Heparin-induced thrombocytopenia differential diagnosis

Heparin-induced thrombocytopenia
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Priyamvada Singh, M.B.B.S. [2]

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 and others.

Differential diagnosis

Diagnosis of Heparin-induced thrombocytopenia is mainly done with the help of lab tests. A decrease in platelet count by > 50% typically after 5-10 days of heparin therapy leads to a diagnosis of HIT. Thus, it should be differentiated from other causes of thrombocytopenia like

• Disseminated Intravascular Coagulation
• Thrombotic Thrombocytopenic Purpura
• Hemolytic-Uremic Syndrome
• Immune Thrombocytopenic Purpura
• Drug-Induced Thrombocytopenia
• Posttransfusion Thrombocytopenia
• Systemic Lupus Erythematosus

The table below summarizes the different findings between HIT and other diseases in the differential diagnosis:

Characteristic/Parameter	HIT	DIC	HUS	ITP	PTP	SLE
Symptoms	Bleeding, thrombosis, skin necrosis.	Bleeding, thrombosis, petechiae, sepsis.	Renal failure, hematuria, bleeding.	Petechiae, bleeding, other autoimmune diseases.	Petechiae, purpura, ecchymoses.	Bleeding, photosensitivity, arthritis, malar rash, discoid rash, renal failure, seizures, psychosis.
Platelet count	Pain radiates to the trapezius ridge (to the lowest portion of the scapula on the back) or no radiation.	Pain radiates to the jaw, or the left or arm, or does not radiate.
PT and PTT	Does not change the pain	Can increase the pain
Systemic systems	Pain is worse supine or upon inspiration (breathing in)	Not positional
Drug-related	Sudden pain, that lasts for hours or sometimes days before a patient comes to the ER	Sudden or chronically worsening pain that can come and go in paroxysms or it can last for hours before the patient decides to come to the ER
Bleeding	Does not change the pain	Can increase the pain

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