Heparin-induced thrombocytopenia differential diagnosis
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Heparin-induced thrombocytopenia |
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Differentiating Heparin-induced thrombocytopenia from other Diseases |
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Diagnosis |
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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 |
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| Symptoms | Bleeding, thrombosis, skin necrosis. | Bleeding, thrombosis, petechiae, sepsis. | 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; 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. | Usually normal. |
| Etiology | Heparin exposure. | Sepsis, delivery of fetus, acute promyelocytic leukemia, other malignancy. | E.coli strain O157:H7; Shiga-like toxin. | 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. | Yes. | No; transfusion-related. | Possible; drug-induced lupus can be caused by medications like hydralazine or isoniazid. |
| Bleeding | Possible. | 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