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. CR, 53 year old gentleman Severe pain of B/L toes -3/7.P/H APA syndrome DVT /PE -1994 on warfarin - Small vessel vasculitis (1989 treated with steroids) - Type II DM - IHD - Renal Calculi - Diverticular Disease re
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1. Cases from the Lab:Heparin Induced ThrombocytopeniaAre we there yet?
2. CR, 53 year old gentleman
Severe pain of B/L toes -3/7.
P/H – APA syndrome
DVT /PE -1994 on warfarin
- Small vessel vasculitis (1989 treated with steroids)
- Type II DM
- IHD
- Renal Calculi
- Diverticular Disease – recent colonoscopy.
Medications – Warfarin, Aspirin( ceased)
Recently Bridged with LMWH for colonoscopy
3. Examination – “ Not unwell looking”
Peripheral pulses intact
Tender toes and ears, blue toe.
Tender abdomen - collapsed with pain
Investigations at admission -
Hb- 140 TC-9.3 Plt-101
Na-135 K-3.6 Creat-85
APTT-44 INR-1.3
(ACA -174 ANA -1280)
XRC – No gas under diaphragm
CT abdomen – adrenal mass ?tumour
?haematoma.- MRI recommended.
Treatment- Switched to UFH heparin ( acute abdomen)
Steroids.
4. Investigations ( cont)
MRI – B/L adrenal haemorrhage
Heparin ceased
LA and Antiprothrombin antibodies requested
Progress – worsening ischaemic change right leg
USG – right extensive DVT
Haematology team consulted.
TIA
Significant thrombocytopenia and thrombosis noted
Most likely HITT
5. Investigations =HITs
Diamed - Negative
ELISA – Positive
Amputation planned
Lepirudin
Monitoring- Prolonged baseline APTT.
6. Heparin and Thrombocytopenia Heparin induced thrombocytopenia – HIT type II
Isolated HIT (HIT syndrome)
HIT associated thrombus (HITT) {White clot syndrome}
Latent HIT { Subacute HIT}
Heparin induced thrombocytopenia – HIT type I
Non immune heparin associated thrombocytopenia{HAT}
Pseudo HIT
7. Heparin and Thrombocytopenia