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 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.

Anticoagulants are a type of blood thinner medicine that helps prevent clots. Clots can cause strokes, heart attacks, and death. These medicines may cause you to bleed or bruise more easily.
  • Watch for bleeding from your gums or nose. Watch for blood in your urine and bowel movements. Use a soft washcloth and a soft toothbrush. If you shave, use an electric razor. Avoid activities that can cause bruising or bleeding.

  • Tell your caregiver about all medicines you take because many medicines cannot be used with anticoagulants. Do not start or stop any medicines unless your caregiver tells you to. Tell your dentist and other caregivers that you take anticoagulants. Wear a bracelet or necklace that says you take this medicine.

  • You will need regular blood tests so your caregiver can decide how much medicine you need. Take anticoagulants exactly as directed. Tell your caregiver right away if you forget to take the medicine, or if you take too much.

  • If you take warfarin, some foods can change how your blood clots. Do not make major changes to your diet while you take warfarin. Warfarin works best when you eat about the same amount of vitamin K every day. Vitamin K is found in green leafy vegetables, broccoli, grapes, and other foods. Ask for more information about what to eat when you take warfarin.
  • 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.

  • You have any of the following signs of a heart attack:

    • Squeezing, pressure, or pain in your chest that lasts longer than 5 minutes or returns

    • Discomfort or pain in your back, neck, jaw, stomach, or arm

    • Trouble breathing

    • Nausea or vomiting

    • Lightheadedness or a sudden cold sweat, especially with chest pain or trouble breathing

  • You have any of the following signs of a stroke:

    • Numbness or drooping on one side of your face

    • Weakness in an arm or leg

    • Confusion or difficulty speaking

    • Dizziness, a severe headache, or vision loss

© 2014 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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