Heparin-induced thrombocytopenia complicated by bilateral adrenal haemorrhage: A forensic autopsy case report

Summary A 70-year-old woman developed, seven days after a right hip replacement surgery, a sepsis shock due to diverticular sigmoid for physicians. A forensic autopsy was performed because outcome was unfavourable and liability was engaged against physicians. A bilateral adrenal hemorrhage was diagnosed during postmortem examination and histological investigations demonstrated infarction of two adrenal glands. Before death, laboratory findings showed Heparin-induced thrombocytopenia (HIT). The main cause of death was bilateral adrenal hemorrhage due to anticoagulant use complicated by HIT, seven days after orthopedic surgery. Acute adrenal hemorrhage is often overlooked because symptoms are attributed to other conditions, especially to sepsis. Death after adrenal insufficiency is rare and the diagnosis is frequently made at autopsy. The goal of this case report is to submit physiopathological characteristics and aspects of bilateral adrenal hemorrhage. Involvements of them are not completely elucidated, because HIT is not necessary to adrenal infarction. Risk factors are identified as thrombocytopenia, heparin usage and sepsis which exposes the patient to bilateral adrenal hemorrhage. Forensic pathologists had to examine carefully adrenal glands during macroscopic examination and their histological examination could be useful if necessary.