The Fellow on Call: The Heme/Onc Podcast New Fellow Bootcamp Series: HIT/HITT
Jul 1, 2024
Dive into the intriguing world of heparin-induced thrombocytopenia (HIT) and its variants! Learn the critical diagnostic tests like ELISA and SRA that differentiate HIT from other conditions. Hear a compelling case study about postoperative challenges in managing anticoagulation. Discover the vital roles of platelets and the 4T score in diagnosing HIT. Also, uncover essential strategies for safely managing HIT patients and the importance of monitoring anticoagulation transitions. Perfect for new hematology/oncology fellows gearing up for their roles!
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Postoperative HIT Case Example
- A 55-year-old cardiac surgery patient developed a DVT and thrombocytopenia on postop day eight.
- His platelet count dropped initially post-op, recovered, then dropped again concurrent with clot development.
HIT Pathogenesis Explained
- HIT results from antibodies to platelet factor 4-heparin complexes activating platelets.
- This activation paradoxically causes thrombosis despite heparin being an anticoagulant.
HIT Antibodies vs. Clinical HIT
- HIT antibodies can exist without clinical disease; many hospitalized patients have antibodies but few develop HIT.
- Hence, clinical context and pretest probability must guide testing to avoid false positives.