Type 2 Heparin-induced Thrombocytopenia

WHAT YOU SHOULD KNOW:

• Heparin-induced thrombocytopenia, or Type 2 HIT, is a condition where there are too few platelets in the blood after receiving heparin. Heparin is a medicine that is usually used to prevent or treat a thrombosis (blood clot) or blood clotting disorder. Platelets are blood cells that help stop bleeding by sticking together to form a clot. With Type 2 HIT, antibodies stick to a heparin and platelet complex and cause blood clots to form in the heart, brain, lungs, or limbs. A heparin and platelet complex is where heparin hooks onto a platelet. It is thought that problems in the body's immune system may cause Type 2 HIT. The immune system is the part of the body that produces antibodies to fight infection and foreign substances. Usually in HIT, the number of platelets decreases 5 to 10 days after heparin was given. With rapid-onset HIT, the number of platelets decreases within minutes to hours after receiving heparin. With delayed-onset HIT, a decrease in platelets may happen up to 100 days after heparin was given. Those who have had recent blood vessel procedures, or bone or heart surgery may be at an increased risk for HIT. Receiving unfractionated heparin or bovine (cow) heparin also increases the risk of HIT. Patients with an intravenous line (IV) or a central line that is flushed or coated with heparin are also at risk of getting HIT.
  
  
• Symptoms include skin sores and black, reddish, or bluish discoloration of the skin, especially where heparin was given. You may also have numbness, pain, tenderness, and swelling in your arms or legs, or have problems moving them. Body weakness, slurred speech, problems seeing, headache, increased sleepiness, chest pain, or trouble breathing may also be present. A fever, chills, sweating, nausea (upset stomach), vomiting (throwing up), or coughing up blood are other symptoms. Blood tests, such as a platelet count and immunoassays for antibodies to heparin may help your caregiver diagnose HIT. Treatment may include anticoagulant and antiplatelet medicines, and surgery to remove blood clots. Diagnosing and treating HIT as soon as possible may relieve symptoms and prevent serious, life-threatening complications.

AFTER YOU LEAVE:

Take your medicine as directed.

Call your primary healthcare provider if you think your medicine is not helping or if you have side effects. Tell him if you are allergic to any medicine. Keep a list of the medicines, vitamins, and herbs you take. Include the amounts, and when and why you take them. Bring the list or the pill bottles to follow-up visits. Carry your medicine list with you in case of an emergency.

Blood thinners:

Blood thinners are medicines that help prevent blood clots from forming. Clots can cause strokes, heart attacks, and death. Blood thinners make it more likely for you to bleed or bruise. If you are taking a blood thinner:

• Watch for bleeding from your gums or nose. Watch for blood in your urine and bowel movements. Use a soft washcloth on your skin and a soft toothbrush on your teeth. This can keep your skin and gums from bleeding. If you shave, use an electric shaver. Do not play contact sports, such as football.
  
  
• Be aware of what medicines you take. Many medicines cannot be used when taking medicine to thin your blood. Tell your dentist and other caregivers that you take blood-thinning medicine. Wear or carry medical alert information that says you are taking this medicine.
  
  
• Take this medicine exactly as your primary healthcare provider tells you. Tell him right away if you forget to take the medicine, or if you take too much. You may need to have regular blood tests while on this medicine. Your primary healthcare provider uses these tests to decide how much medicine is right for you.
  
  
• Talk to your primary healthcare provider about your diet. This medicine works best when you eat about the same amount of vitamin K every day. Vitamin K is found in green leafy vegetables and other foods, such as cooked peas and kiwifruit.

• Inform caregivers that you have had Type 2 HIT before taking any form of heparin.
  
  

Ask for information about where and when to go for follow-up visits:

For continuing care, treatments, or home services, ask for more information.

Wellness tips:

• Eat a variety of healthy foods: This may help you have more energy and heal faster. Healthy foods include fruit, vegetables, whole-grain breads, low-fat dairy products, beans, lean meat, and fish. Ask if you need to be on a special diet.
  
  
• Drink liquids as directed: Adults should drink between 9 and 13 eight-ounce cups of liquid every day. Ask what amount is best for you. For most people, good liquids to drink are water, juice, and milk.
  
  
• Get plenty of exercise: Talk to your caregiver about the best exercise plan for you. Exercise can decrease your blood pressure and improve your health.
  
  
• Do not smoke: If you smoke, it is never too late to quit. You are more likely to have heart disease, lung disease, cancer, and other health problems if you smoke. Quitting smoking will improve your health and the health of those around you. If you smoke, ask for information about how to stop.
  
  
• Manage stress: Stress may slow healing and cause illness. Learn new ways to relax, such as deep breathing.

For support and more information:

Having heparin-induced thrombocytopenia may be a life-changing disease for you and your family. Accepting that you have Type 2 HIT may be hard. You and those close to you may feel angry, sad, or frightened. These feelings are normal. Talk to your caregivers, family, or friends about your feelings. You may also want to join a support group for people who have Type 2 HIT. Contact the following for more information:

• National Heart, Lung and Blood Institute
  Health Information Center
  P.O. Box 30105
  Bethesda , MD 20824-0105
  Phone: 1- 301 - 592-8573
  Web Address: http://www.nhlbi.nih.gov/health/infoctr/index.htm
  

• American Academy of Family Physicians
  11400 Tomahawk Creek Parkway
  Leawood , KS 66211-2680
  Phone: 1- 913 - 906-6000
  Phone: 1- 800 - 274-2237
  Web Address: http://www.aafp.org
  

CONTACT A CAREGIVER IF:

• You have a fever.
  
  
• You have black, reddish, or bluish discoloration of the skin, a rash, or skin sores.
  
  
• You have numbness of your arms or legs.
  
  
• You have chest pain or trouble breathing that is getting worse over time.
  
  
• You have any questions or concerns about your condition, medicine, or care.

SEEK CARE IMMEDIATELY IF:

• You have severe (bad) pain in your arms or legs that does not go away.
  
  
• You have trouble standing and walking.
  
  
• You suddenly feel lightheaded and have trouble breathing.
  
  
• You have new and sudden chest pain. You may have more pain when you take deep breaths or cough. You may cough up blood.
  
  
• Your arm or leg feels warm, tender, and painful. It may look swollen and red.
  
  
• Call 911 or an ambulance if you have any signs of a heart attack:
  
  
  • Discomfort in the center of your chest that feels like squeezing, pressure, fullness, or pain, that lasts for more than a few minutes or keeps returning
    
    
  • Discomfort or pain in your back, neck, jaw, stomach, or one or both of your arms
    
    
  • Feeling sick to your stomach
    
    
  • Having trouble breathing
    
    
  • A sudden cold sweat, particularly in combination with chest discomfort or trouble breathing
    
    
  • Feeling very lightheaded or dizzy, particularly in combination with chest discomfort or trouble breathing
  
  
• You have signs of a stroke: The following signs are an emergency. Call 911 immediately if you have any of the following:
  
  
  • Weakness or numbness in your arm, leg, or face (may be on only one side of your body)
    
    
  • Confusion and problems speaking or understanding speech
    
    
  • A very bad headache that may feel like the worst headache of your life
    
    
  • Not being able to see out of one or both of your eyes
    
    
  • Feeling too dizzy to stand

Learn more about Type 2 Heparin-induced Thrombocytopenia (Discharge Care)