Clotting: Heparin-induced Thrombocytopenia

Question 1

What is the acronym for heparin-induced thrombocytopenia?

Answer 1

HIT

Question 2

Does heparin occur naturally in our bodies?

Answer 2

Yes. It occurs in human tissues and inflammatory cells. It can react directly with platelets, causing them to agglutinate (clump), and be removed from circulation by phagocytosis.

Question 3

What type of thrombocytopenia does type I HIT cause?

Answer 3

Mild

Question 4

What type of thrombocytopenia does Type II HIT cause?

Answer 4

Severe. The heparin forms an immune complex with a platelet protein known as platelet factor 4. This creates antibody production. The antibodies bind with the heparin-PF4 complex and cause the platelets to clump together and remove them from circulation.= thrombocytopenia

Question 5

What can happen to small pieces of platelets in TYpe II HIT?

Answer 5

They can break loose, start the clotting cascade, and make a thrombosis.

Question 6

What are the manifestations of HIT?

Answer 6

1. bleeding
2. arterial thrombosis
3. venous thrombosis
4. rare: an acute inflammatory response that has manifestations like PE (fever, chills, hypertension, tachycardia, dyspnea, chest pain, and cardiopulmonary arrest

Question 7

what are the manifestations of arterial thrombosis?

Answer 7

1. severe pain
2. paresthesia
3. pallor and cool skin
4. pulselessness distal to the arterial occlusion

Question 8

What are the signs of Venous thrombosis?

Answer 8

1. edema
2. redness
3. warmth of the affected area

Question 9

What are the diagnostic tests used to diagnose thrombocytopenia?

Answer 9

1. CBC with platelet count
2. antinuclear antibodies
3. Serologic studies (specifically for HIT)
4. Bone marrow examination

Question 10

What medications can be used to treat thrombocytopenia?

Answer 10

1. Oral glucocorticoids (prednisone) to suppress the autoimmune response
2. Immunosuppressive drugs (azathioprine, cyclophosphamide, cyclosporine)
3. Nonheparin anticoagulants (lepirudin)
4. Argatroban (synthetic direct thrombin inhibitor)

Question 11

What other treatments can be used for thrombocytopenia?

Answer 11

1. Removing or replacing heparin use
2. platelet transfusion
3. Plasmapheresis (plasma exchange therapy)

Question 12

What is plasma exchange therapy (plasmapheresis)?

Answer 12

the pt’s plasma is removed and replaced with fresh frozen plasma to remove autoantibodies, immune complexes, and toxins

Question 13

What in the health hx should be assessed for someone with thrombocytopenia or HIT?

Answer 13

1. complaints of bruising with minor or no trauma
2. bleeding gums
3. nose bleeds
4. heavy or prolonged menstrual periods
5. black, tarry, or bloody stools
6. blood in vomit
7. headache
8. fever
9. Change in LOC
10. recent weight loss,
11. recent viral or other illness
12. current and recent meds
13. exposure to toxins
14. previous exposure to heparin

Question 14

What should be assessed in the physical assessment for thrombocytopenia or HIT?

Answer 14

1. skin and mucous membranes for color, temp, petechia, purpura, bruising
2. VS
3. weight
4. LOC
5. Heart and breath sounds
6. abdominal exam
7. body fluid for occult blood

Question 15

What are the nursing interventions for thrombocytopenia or HIT?

Answer 15

1. watch for manifestations (petechia, bruising, blood in urine, BMs, or gums, etc.)
2. soft bristle toothbrush
3. electric razor
4. no contact sports or hazardous activities
5. avoid meds that would interfere with platelet function
6. apply pressure to puncture sites for 3-5 minutes (ABG sites 15-20 mintues)
7. avoid forcefully blowing the nose or picking crusts from the nose, straining for BM, and forcefully coughing or sneezing

Question 16

What are some nursing interventions for impaired oral mucous membranes with thrombocytopenia or HIT?

Answer 16

1. look for signs of bleeding or pain in oral mucosa
2. soft-bristle toothbrush or sponge
3. rinse mouth with saline every 2-4 hours. use Vaseline on lips to prevent dryness and cracking
4. avoid alcohol-based mouthwashes, very hot foods, alcohol, and crusty foods (traumatizes oral mucosa)
5. Drink cool liquids every 2 hours

Question 17

What are some OTC medications that may interfere with platelet function?

Answer 17

1. aspirin and salicylates (Alka-seltzer, Bufferin, Excedrin, Midol, Pepto-Bismol)
2. NSAIDS (Advil, Aleve, Nuprin, pamprin IB)

Question 18

What are some prescription meds that can interfere with platelet function?

Answer 18

1. aspirin-containing analgesics
2. chemotherapy drugs
3. antibiotics (penicillin)
4. Carbamazepine
5. Gold salts
6. heparin
7. sulfonamides
8. thiazide diuretics

Question 19

What are the priorities of care with HIT?

Answer 19

1. ensure adequate treatment of underlying process while providing care
2. inadequate platelets impair hemostasis placing the pt at risk for bleeding
3. early identification of bleeding is important to prevent serious blood loss and shock
4. pt will remain free of any evidence of new bleeding and take precautions to prevent bleeding

Question 20

What is some safety rules related to HIT?

Answer 20

1. avoid invasive procedures
2. avoid diagnostics such as a biopsy or lumbar puncture if the platelet count is less than 50,000 mm3
3. avoid procedures that use large-bore needles until the platelet count is increased
4. apply pressure to puncture sites for 3-5 minutes (ABG sites 15-20 minutes)