Abstract：
BACKGROUND Heparin-induced thrombocytopenia (HIT) is a disease in which the immune response elicited by heparin results in a state of hypercoagulability and platelet activation, leading to thrombocytopenia and thromboembolism. Gustilo-Anderson type IIIC open fractures of the extremities are defined as open fractures presenting with arterial injuries that require repair and result in treatment challenges and complications. The diagnosis of HIT can be difficult in patients with severe trauma with consumptive thrombocytopenia associated with heavy bleeding and the use of heparin after vascular anastomosis. CASE REPORT A 48-year-old man was injured in a car accident, pinching his right lower leg and sustaining a Gustilo-Anderson type IIIc open fracture, for which he underwent emergency revascularization surgery. Heparin was administered continuously immediately after the surgery. On postoperative day 9, ischemic changes were observed in the right foot, and we performed suture re-anastomosis; however, the blood circulation in the right lower leg did not resume, and right lower leg amputation was performed due to ischemic necrosis with the onset of HIT. Postoperatively, the patient was switched to edoxaban after the recovery of his platelet count. Thereafter, the patient experienced no new thrombus occlusion or wound trouble, and was able to walk on a prosthetic leg and return to daily life. CONCLUSIONS It is important to consider the possibility of HIT as soon as thrombocytopenia appears in patients with Gustilo-Anderson type IIIC open fracture who are receiving heparin after vascular anastomosis, as a delayed diagnosis of HIT can make it difficult to save the limb.
摘要：
背景技术肝素诱导的血小板减少症(HIT)是一种由肝素引起的免疫应答导致高凝状态和血小板活化的疾病。导致血小板减少症和血栓栓塞.Gustilo-AndersonIIIC型四肢开放性骨折被定义为表现为动脉损伤的开放性骨折，需要修复并导致治疗挑战和并发症。对于患有严重创伤并伴有大量出血和血管吻合后使用肝素的消耗性血小板减少症的患者，HIT的诊断可能很困难。个案报告一名四十八岁男子在一场车祸中受伤,捏他的右小腿并维持着Gustilo-AndersonIIIc型开放性骨折，为此，他接受了紧急血运重建手术。手术后立即连续给予肝素。术后第9天，观察到右脚缺血改变，我们进行了缝合再吻合；然而，右小腿的血液循环没有恢复，右小腿截肢是由于HIT发作后缺血性坏死而进行的。术后,患者在血小板计数恢复后改用edoxaban.此后,患者没有出现新的血栓闭塞或伤口问题，能够用假肢走路，回到日常生活中。结论血管吻合术后接受肝素治疗的Gustilo-AndersonIIIC型开放性骨折患者一旦出现血小板减少，就应考虑HIT的可能性。因为HIT的延迟诊断可能使挽救肢体变得困难。
