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Delayed-onset heparin-induced thrombocytopenia
Maureen A Smythe1, Jennifer L Stephens, Joan C Mattson
1Department of Pharmacy Practice, Wayne State University, William Beaumont Hospital, Royal Oak, MI 48201, USA. msmythe@beaumont.edu
Annals of Emergency Medicine
|March 30, 2005
Summary
Delayed-onset heparin-induced thrombocytopenia (HIT) causes low platelets and clots days after stopping heparin. This immune response to the heparin-platelet factor 4 complex can occur without heparin in the blood.
Area of Science:
- Immunology
- Hematology
- Clinical Medicine
Background:
- Heparin-induced thrombocytopenia (HIT) is a prothrombotic immune disorder.
- Delayed-onset HIT presents with thrombocytopenia and thrombosis after heparin cessation.
Observation:
- Two male patients, aged 88 and 62, presented with symptoms of delayed-onset HIT.
- Thrombocytopenia and thrombosis occurred 9 or more days after heparin discontinuation.
- Platelet counts further decreased upon re-exposure to heparin.
Findings:
- Delayed-onset HIT involves immunoglobulin G antibodies against the heparin-platelet factor 4 complex.
- Antibody reactivity persists in the absence of circulating heparin.
- This syndrome can manifest days after heparin cessation.
Implications:
- Delayed-onset HIT should be considered in patients with recent heparin exposure presenting with thrombosis or thrombocytopenia.
- Early diagnosis and management are crucial for patient outcomes.
- Understanding the pathophysiology aids in differential diagnosis and treatment strategies.