of an abnormal circulating heparin‐like anticoagulant with demonstrable anti‐Xa activity. She was initially treated with antifibrinolytic therapy and was subsequently started on MMF alongside intravenous immunoglobulin, which significantly improved her bleeding symptoms. The presence of abnormal circulating heparin‐like anticoagulants is a rare cause of coagulopathy. Few cases exist in the literature, with nearly all occurring in the setting of hematologic or solid‐organ malignancy. The mechanism by which these endogenous anticoagulants develop is unclear. Clinical manifestations range from mild bleeding and bruising to life‐threatening hemorrhage refractory to conventional therapy. Diagnosis of a heparin‐like anticoagulant is based on coagulation testing as well as exclusion of other exogenous anticoagulants, acquired inhibitors, and/or factor deficiencies.
ISSN:0041-1132
1537-2995
DOI:10.1111/trf.16236