Heparin Induced Thrombocytopenia

The HIT I involve the decrease in the count of platelets, usually not less than 100,000 platelets/µL, and returns to normal after few days with continual heparin treatment and usually show no symptoms. In Type II, there is a significant decrease in platelet counts, and the onset is usually after the 5th day of exposure to heparin. A normal healthy human being has a range of between 150,000 to 450,000 platelet counts per microliter of blood and therefore since the 36-year-old man had a platelet count of 30,000/µL which significantly dropped from 170,000/µL, he had HIT type II. This paper seeks to describe the condition, causes, clinical manifestations, and epidemiological trends of HIT as well as discussing its diagnosis, treatment and patient education strategies.

Epidemiological Trends The occurrence of HIT varies between 0. The possibility of getting HIT increases with the period of using of heparin for post-operative thrombophylaxis, although previous studies have revealed a possibility of acquiring HIT with minimum exposure to heparin through intravascular flushes to preserve the patency of inhibiting arterial or venous tubes. Fathi (2018) explains that the risk of acquiring HIT antibodies when exposed to heparin is about 8% and 15% of the patients exposed to heparin and develop thrombocytopenia. Additionally, a third of these patients suffer from arterial and venous thrombosis. The possibility of getting HIT does not depend on patients’ sex, heparin dose, age, or route of administration. Instead, it is different depending on the type of heparin used (Cai et al.

On the other hand, venous thrombosis appears in the lungs as pulmonary embolism (PE) as well as in legs and arms in forms of deep vein thrombosis (DVT). A mixture of signs may occur when infusion occurs in patients getting heparin via an intravenous infusion (Crowther et al. These symptoms include, chills, high blood pressure, fever, fast heart rate, chest pain and shortness of breath. Some patients can suffer from skin rashes that contain red spots. Pathophysiology of Heparin-Induced Thrombocytopenia Heparin possesses the ability to stimulate platelets immediately it interacts with platelet integrin which act as heparin receptors. Additionally, healthcare facilities can provide educational materials by modifying and printing them out for patients as well as use internet sources. Also, when educating patients it is required that doctors identify the patient’s style of learning due to various differences.

Teaching is improved by providing education using different methods e. g. some patients may prefer watching while others would just want to read. The “4 Ts” score, which was introduced in 2003, is commonly used to predict the probability that HIT is present. A 0–8 points score is created so that in case the score ranges between 0 and 3 then HIT is likely to be absent. A score between 4 and 5 shows a halfway probability, while scores between 6 and 8 make it highly possible. Patients with high scores need to be treated with a substitute drug as more specific tests for HIT are carried out. On the other hand, those with lower scores can, without harm, continue taking heparin since the probability of them having HIT is very low (Linkins et al.

References Cai, Z. , Yarovoi, S. V. , Zhu, Z. , Rauova, L. The impact of bleeding complications in patients receiving target-specific oral anticoagulant: a systematic review and meta-analysis. Blood, blood-2014. Crowther, M. , Cook, D. , Guyatt, G. Heparin-induced thrombocytopenia (HIT): Identification and treatment pathways. Global cardiology science & practice, 2018(2). Joseph, L. , Casanegra, A. I. Journal of Thrombosis and Haemostasis, 12(7), 1044-1053. Kang, M. , Alahmadi, M. , Sawh, S. , Kovacs, M. , Heddle, N. M. , Wang, G. , & Warkentin, T. E. , Ogilvy, C. S. , & Nogueira, R. G. Predictors and outcomes of suspected heparin-induced thrombocytopenia in subarachnoid hemorrhage patients. Schindewolf M, Steindl J, Beyer-Westendorf J, Schellong S, Dohmen PM, Brachmann J, et al. Frequent off-label use of fondaparinux in patients with suspected acute heparin-induced thrombocytopenia (HIT)? findings from the GerHIT multi-centre registry study.