HEPARIN-INDUCED PLATELET-AGGREGATION SYND ROME WITH SKIN NECROSES IN A PATIENT ON CHRONIC-HEMODIALYSIS

History and clinical findings: A 52-year-old man had been in terminal renal failure for 6 years. On haemodialysis under heparin without comp lications, acral skin necroses occurred. Even with low-molecular hepar in anticoagulation further lesions developed. Within 12 weeks of haemo dialysis being performed without heparin the necroses healed, but they recurred when heparin was again added for dialysis. On admission the patient was in poor general condition, with a weight of 55 kg (height 175 cm). Laboratory investigations: The heparin-induced platelet aggre gation (HIPA) test was positive in the absence of thrombocytopenia. Na -heparin reacted positively in three out of four tests, but Danaparoid did not react. Treatment and course: The skin necroses once again hea led after the heparinoid Danaparoid, which had not reacted in the HIPA test, had been substituted for heparin. Conclusion: This case illustr ates that skin necroses, thrombocytopenia and thromboembolism can be i ndependent signs of immunologically induced platelet aggregation.