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The patient subsequently developed severe thrombocytopenia consistent with HIT. Despite cessation of UFH and initiation of argatroban, thrombocytopenia did not improve. A HIT-antibody immunoassay and functional assay (HIPA) was strongly positive, and HIPA showed activity even in the absence of heparin, supporting the diagnosis of delayed-onset, persisting autoimmune HIT (aHIT). The patient was treated with immunoglobulin, resulting in a rapid recovery of platelet counts. This case highlights the importance of early recognition and appropriate management of aHIT, especially in patients with persisting thrombocytopenia despite standard HIT therapy.<\/jats:p>","DOI":"10.1136\/bcr-2025-269479","type":"journal-article","created":{"date-parts":[[2026,2,15]],"date-time":"2026-02-15T19:15:26Z","timestamp":1771182926000},"page":"e269479","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Delayed-onset, persisting autoimmune heparin-induced thrombocytopenia with thrombosis following craniofacial surgery"],"prefix":"10.1136","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4623-9554","authenticated-orcid":false,"given":"Valerie J.","family":"Will","sequence":"first","affiliation":[{"name":"Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tobias","family":"Tritschler","sequence":"additional","affiliation":[{"name":"Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Caterina E.","family":"Marx","sequence":"additional","affiliation":[{"name":"Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2026,2,15]]},"reference":[{"key":"2026021511152018000_19.2.e269479.1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMcp1411910"},{"key":"2026021511152018000_19.2.e269479.2","doi-asserted-by":"crossref","DOI":"10.1016\/j.rpth.2023.100283","article-title":"Heparin-induced thrombocytopenia: An illustrated review","volume":"7","author":"May","year":"2023","journal-title":"Res Pract Thromb Haemost"},{"key":"2026021511152018000_19.2.e269479.3","doi-asserted-by":"publisher","DOI":"10.1182\/bloodadvances.2018024489"},{"key":"2026021511152018000_19.2.e269479.4","doi-asserted-by":"crossref","DOI":"10.3390\/jcm12216921","article-title":"Autoimmune Heparin-Induced Thrombocytopenia","volume":"12","author":"Warkentin","year":"2023","journal-title":"J Clin Med"},{"key":"2026021511152018000_19.2.e269479.5","doi-asserted-by":"crossref","DOI":"10.1016\/j.rpth.2023.102245","article-title":"Heparin-induced thrombocytopenia (and autoimmune heparin-induced thrombocytopenia): an illustrious review","volume":"7","author":"Warkentin","year":"2023","journal-title":"Res Pract Thromb Haemost"},{"key":"2026021511152018000_19.2.e269479.6","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1182\/hematology.2023000503","article-title":"Thrombotic anti-PF4 immune disorders: HIT, VITT, and beyond","volume":"2023","author":"Greinacher","year":"2023","journal-title":"Hematology"},{"key":"2026021511152018000_19.2.e269479.7","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1111\/j.1538-7836.2011.04322.x","article-title":"HIT paradigms and paradoxes","volume":"9 Suppl 1","author":"Warkentin","year":"2011","journal-title":"J Thromb Haemost"},{"key":"2026021511152018000_19.2.e269479.8","doi-asserted-by":"publisher","DOI":"10.1160\/TH12-03-0201"},{"key":"2026021511152018000_19.2.e269479.9","doi-asserted-by":"publisher","DOI":"10.1160\/TH14-08-0711"},{"key":"2026021511152018000_19.2.e269479.10","unstructured":"Warkentin TE , Greinacher A . 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