Heparin-induced thrombocytopenia differential diagnosis: Difference between revisions

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|-
|-
! scope="row" | PT and PTT
! scope="row" | PT and PTT
| Does not change the pain
| Normal.
| Can increase the pain
| Elevated.
| Normal.
| Normal.
| Normal.
| Usually normal.
|-
|-
! scope="row" | Systemic systems
! scope="row" | Etiology
| Pain is worse [[supine]] or upon [[inspiration]] (breathing in)
| Heparin exposure.
| Not positional
| 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.
|-
|-
! scope="row" | Drug-related
! scope="row" | Drug-related
| Sudden pain, that lasts for hours or sometimes days before a patient comes to the ER
| Yes, always.
| Sudden or chronically worsening pain that can come and go in [[paroxysm]]s or it can last for hours before the patient decides to come to the ER
| Possible.
| No.
| Yes.
| No; transfusion-related.
| Possible; drug-induced lupus can be caused by medications like hydralazine or isoniazid.
|-
|-
! scope="row" | Bleeding
! scope="row" | Bleeding
| Does not change the pain
| Possible.
| Can increase the pain
| Usually.
| Usually.
| Yes; spontaneous bleeding if platelet count < 10000 per microliter.
| Yes; spontaneous bleeding if platelet count < 10000 per microliter.
| Rare.
|}
|}



Revision as of 06:52, 13 July 2017

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

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, 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

Reference

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