The Fellow on Call: The Heme/Onc Podcast Episode 071: Heme Consults Series: Heparin-induced thrombocytopenia (A deeper dive!)
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Aug 30, 2023 In this podcast, they dive deeper into the pathophysiology, diagnosis, and management of heparin-induced thrombocytopenia (HIT). They discuss the risk factors and diagnostic assays for HIT, as well as practical points about its management. The podcast provides an overview of platelets and their role in blood, and explains the importance of optical density in determining SRA positivity. They also cover the challenges in diagnosing and treating HIT.
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Post-Cardiac Surgery HIT Case
- A 55-year-old man underwent cardiac bypass surgery and received large amounts of heparin.
- Post-op, his platelets dropped again with a DVT on day 8, raising concern for HIT.
PF4 Role in HIT Pathogenesis
- Platelets contain alpha granules with proteins, including platelet factor 4 (PF4), which is key in clotting.
- PF4 binds heparin, forming a complex that can activate platelets and lead to thrombosis in HIT.
Antibody-Mediated HIT Mechanism
- HIT arises from antibodies against the heparin-PF4 complex that activate platelets via Fc receptors.
- Not all antibodies cause HIT; pathogenic IgG antibodies induce thrombosis and platelet activation.