SEVERE SKIN NECROSIS ASSOCIATED WITH HEPARIN IN HEMODIALYSIS

Skin necrosis is a well-recognized although rare complication of conti nuous heparin therapy. We report the case of a 66-year-old diabetic wo man with end-stage renal failure who received intermittent intravenous heparin during hemodialysis. She developed severe necrotic cutaneous ulcers over both legs, with typical histological findings. Thrombocyto penia never occurred but platelet studies demonstrated enhanced aggreg ation when heparin was added in vitro. Platelet-aggregating immunoglob ulins produced in response to heparin can lead to thrombotic events. T hrombocytopenia usually develops prior to the onset of cutaneous lesio ns, but as in this case, may be absent. Heparin should be discontinued when the condition is recognized. Unfortunately, a poor outcome is fr equently observed.