# Acute Intracerebral Hemorrhage Associated with Extensive Venous Thrombosis Due to Spontaneous Heparin-Induced Thrombocytopenia After Total Knee Replacement: A Case Report

## TL;DR

A rare case of spontaneous heparin-induced thrombocytopenia (S-HIT) led to severe blood clotting and bleeding in the brain after knee surgery.

## Contribution

This case report highlights S-HIT as a rare but critical differential diagnosis in unexplained thrombocytopenia and thrombosis.

## Key findings

- S-HIT was diagnosed in a patient with cerebral hemorrhage and venous thrombosis after knee replacement.
- The case emphasizes the importance of considering S-HIT in patients with unexplained thrombocytopenia and thrombosis.
- Management focused on avoiding heparin, similar to standard HIT protocols.

## Abstract

Introduction: Heparin-induced thrombocytopenia (HIT) is an autoimmune life-threatening prothrombotic syndrome associated with low platelet count after heparin exposure. Spontaneous heparin-induced thrombocytopenia (S-HIT) is an even less frequent variant of HIT, with only a handful of reports available in the literature, where unexplained thrombocytopenia and/or thrombosis without recent heparin exposure occurs in the setting of positive anti-PF4 antibodies. Case Presentation: We report a case of S-HIT associated with pulmonary artery embolism, left internal jugular vein, and cerebral vein sinus thrombosis complicated with ipsilateral acute intracerebral hemorrhage. Discussion: It is important to highlight that in patients with otherwise unexplained thrombocytopenia and prior exposure to an inflammatory process, S-HIT should be on the differential. Conclusions: Recognition and avoidance of heparin exposure is the most important aspect of S-HIT, as the management is otherwise similar to HIT.