CHSU Discovery

Abstract:

Myelodysplastic syndrome (MDS) represents neoplasms characterized by myelopoiesis with altered differentiation. Patients with MDS often present with cytopenias including anemia and thrombocytopenia. Here, we present a case of MDS in the setting of multivessel artery disease who developed left upper extremity (LUE) deep venous thrombosis (DVT) and subsequent compartment syndrome while on IV heparin and negative heparin-induced thrombocytopenia (HIT) antibodies. Patient is an 80-year-old male with a history of MDS, coronary artery disease s/p quadruple bypass surgery and stent placement, and HFmrEF (EF 45%) who presented with concerns of chest pain scaled 10/10. Found to have uptrending troponin 1.17 ng/mL. Angiogram was planned, however the course was complicated by hemoglobin of 7.4 g/dL and platelets of 32 thou/mm3. While undergoing IV heparin and pRBC transfusion, the patient developed DVT in the left brachial vein causing the arm to become firm with weakening pulses and signs of bullous eruption. Compartment syndrome was clinically diagnosed. Hematology/Oncology consulted, heparin switched to argatroban and eventually Eliquis despite negative HIT workup, symptoms subsequently improved. No signs of active bleeding on EGD, catheterization revealed severe multivessel disease, total occlusion of RCA and native left main coronary artery distal vessel, and all grafts patent. Patient received a total of 9 units pRBC during course yet hemoglobin remained mostly between 7-8 g/dL despite no evidence of active GI bleeding or hemolysis. The occurrence of DVT in the upper extremity and the subsequent development of compartment syndrome in the setting of IV heparin is also unusual. This case highlights the importance of recognizing clinical and laboratory changes while on IV heparin, particularly in those with history of MDS coupled with multivessel artery disease, and the urgency to switch to alternate anticoagulants despite negative HIT panels.