Gaines M, Grant M, Robinson S, Stevenson H. Upper Limb Phlegmasia Cerulea Dolens Secondary to Heparin-induced Thrombocytopenia: A Case Study.
J Orthop Case Rep 2018;
7:55-58. [PMID:
29600212 PMCID:
PMC5868885 DOI:
10.13107/jocr.2250-0685.948]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction:
Phlegmasia cerulea dolens (PCD) is a rare pathology with a very high morbidity and mortality rate, which usually occurs in the lower limb. There is very little literature available to aid management.
Case Report:
We present a case of upper limb PCD in a 67-year-old female secondary to heparin-induced thrombocytopenia caused by warfarin bridging. She presented to the orthopedic team with upper limb compartment syndrome from a bleed around a peripherally inserted central catheter, for which she was urgently taken to the theater for fasciotomies. Postoperatively, the patient’s platelets dropped and the upper limb pain and swelling continued; after conservative management and anticoagulation failed the patient had an upper limb amputation of her right arm.
Conclusion:
With limited guidelines and management options restricted by the large fasciotomy wounds, we believe amputation was the patients’ best option.
Collapse