A Rare Case of Enoxaparin Induced Reversible Pancytopenia in a Patient of Decompensated Cryptogenic CLD with Portal Hypertension with Portal Vein Thrombosis Due to Protein S Deficiency

Subcutaneous Low molecular weight heparin (LMWH) enoxaparin, given at therapeutic dose of 1mg/kg twice daily, is as effective and safe as intravenous unfractionated heparin for treating acute venous thromboembolic disease. Heparin may cause drug induced immune thrombocytopenia which is caused by IgG anti- platelet factor-4 antibody and heparin immune complexes, resulting in platelet activation, clumping, and thrombotic events. It occurs <1% of patients in intensive care units but can occur in any patient on long-term heparin therapy. But heparin induced pancytopenia is a very rare event in clinical practice, here we present a case of 23 years old lady who presented to us with progressive abdominal distension and abdominal pain with the history of recent intrauterine death (IUD). Later she was diagnosed as a case of portal vein thrombosis due to protein S deficiency with decompensated chronic liver disease (CLD) with portal hypertension. She started treatment with therapeutic doses of subcutaneous enoxaparin. Eventually she developed pancytopenia. Upon discontinuation of enoxaparin and after ruling out other causes of pancytopenia, her pancytopenia reversed completely.

Keywords:Enoxaparin; Pancytopenia; Portal vein thrombosis; Chronic liver disease