Resolution of thrombocytopenia through sodium bicarbonate intervention as an alternative diluent for heparin in an extracorporeal membrane oxygenation patient: a case report

BACKGROUND: Thrombocytopenia is a common and multifaceted complication in patients receiving heparin therapy during extracorporeal membrane oxygenation (ECMO). Its development may result from several mechanisms, such as platelet consumption, hemodilution, shear stress, circuit activation, and heparin-induced thrombocytopenia. Managing thrombocytopenia in this context can be challenging. Therefore, we present a patient who developed thrombocytopenia while receiving a heparin infusion, which resolved after changing the infusion diluent. CASE PRESENTATION: We presented a case of a 64-year-old Pakistani male with multiple cardiac comorbidities who was admitted in a critical condition following cardiac arrest, requiring immediate resuscitation and veno-arterial ECMO initiation for circulatory support. During the ICU course, he developed thrombocytopenia while on heparin infusion diluted in D5W. Despite ruling out heparin-induced thrombocytopenia, his platelet counts continued to decline. As an alternative approach, the heparin diluent was switched to sodium bicarbonate, leading to recovery in platelet levels without the need for transfusion. CONCLUSIONS: This case highlights a possible association between using sodium bicarbonate as a diluent for heparin infusion and platelet recovery. While this finding warrants further investigation, additional studies are necessary to determine its broader clinical implications.

Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.

Peer-reviewed clinical and outcomes research relevant to anticoagulation, leech therapy, and microsurgical flap management. Indexed in PubMed and verified against the NCBI record.

Explore cómo esta investigación se conecta con la práctica clínica

More peer-reviewed studies in Ensayos clínicos.

• Leech Therapy for Knee Osteoarthritis — The Landmark RCT — Michalsen et al. (2003)
• Leech-Assisted Flap Salvage — Systematic Review of 277 Cases — Whitaker et al. (2012)
• Effects of hirudotherapy on liver functions, lipid profile, and insulin sensitivity in rats with metabolic syndrome — Bilden A et al. (2026)
• HIRUDOTHERAPY IN PRESBYACUZIS PRAECOX IN CLEAN-UP WORKERS AFTER THE CHORNOBYL ACCIDENT DURING THE POST-CATASTROPHE YEARS — Zabolotnyi D, Mishchanchuk N (2019)
• Wound healing potential of bark paste of Pongamia pinnata along with hirudotherapy: A case report — Balasooriya D, Karunarathna C, Uluwaduge I (2021)
• AIF-1 and RNASET2 Play Complementary Roles in the Innate Immune Response of Medicinal Leech — Baranzini N et al. (2019)
• Study on the effect of medicinal leech therapy (Hirudo medicinalis) on full-thickness excisional wound healing in the animal model — Zakian A et al. (2022)
• [Hirudo medicinalis-leech applications in plastic and reconstructive microsurgery--a literature review] — Knobloch K et al. (2007)
• The duration of rest and feeding greatly affects the re-breeding of ectoparasites: Hirudo verbana, Hirudo medicinalis and Hirudo orientalis — Aminov R, Frolov A, Aminova A (2022)
• Recombinant hirudin in clinical practice: focus on lepirudin — Greinacher A, Lubenow N (2001)

Browse all ASH-analysed research →