PSEUDOPULMONARY EMBOLISM - ACUTE RESPIRATORY-DISTRESS IN THE SYNDROMEOF HEPARIN-INDUCED THROMBOCYTOPENIA

A 73-year-old man with myasthenia gravis was treated with daily plasma pheresis. During the course of treatment, the patient developed progre ssive thrombocytopenia and an episode of severe acute respiratory dist ress suggesting pulmonary embolism, The thrombocytopenia and respirato ry impairment improved after discontinuation of heparin, and both recu rred on heparin rechallenge, The presence of heparin-specific antibodi es was confirmed by in vitro assay, The time frame of clinical events suggests a heparin-mediated mechanism for both the thrombocytopenia an d respiratory compromise. We conclude that acute respiratory distress may be the presenting manifestation of the syndrome of heparin-associa ted thrombocytopenia in patients treated with dialysis or apheresis. ( C) 1997 by the National Kidney Foundation, Inc.