]> 2026-07-31T07:51:29+00:00 WBR0956 0 en Heparin induced skin necrosis Heparin induced thrombocytopenia ''' Incorrect ''' : The appearance of otherwise unexplained thrombocytopenia, thrombosis associated with thrombocytopenia, a platelet count which has fallen 50 percent or more from a prior value, or necrotic skin lesions at heparin injection sites should raise the possibility of heparin-induced thrombocytopenia (HIT) in any patient begun on heparin therapy within the preceding 5 to 10 days. Warfarin induced skin necrosis Disseminated intravascular coagulation Sub therapeutic anti-coagulation ''' Incorrect ''' : Even though in this patient PT/INR are subtherpeutic, the PTT is therapeutic and hence properly anti-coagulated. Emergency Room A 62 year old woman comes to the emergency department with complaints of shortness of breath and chest pain. She was in her usual state this morning but suddenly developed these symptoms. Her past history is otherwise insignificant and her family history is unremarkable. She is a chronic smoker and smoked two packs of cigarette for the past 25 years. She occasionally consumes alcohol. She attained menopause at the age of 50 and not on any medications. Her vitals are temperature: 36.7 C, blood pressure: 140/80 mmHg, pulse: 80/min and respiration: 15/min. The patients pulse oximetry shows 92 % on 4-litres of oxygen. All system examinations are normal. V/Q scan of the chest shows high probablity for pulmonary embolism. Her intial laboratory values are : Hb : 11 g/dl Hct : 37% RBC’s : 3 million/cmm WBC’s : 8000/cmm Platelet’s : 300,000/cmm PT : 13 sec (N 11-15 sec) APTT : 30 sec (N 25-40 sec) BT : 7 min (N 2-7 min) INR : 1.06 You start the patient on unfractionated heparin and warfarin. Her symptoms gradually resolve over the next five days. On the 7th day, she complaints of pain and pallor in the right arm. Examination of the right extremity reveals pale, tender arm with diminished peripheral pulses. A repeat CBC reveals Hb : 12 g/dl Hct : 37.5% RBC’s : 2.8 million/cmm WBC’s : 10000/cmm Platelet’s : 60,000/cmm PT : 19 sec (N 11-15 sec) APTT : 60 sec (N 25-40 sec) BT : 11 min (N 2-7 min) INR : 2 What is the most likely cause of her symptoms ? B Hematology 2020-10-28T02:11:06Z 2459150.5910417 WBR0956