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CC BY 4.0 · TH Open 2018; 02(03): e261-e264
DOI: 10.1055/s-0038-1669456
Case Report
Georg Thieme Verlag KG Stuttgart · New York

Mesenteric Vein Thrombosis Following Platelet Transfusion in a Patient with Hemorrhagic Fever with Renal Syndrome: A Case Report

Anne-Marie Connolly-Andersen
1   Department of Clinical Microbiology, Infectious Diseases, Umeå University, Umeå, Sweden
,
Johan Rasmuson
1   Department of Clinical Microbiology, Infectious Diseases, Umeå University, Umeå, Sweden
,
Mikael Öman
2   Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden
,
Clas Ahlm
1   Department of Clinical Microbiology, Infectious Diseases, Umeå University, Umeå, Sweden
› Author Affiliations Funding This work was supported by The Swedish Society of Medicine (SLS-690711); Scandinavian Research Foundation for Varicose Veins and other Venous Diseases; Swedish Heart-Lung Foundation (20170334); The County Council of Västerbotten (VLL-579011; VLL-578991); The Medical Faculty, Umeå University (FS 2.1.12–1605–14); and the Swedish Foundation for Strategic Research (SB12–0003).
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Publication History

22 November 2017

23 July 2018

Publication Date:
27 August 2018 (online)

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Introduction

Viral hemorrhagic fevers (VHFs) are typically characterized by life-threatening thrombocytopenia and tendency to bleed. Still, there are gaps of knowledge regarding risks and benefits of platelet transfusion for patients with severe thrombocytopenia during VHF and other infectious diseases.[1] [2] [3] [4] Hemorrhagic fever with renal syndrome (HFRS) is a mild rodent-borne VHF, caused by Puumala virus, endemic in central and northern Europe. The infection is characterized by fever, nausea, back- and headache, thrombocytopenia, and transient renal impairment. We have shown that HFRS is a risk factor for both arterial and venous thrombosis.[5] [6] We here report a case of a patient with HFRS with prolonged thrombocytopenia who developed thrombosis shortly after receiving platelet transfusion.

 

  • References

  • 1 Thachil J, Warkentin TE. How do we approach thrombocytopenia in critically ill patients?. Br J Haematol 2017; 177 (01) 27-38
    CrossrefPubMedGoogle Scholar
  • 2 Wada H, Thachil J, Di Nisio M. , et al; The Scientific Standardization Committee on DIC of the International Society on Thrombosis Haemostasis. Guidance for diagnosis and treatment of DIC from harmonization of the recommendations from three guidelines. J Thromb Haemost 2013; 11: 761-767
    CrossrefPubMedGoogle Scholar
  • 3 Lee TH, Wong JG, Leo YS. , et al. Potential harm of prophylactic platelet transfusion in adult dengue patients. PLoS Negl Trop Dis 2016; 10 (03) e0004576
    CrossrefPubMedGoogle Scholar
  • 4 Lye DC, Archuleta S, Syed-Omar SF. , et al. Prophylactic platelet transfusion plus supportive care versus supportive care alone in adults with dengue and thrombocytopenia: a multicentre, open-label, randomised, superiority trial. Lancet 2017; 389 (10079): 1611-1618
    CrossrefPubMedGoogle Scholar
  • 5 Connolly-Andersen AM, Hammargren E, Whitaker H. , et al. Increased risk of acute myocardial infarction and stroke during hemorrhagic fever with renal syndrome: a self-controlled case series study. Circulation 2014; 129 (12) 1295-1302
    CrossrefPubMedGoogle Scholar
  • 6 Connolly-Andersen AM, Whitaker H, Klingström J, Ahlm C. Risk of venous thromboembolism following hemorrhagic fever with renal syndrome: a self-controlled case series study. Clin Infect Dis 2018; 66 (02) 268-273
    CrossrefPubMedGoogle Scholar
  • 7 Taylor Jr FB, Toh CH, Hoots WK, Wada H, Levi M. ; Scientific Subcommittee on Disseminated Intravascular Coagulation (DIC) of the International Society on Thrombosis and Haemostasis (ISTH). Towards definition, clinical and laboratory criteria, and a scoring system for disseminated intravascular coagulation. Thromb Haemost 2001; 86 (05) 1327-1330
    Article in Thieme ConnectPubMedGoogle Scholar
  • 8 Sundberg E, Hultdin J, Nilsson S, Ahlm C. Evidence of disseminated intravascular coagulation in a hemorrhagic fever with renal syndrome-scoring models and severe illness. PLoS One 2011; 6 (06) e21134
    CrossrefPubMedGoogle Scholar
  • 9 Pettersson L, Thunberg T, Rocklöv J, Klingström J, Evander M, Ahlm C. Viral load and humoral immune response in association with disease severity in Puumala hantavirus-infected patients—implications for treatment. Clin Microbiol Infect 2014; 20 (03) 235-241
    CrossrefPubMedGoogle Scholar
  • 10 Connolly-Andersen AM, Sundberg E, Ahlm C. , et al. Increased thrombopoiesis and platelet activation in hantavirus-infected patients. J Infect Dis 2015; 212 (07) 1061-1069
    CrossrefPubMedGoogle Scholar
  • 11 Laine O, Mäkelä S, Mustonen J. , et al. Enhanced thrombin formation and fibrinolysis during acute Puumala hantavirus infection. Thromb Res 2010; 126 (02) 154-158
    CrossrefPubMedGoogle Scholar
  • 12 Rasmuson J, Andersson C, Norrman E, Haney M, Evander M, Ahlm C. Time to revise the paradigm of hantavirus syndromes? Hantavirus pulmonary syndrome caused by European hantavirus. Eur J Clin Microbiol Infect Dis 2011; 30 (05) 685-690
    CrossrefPubMedGoogle Scholar
  • 13 Smeeth L, Thomas SL, Hall AJ, Hubbard R, Farrington P, Vallance P. Risk of myocardial infarction and stroke after acute infection or vaccination. N Engl J Med 2004; 351 (25) 2611-2618
    CrossrefPubMedGoogle Scholar
  • 14 Smeeth L, Cook C, Thomas S, Hall AJ, Hubbard R, Vallance P. Risk of deep vein thrombosis and pulmonary embolism after acute infection in a community setting. Lancet 2006; 367 (9516): 1075-1079
    CrossrefPubMedGoogle Scholar
  • 15 Laine O, Joutsi-Korhonen L, Lassila R. , et al. Elevated thrombopoietin and platelet indices confirm active thrombopoiesis but fail to predict clinical severity of Puumala hantavirus infection. Medicine (Baltimore) 2016; 95 (52) e5689
    CrossrefPubMedGoogle Scholar
  • 16 Connolly-Andersen AM, Thunberg T, Ahlm C. Endothelial activation and repair during hantavirus infection: association with disease outcome. Open Forum Infect Dis 2014; 1 (01) ofu027
    PubMedGoogle Scholar
  • 17 Goeijenbier M, Meijers JC, Anfasa F. , et al. Effect of Puumala hantavirus infection on human umbilical vein endothelial cell hemostatic function: platelet interactions, increased tissue factor expression and fibrinolysis regulator release. Front Microbiol 2015; 6: 220
    PubMedGoogle Scholar
  • 18 Khorana AA, Francis CW, Blumberg N, Culakova E, Refaai MA, Lyman GH. Blood transfusions, thrombosis, and mortality in hospitalized patients with cancer. Arch Intern Med 2008; 168 (21) 2377-2381
    CrossrefPubMedGoogle Scholar
  • 19 Cook D, Crowther M, Meade M. , et al. Deep venous thrombosis in medical-surgical critically ill patients: prevalence, incidence, and risk factors. Crit Care Med 2005; 33 (07) 1565-1571
    CrossrefPubMedGoogle Scholar
  • 20 Goel R, Ness PM, Takemoto CM, Krishnamurti L, King KE, Tobian AA. Platelet transfusions in platelet consumptive disorders are associated with arterial thrombosis and in-hospital mortality. Blood 2015; 125 (09) 1470-1476
    CrossrefPubMedGoogle Scholar