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.

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A 64-year-old man on veno-arterial extracorporeal membrane oxygenation developed falling platelet counts on heparin diluted in D5W despite heparin-induced thrombocytopenia being ruled out; switching the diluent to sodium bicarbonate was followed by platelet recovery without transfusion.

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