Heparin-induced thrombocytopenia resident survival guide

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Karol Gema Hernandez, M.D. [2]

Definition

This section provides a short and straight to the point definition of the disease or symptom in one sentence.

Causes

Life Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.

• Life threatening cause 1
• Life threatening cause 2
• Life threatening cause 3

Common Causes

• Common cause 1
• Common cause 2
• Common cause 3
• Common cause 4
• Common cause 5

Management

Shown below is an algorithm summarizing the approach to heparin induced thrombocytopenia.

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Thrombocytopenia: ❑ Platelet count <150,000/mm3 or ❑ >50% decrease from highest level before initiation of heparin therapy ❑ Making sure patient has received heparin or LMWH in the previous 5- 14 days ❑ After ruling out other causes of thrombocytopenia

High or intermediate clinical suspicion of HIT ❑ Venous/arterial thrombosis ❑ Unusual manifestations: Skin necrosis at SC heparin injection sites Transient global amnesia ❑ Abscence of petechiae and/or significant bleeding

Discontinue heparin

Order labs: ❑ Plasma electrolytes ❑ Random blood sugar(Urgent) ❑ Serum calcium ❑ Toxicology screen ❑ Antiepileptic drugs (AED) levels (if patient already on AED) ❑ BUN/Cr. Order imaging studies: ❑ MRI/CT scan Order EEG studies: ❑ 12 lead EEG

Begin treatment with AED if: ❑ There is a neurological deficit or ❑ EEG shows unequivocal epileptic activity or ❑ Risk of having another seizure unacceptable to pt./family or ❑ Brain imaging shows a structural abnormality

Suspected epileptic seizure

Diagnostic doubt

Refer to specialist in 2 weeks

Refer to specialist

Diagnosis by specialist

Uncertain

Epilepsy

Non-seizure disorder

Further investigations

Classify & treat

Refer to psychologist