Type 2 Heparin-induced Thrombocytopenia

WHAT YOU SHOULD KNOW:

Type 2 Heparin-induced Thrombocytopenia (Inpatient Care) Care Guide

  • 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.

CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

RISKS:

  • Treatment for Type 2 heparin-induced thrombocytopenia carries certain risks. Medicines used to prevent or treat blood clots may cause bleeding. Surgery to remove blood clots may cause infection and too much bleeding. With this condition, you may get a blood clot in your leg or arm. This can cause pain and swelling, and it can stop blood from flowing where it needs to go in your body. The blood clot can break loose and travel to your lungs. A blood clot in your lungs can cause chest pain and trouble breathing. This problem can be life-threatening.

  • If left untreated, Type 2 HIT may cause long-term problems. This may include gangrene (tissue death), which may lead to amputation (removal) of the affected limb and even death. The sooner HIT is diagnosed and treated, the better chance you have of preventing serious complications. Ask your caregiver if you have any questions about your illness, medicine, or care.

WHILE YOU ARE HERE:

Informed consent

is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.

An IV

is a small tube placed in your vein that is used to give you medicine or liquids.

Medicines:

You may be given the following medicines:

Heparin medicines will need to be stopped. Your caregiver may want to watch for changes in the number of your platelets before starting any treatment. You may have any of the following:
  • Anticoagulant medicines: These medicines are also called blood thinners. Anticoagulants also decrease the effect of thrombin, which is an enzyme that causes blood to clot.

  • Antiplatelet medicines: These medicines work by decreasing the function of platelets, and may be given together with anticoagulants.

Neurologic exam:

This is also called neuro signs, neuro checks, or neuro status. A neurologic exam can show caregivers how well your brain works after an injury or illness. Caregivers will check how your pupils (black dots in the center of each eye) react to light. They may check your memory and how easily you wake up. Your hand grasp and balance may also be tested.

Oxygen:

You may need extra oxygen if your blood oxygen level is lower than it should be. You may get oxygen through a mask placed over your nose and mouth or through small tubes placed in your nostrils. Ask your caregiver before you take off the mask or oxygen tubing.

Tests:

You may need any of the following:

  • Platelet count: This blood test will tell your caregiver how many platelets are in your blood. The blood may be taken from a vein in your hand, arm, or bend in your elbow. You may need to have blood drawn more than once.

  • Immunoassay test: This blood test checks for antibodies to heparin. The presence of these antibodies will help your caregiver diagnose HIT.

Treatment options:

  • Surgery: Surgery to remove clots in a blood vessel may be done, in addition to giving medicines. This surgery is called a thromboembolectomy. Ask your caregiver for more information about surgery as a treatment for heparin-induced thrombocytopenia.

Vital signs:

Caregivers will check your blood pressure, heart rate, breathing rate, and temperature. They will also ask about your pain. These vital signs give caregivers information about your current health.

© 2013 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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