C 2, 21 treatment is rarely indicated in patients with platelet. Diagnosis of hit is based on both clinical thrombocytopenia or new thrombosis and laboratory findings. Thrombocytopenia is most frequently encountered hematological problem in hospitalized patients. Clinical presentation and diagnosis of heparininduced thrombocytopenia. Thrombocytopenia low platelets red flags if significant bleeding and acute admission may be necessary, phone the oncall haematologist. The following guideline is intended to guide the diagnosis and management of heparin induced thrombocytopenia. The page below is a sample from the labce course white cell and platelet disorders.
This algorithm has been developed for md anderson using a multidisciplinary approach considering circumstances particular to md andersons specific patient population, services and structure, and clinical information. New guidelines for heparininduced thrombocytopenia. Heparininduced thrombocytopenia, fifthedition although first reported in 1973, immune heparininduced thrombocytopenia hit remains one of the most frequent and devastating adverse drug reactions. A practical approach to evaluation and management sudhir s. Ditp should be suspected when a patient, child or adult, has sudden, severe thrombocytopenia. Riia on platelets and monocytes to propagate a hypercoagulable state culminating in lifethreatening thrombosis. With the widespread use of automated cell counters. Thrombotic thrombocytopenic purpura hemolytic uremic. Thrombocytopenia disease causes of thrombocytopenia disease. Researches have shown that thrombocytopenia is associated with mortality among those patients.
It is important as a healthcare worker to recognize the signs of heparininduced thrombocytopenia hit as treatment should begin before the laboratory confirms the diagnosis. For many mechanisms for linezolidinduced anemia and thrombocytopenia high blood pressure tested in tissues. It is common, yet underrecognized, difficult to diagnose and associated with severe bleeding complications. Immune thrombocytopenia nord national organization for rare. Heparininduced thrombocytopenia is an antibodymediated adverse drug reaction to heparin therapy with potentially lifethreatening complications. The important diagnostic issue is to distinguish between druginduced thrombocytopenia and idiopathic thrombocytopenic purpura because the latter diagnosis. What are the risk factors for druginduced thrombocytopenia. Algorithm for thrombocytopenia case definition only. In those cases, treatment that has a rapid onset of effect and is minimally harmful is reasonable. The incidence of heparin induced thrombocytopenia in orthopedic surgery patients in khartoum, sudan.
Recent cancer treatment with cytotoxic chemotherapy andor radiotherapy within 3 months. Druginduced thrombocytopenia can affect any individual irrespective of age, gender, race or ethnic group status. Many drugs have been associated with the development of thrombocytopenia. Heparininduced thrombocytopenia article nursingcenter. Heparin induced thrombocytopenia hit treatment page 1 of 7. Thrombocytopenia disease happens when number of count falls under 150,000 micro liter.
New guidelines for heparininduced thrombocytopenia on september 3, 20 uwmedicine laboratory services released a new reflexive. Pdf heparin induced thrombocytopenia hit is a major side effect secondary to the administration of heparin. Heparin induced thrombocytopenia hit treatment page 1 of 7 disclaimer. Most cases of druginduced thrombocytopenia ditp are caused by drugdependent antibodies that are specific for the drug structure and bind tightly to platelets by their fab regions but only in the presence. Heparininduced thrombocytopenia, fifth edition crc press book although first reported in 1973, immune heparininduced thrombocytopenia hit remains one of the most frequent and devastating adverse drug reactions encountered by physicians.
Drug induced thrombocytopenia is a serious condition and considered a rare side effect of numerous medicines, namely anticancer drugs and antibiotics like cephalosporins. The important diagnostic issue is to distinguish between druginduced. Heparininduced thrombocytopenia, fifth edition crc. Heparininduced thrombocytopenia hit is an immune complication of heparin therapy caused by antibodies to complexes of platelet factor 4 pf4 and heparin. Diagnosis and treatment of heparininduced thrombocytopenia. This article discusses the pathogenesis, diagnosis, and. Heparin and anticancer drugs are thought to be most commonly associated drugs with this adverse reaction. Delayed onset heparininduced thrombocytopenia is a well recognized complication of heparin therapy. Smock, md associate professor of pathology, medical director, arup hemostasisthrombosis laboratory. Pregnant patients with visual symptoms, headaches, abdominal pain, or influenzalike.
Currently, no standard therapy exist for critical patients with thrombocytopenia. Heparininduced thrombocytopenia hit may develop in two distinct forms, type i and type ii see table 1. Unexplained thrombocytopenia is a common clinical problem, and the possibility of druginduced thrombocytopenia must be considered, especially in hospitalized patients. Peripheral blood clues to nonneoplastic conditions. What tests to do to exclude other causes is not wellestablished and can differ among. Heparininduced thrombocytopenia type ii hit ii is based on a hypersensitivity to heparin and results in serious thromboembolic complications with a lethality of up to 23%. Health, general adverse drug reactions health aspects research antibodies. Ash has developed a series of brief, evidencebased pocket guides to help physicians provide quality care to patients.
Howtoapproachthrombocytopenia robertostasi1 1departmentofhaematology,stgeorgeshospital,london,unitedkingdom thrombocytopenia is a. Immune thrombocytopenia itp is an autoimmune bleeding disorder. The list of medications associated with drug induced thrombocytopenia is vast and growing. Ditp refers to acute, immunemediated thrombocytopenia. Approach to thrombocytopenia in the inpatient setting shweta kurian, md. Thrombocytopenia is a condition characterized by abnormally low levels of thrombocytes, also known as platelets, in the blood a normal human platelet count ranges from 150,000 to 450,000 platelets per. Unfractionated heparin ufh and the low molecular weight heparin lmwh preparations are two of the most commonly prescribed medications in the hospital, and indications for their use are. Clinical presentation and diagnosis of heparininduced. Heparininduced thrombocytopenia hit is an adverse reaction to the drug heparin resulting in an abnormally low amount of platelets thrombocytopenia. Project on platlet count using image processing techniques pdf.
If druginduced thrombocytopenia is severe, ivig or corticosteroids may be used. Thrombocytopenia is a serious side effect of such treatment and occurs mostly due to rifampicin rif. Heparininduced thrombocytopenia, fifth edition fundamental and clinical cardiology warkentin, theodore e. Effects on in vivo thrombin and crosslinked fibrin generation. Heparininduced thrombocytopenia, fifth edition fundamental. Then, the free fc portion of that bound igg antibody is bound to a macrophage and the whole plateletlinezolidigg complex is processed by the reticuloendothelial system. Pathogenic antibodies to pf4 heparin bind and activate cellular fc. Heparininduced thrombocytopenia rn continued education.
Two types of hit have been classified in accordance with the timing of thrombocytopenia in relation to heparin exposure. Pathophysiology of heparininduced thrombocytopenia. Approach to thrombocytopenia in the inpatient setting. Heparininduced thrombocytopenia hit is a lifethreatening complication of exposure to heparin eg, unfractionated heparin, low molecular weight lmw heparin that occurs in a small percentage of. Heparin induced thrombocytopenia type i rapidonset, manifests itself within the first 24 to 48 hours after heparin reexposure in patients who were exposed to heparin products within the preceding 100 days. Diagnosis and treatment of serious thrombocytopenia is usually directed by a. Heparin induced thrombocytopenia is an autoimmune condition secondary to autoantibodies against pf4 heparin complexes, which occurs in up to 2. The discovery of isolated thrombocytopenia in a patient who is taking several medications presents a challenging clinical problem. Thrombocytopenia disease with causes and nursing intervention.
Druginduced immune thrombocytopenia ditp is a rare, but potentially fatal cause of isolated thrombocytopenia with a cited incidence of 10 in 1,000,000 cases 2. The most common causes and differential diagnosis of inpatient and outpatient. Uw health moderate quality of evidence, strong recommendation 2. Druginduced thrombocytopenia occurs when certain drugs or medications destroy platelets or interfere with the bodys ability to make enough of them. Mechanisms for linezolidinduced anemia and thrombocytopenia. Heparin induced thrombocytopenia adult inpatient clinical. Management of thrombocytopenia in neonates roberts.
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