Heparin-induced thrombocytopenia differential diagnosis: Difference between revisions
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[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Heparin-induced_thrombocytopenia]] | |||
{{CMG}}; '''Associate Editor(s)-In-Chief:''' [[Priyamvada Singh|Priyamvada Singh, M.B.B.S.]] [mailto:psingh13579@gmail.com] {{shyam}} | {{CMG}}; '''Associate Editor(s)-In-Chief:''' [[Priyamvada Singh|Priyamvada Singh, M.B.B.S.]] [mailto:psingh13579@gmail.com] {{shyam}} | ||
==Overview== | ==Overview== | ||
[[Heparin-induced thrombocytopenia]] is diagnosed when the [[platelet]] count falls by > 50% typically after 5-10 days of [[heparin]] therapy. It should be differentiated by other causes of thrombocytopenia like hemolytic uremic syndrome, | [[Heparin-induced thrombocytopenia]] is diagnosed when the [[platelet]] count falls by > 50% typically after 5-10 days of [[heparin]] therapy. It should be differentiated by other causes of thrombocytopenia like [[Hemolytic-uremic syndrome|hemolytic uremic syndrome]], t[[Thrombotic thrombocytopenia|hrombotic thrombocytopenia]], [[disseminated intravascular coagulation]], [[post-transfusion purpura]], and [[systemic lupus erythematosis]]. | ||
==Differential diagnosis== | ==Differential diagnosis== | ||
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|- | |- | ||
! scope="row" | Symptoms | ! scope="row" | Symptoms | ||
| Bleeding, thrombosis, skin necrosis | | [[Bleeding]], [[thrombosis]], [[Necrosis|skin necrosis]] | ||
| Bleeding, thrombosis, petechiae, sepsis | | [[Bleeding]], [[thrombosis]], [[petechiae]], [[sepsis]] | ||
| Renal failure, hematuria, bleeding, microangiopathic hemolytic anemia | | [[Renal failure]], [[hematuria]], [[bleeding]], [[microangiopathic hemolytic anemia]] | ||
| Renal failure, hematuria, bleeding, microangiopathic hemolytic anemia | | [[Renal failure]], [[hematuria]], [[bleeding]], [[microangiopathic hemolytic anemia]] | ||
| Petechiae, bleeding, other autoimmune diseases | | [[Petechiae]], [[bleeding]], other [[autoimmune diseases]] | ||
| | | [[Petechia]]<nowiki/>e, [[purpura]], [[ecchymoses]] | ||
| Bleeding, photosensitivity, arthritis, malar rash, discoid rash, renal failure, seizures, psychosis | | [[Bleeding]], [[photosensitivity]], [[arthritis]], [[malar rash]], discoid rash, [[Renal insufficiency|renal failure]], [[seizures]], [[psychosis]] | ||
|- | |- | ||
! scope="row" | Platelet count | ! scope="row" | Platelet count | ||
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| Low | | Low | ||
| Low; can be as low as 10000 per microliter | | Low; can be as low as 10000 per microliter | ||
| Low; can be less than 10000 per microliter; sudden onset after transfusion | | Low; can be less than 10000 per microliter; sudden onset after [[transfusion]] | ||
| Variable; usually low | | Variable; usually low | ||
|- | |- | ||
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|- | |- | ||
! scope="row" | Etiology | ! scope="row" | Etiology | ||
| Heparin exposure | | [[Heparin]] exposure | ||
| Sepsis, delivery of fetus, acute promyelocytic leukemia, other malignancy | | [[Sepsis]], delivery of fetus, [[acute promyelocytic leukemia]], other [[malignancy]] | ||
| E.coli strain O157:H7; Shiga-like toxin | | [[Escherichia coli O157:H7|E.coli strain O157:H7]]; [[Shiga-like toxin]] | ||
| Dysregulation of complement activation; mutation in complement factor H | | Dysregulation of [[Complement|complement activation]]; mutation in [[Factor H|complement factor H]] | ||
| Idiopathic; can be secondary to chronic lymphocytic leukemia, HIV, viral hepatitis, H. pylori | | Idiopathic; can be secondary to [[chronic lymphocytic leukemia]], [[Human Immunodeficiency Virus (HIV)|HIV]], [[Hepatitis|viral hepatitis]], [[H. pylori]] | ||
| Exposure to transfused products | | Exposure to transfused products | ||
| Autoimmunity with development of antibodies to DNA | | Autoimmunity with development of [[antibodies]] to [[DNA]] | ||
|- | |- | ||
! scope="row" | Drug-related | ! scope="row" | Drug-related | ||
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| Yes | | Yes | ||
| No; transfusion-related | | No; transfusion-related | ||
| Possible; drug-induced lupus can be caused by medications like hydralazine or isoniazid | | Possible; drug-induced lupus can be caused by medications like [[hydralazine]] or [[isoniazid]] | ||
|- | |- | ||
! scope="row" | Bleeding | ! scope="row" | Bleeding | ||
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| Usually | | Usually | ||
| Usually | | Usually | ||
| Yes; spontaneous bleeding if platelet count < 10000 per microliter | | Yes; spontaneous bleeding if [[platelet]] count < 10000 per microliter | ||
| Yes; spontaneous bleeding if platelet count < 10000 per microliter | | Yes; spontaneous bleeding if platelet count < 10000 per microliter | ||
| Rare | | Rare | ||
Latest revision as of 21:08, 26 February 2019
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Priyamvada Singh, M.B.B.S. [2] Shyam Patel [3]
Overview
Heparin-induced thrombocytopenia is diagnosed when the platelet count falls by > 50% typically after 5-10 days of heparin therapy. It should be differentiated by other causes of thrombocytopenia like hemolytic uremic syndrome, thrombotic thrombocytopenia, disseminated intravascular coagulation, post-transfusion purpura, and systemic lupus erythematosis.
Differential diagnosis
HIT must be differentiated from other diseases that present with thrombocytopenia. Please scroll down to view the table.
| Characteristic/Parameter | HIT | DIC | HUS[1] | Atypical HUS | ITP | PTP | SLE |
|---|---|---|---|---|---|---|---|
| Symptoms | Bleeding, thrombosis, skin necrosis | Bleeding, thrombosis, petechiae, sepsis | Renal failure, hematuria, bleeding, microangiopathic hemolytic anemia | Renal failure, hematuria, bleeding, microangiopathic hemolytic anemia | Petechiae, bleeding, other autoimmune diseases | Petechiae, purpura, ecchymoses | Bleeding, photosensitivity, arthritis, malar rash, discoid rash, renal failure, seizures, psychosis |
| Platelet count | Low but usually more than 20000 per microliter | Low | Low | Low | Low; can be as low as 10000 per microliter | Low; can be less than 10000 per microliter; sudden onset after transfusion | Variable; usually low |
| PT and PTT | Normal | Elevated | Normal | Normal | Normal | Normal | Usually normal |
| Etiology | Heparin exposure | Sepsis, delivery of fetus, acute promyelocytic leukemia, other malignancy | E.coli strain O157:H7; Shiga-like toxin | Dysregulation of complement activation; mutation in complement factor H | Idiopathic; can be secondary to chronic lymphocytic leukemia, HIV, viral hepatitis, H. pylori | Exposure to transfused products | Autoimmunity with development of antibodies to DNA |
| Drug-related | Yes, always | Possible | No | No | Yes | No; transfusion-related | Possible; drug-induced lupus can be caused by medications like hydralazine or isoniazid |
| Bleeding | Possible | Usually | Usually | Usually | Yes; spontaneous bleeding if platelet count < 10000 per microliter | Yes; spontaneous bleeding if platelet count < 10000 per microliter | Rare |
Table legend: HIT, heparin-induced thrombocytopenia; DIC, disseminated intravascular coagulation; HUS, hemolytic-uremic syndrome; ITP, immune thrombocytopenia purpura; PTP, post-transfusion purpura; SLE, systemic lupus erythematosis
Reference
- ↑ Jokiranta TS (2017). "HUS and atypical HUS". Blood. 129 (21): 2847–2856. doi:10.1182/blood-2016-11-709865. PMC 5445567. PMID 28416508.