Tasty Morsels of Critical Care Tasty Morsels of Critical Care 086 | Heparin Induced Thrombocytopaenia
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Mar 3, 2025 Dive into the complexities of Heparin-Induced Thrombocytopenia (HIT), where two forms pose different risks. Type 1 is benign, but Type 2 involves serious immune responses that lead to clotting despite low platelets. Learn how exposure to heparin triggers this condition and the role of platelet factor 4 in generating an immune reaction. The discussion also highlights the importance of proper assessment techniques and alternative anticoagulation strategies for effective management.
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Host Preferred Calling It 'HITS'
- The host initially noted the syndrome as “HITS” to emphasize thrombosis with thrombocytopenia but accepted HIT as the snappier term.
- This framing highlights the clinical importance of thrombosis in the condition.
Type 1 Versus Type 2 Platelet Drops
- Type 1 is a benign, transient platelet drop in the first days of heparin exposure that recovers despite continued heparin.
- Type 2 is immune-mediated and causes thrombocytopenia with a significant thrombotic risk.
PF4 Antibodies Drive Paradoxical Clotting
- Heparin binds platelet factor 4 (PF4) and can provoke IgG against the heparin–PF4 complex.
- IgG labels platelets for destruction and paradoxically activates others, causing arterial and venous thrombosis.