Heparin-induced thrombocytopenia physical examination: Difference between revisions
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==Overview== | ==Overview== | ||
The physical exam for HIT focuses on the skin, pulmonary, and musculoskeletal exam. These are the common areas of thrombotic manifestations. Bleeding can also occur in these organs. A complete physical exam can help with evaluation of thrombosis or bleeding in other organs. | |||
==Physical Examination== | ==Physical Examination== | ||
===Skin Exam=== | ===Skin Exam=== | ||
* Skin necrosis from thrombotic physiology<ref name="pmid22315270">{{cite journal| author=Linkins LA, Dans AL, Moores LK, Bona R, Davidson BL, Schulman S et al.| title=Treatment and prevention of heparin-induced thrombocytopenia: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. | journal=Chest | year= 2012 | volume= 141 | issue= 2 Suppl | pages= e495S-e530S | pmid=22315270 | doi=10.1378/chest.11-2303 | pmc=3278058 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22315270 }} </ref> | ===Appearance of the Patient=== | ||
* Petechiae from thrombocytopenia | *Patients with heparin induced thrombocytopenia usually appear flushed. | ||
* Purpura from thrombocytopenia | |||
* Ecchymoses from thrombocytopenia | ===Vital Signs=== | ||
*Fever | |||
*Chill | |||
*Tachycardia | |||
*Tachypnea | |||
===Skin=== | |||
*Skin necrosis from thrombotic physiology<ref name="pmid22315270">{{cite journal| author=Linkins LA, Dans AL, Moores LK, Bona R, Davidson BL, Schulman S et al.| title=Treatment and prevention of heparin-induced thrombocytopenia: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. | journal=Chest | year= 2012 | volume= 141 | issue= 2 Suppl | pages= e495S-e530S | pmid=22315270 | doi=10.1378/chest.11-2303 | pmc=3278058 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22315270 }} </ref><ref name="pmid24992313">{{cite journal| author=McKenzie SE, Sachais BS| title=Advances in the pathophysiology and treatment of heparin-induced thrombocytopenia. | journal=Curr Opin Hematol | year= 2014 | volume= 21 | issue= 5 | pages= 380-7 | pmid=24992313 | doi=10.1097/MOH.0000000000000066 | pmc=4232774 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24992313 }} </ref> | |||
* [[Petechiae]] from [[thrombocytopenia]] | |||
* [[Purpura]] from [[thrombocytopenia]] | |||
* [[Ecchymoses]] from [[thrombocytopenia]] | |||
===HEENT=== | |||
* HEENT examination of patients with heparin induced thrombocytopenia is usually normal. | |||
===Neck=== | |||
* Neck examination of patients with heparin induced thrombocytopenia is usually normal. | |||
===Lungs=== | |||
*Pulmonary examination of patients with heparin induced thrombocytopenia is usually normal. | |||
=== | ===Heart=== | ||
* Tachypnea from pulmonary embolism | * [[Tachypnea]] from [[pulmonary embolism]] | ||
* Tachycardia from pulmonary embolism | * [[Tachycardia]] from [[pulmonary embolism]] | ||
* Hypoxia from pulmonary embolism | * [[Hypoxia]] from [[pulmonary embolism]] | ||
===Musculoskeletal Exam=== | ===Musculoskeletal Exam=== | ||
* Leg swelling from deep vein thrombosis<ref name="pmid22315270">{{cite journal| author=Linkins LA, Dans AL, Moores LK, Bona R, Davidson BL, Schulman S et al.| title=Treatment and prevention of heparin-induced thrombocytopenia: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. | journal=Chest | year= 2012 | volume= 141 | issue= 2 Suppl | pages= e495S-e530S | pmid=22315270 | doi=10.1378/chest.11-2303 | pmc=3278058 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22315270 }} </ref> | * [[Leg swelling]] from [[deep vein thrombosis]]<ref name="pmid22315270">{{cite journal| author=Linkins LA, Dans AL, Moores LK, Bona R, Davidson BL, Schulman S et al.| title=Treatment and prevention of heparin-induced thrombocytopenia: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. | journal=Chest | year= 2012 | volume= 141 | issue= 2 Suppl | pages= e495S-e530S | pmid=22315270 | doi=10.1378/chest.11-2303 | pmc=3278058 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22315270 }} </ref> | ||
* Calf tenderness from deep vein thrombosis | * Calf tenderness from [[deep vein thrombosis]] | ||
===Other Exam Findings=== | ===Other Exam Findings=== | ||
* Mucosal bleeding from thrombocytopenia (i.e. oral, nasal, urinary, menstrual, gastrointestinal, or other) | * Mucosal bleeding from [[thrombocytopenia]] (i.e. oral, nasal, urinary, menstrual, gastrointestinal, or other) | ||
* Abdominal tenderness from mesenteric venous thrombosis | * Abdominal tenderness from mesenteric [[venous thrombosis]] | ||
* Neurologic deficits from cerebral arterial or dural venous sinus thrombosis | * Neurologic deficits from cerebral arterial or [[dural venous sinus]] thrombosis | ||
==Reference== | ==Reference== | ||
Latest revision as of 16:16, 8 August 2018
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Heparin-induced thrombocytopenia |
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Differentiating Heparin-induced thrombocytopenia from other Diseases |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Shyam Patel [2]
Overview
The physical exam for HIT focuses on the skin, pulmonary, and musculoskeletal exam. These are the common areas of thrombotic manifestations. Bleeding can also occur in these organs. A complete physical exam can help with evaluation of thrombosis or bleeding in other organs.
Physical Examination
Skin Exam
Appearance of the Patient
- Patients with heparin induced thrombocytopenia usually appear flushed.
Vital Signs
- Fever
- Chill
- Tachycardia
- Tachypnea
Skin
- Skin necrosis from thrombotic physiology[1][2]
- Petechiae from thrombocytopenia
- Purpura from thrombocytopenia
- Ecchymoses from thrombocytopenia
HEENT
- HEENT examination of patients with heparin induced thrombocytopenia is usually normal.
Neck
- Neck examination of patients with heparin induced thrombocytopenia is usually normal.
Lungs
- Pulmonary examination of patients with heparin induced thrombocytopenia is usually normal.
Heart
- Tachypnea from pulmonary embolism
- Tachycardia from pulmonary embolism
- Hypoxia from pulmonary embolism
Musculoskeletal Exam
- Leg swelling from deep vein thrombosis[1]
- Calf tenderness from deep vein thrombosis
Other Exam Findings
- Mucosal bleeding from thrombocytopenia (i.e. oral, nasal, urinary, menstrual, gastrointestinal, or other)
- Abdominal tenderness from mesenteric venous thrombosis
- Neurologic deficits from cerebral arterial or dural venous sinus thrombosis
Reference
- ↑ 1.0 1.1 Linkins LA, Dans AL, Moores LK, Bona R, Davidson BL, Schulman S; et al. (2012). "Treatment and prevention of heparin-induced thrombocytopenia: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines". Chest. 141 (2 Suppl): e495S–e530S. doi:10.1378/chest.11-2303. PMC 3278058. PMID 22315270.
- ↑ McKenzie SE, Sachais BS (2014). "Advances in the pathophysiology and treatment of heparin-induced thrombocytopenia". Curr Opin Hematol. 21 (5): 380–7. doi:10.1097/MOH.0000000000000066. PMC 4232774. PMID 24992313.