Contemporary standards for the diagnosis and treatment of heparin-induced thrombocytopenia (HIT)

Baldwin, Zachary K.; Spitzer, Austin L.; Ng, Valerie; Harken, Alden H.

doi:10.1016/j.surg.2007.09.036

Cited by 27 publications

(19 citation statements)

References 11 publications

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“…If the platelets are activated by the serum to release serotonin, the serum contains functional anti-heparin-PF4 antibody. 12 Laboratory tests have limited usefulness for the diagnosis of HIT. ELISA is sensitive but less specific than SRA, and SRA is highly specific but less sensitive than ELISA.…”

Section: Discussionmentioning

confidence: 99%

“…The smear showed no evidence indicative of vitamin B 12 and/or folate deficiency, ie, macroovalocytes, megaloblasts, and/or hypersegmented neutrophils, and subsequent blood tests also revealed normal levels. The remarkable degree of thrombocytopenia and the time course of its development are clinically consistent with type II immune-mediated HIT.…”

Section: Which One Of the Following Ismentioning

confidence: 96%

“…Uremia and uremic toxins can interfere with platelet function, but notable thrombocytopenia is not typically associated with uremia. Vitamin B 12 and/or folate deficiency may cause thrombocytopenia. Our patient is an elderly woman with chronic illness (membranous nephropathy).…”

Section: At This Point In the Evaluationmentioning

confidence: 99%

“…Our patient is an elderly woman with chronic illness (membranous nephropathy). Although vitamin B 12 deficiency is rare in the absence of major malabsorption, she could have had chronic poor nutritional intake that might have resulted in folate deficiency and thrombocytopenia. However, the lack of mean corpuscular volume elevation and the relatively rapid onset and progressive nature of thrombocytopenia would not be consistent with chronic nutritional deficiency.…”

Section: At This Point In the Evaluationmentioning

confidence: 99%

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84-Year-Old Woman With Hemodialysis-Associated Shortness of Breath

Kapa

Qian

2009

Mayo Clinic Proceedings

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A n 84-year-old woman was admitted to the hospital for evaluation of shortness of breath, hypoxia, and hypotension occurring during hemodialysis. She had recently been diagnosed as having end-stage renal failure due to membranous nephropathy and had started dialysis treatment 3 weeks previously. She had a history of hypertension, and an echocardiogram obtained 2 weeks before admission showed mild concentric left ventricular hypertrophy. Her medications included a β-blocker and oral phosphate binder. She denied smoking cigarettes or drinking alcohol.Review of her outpatient records revealed that dialysis via a tunneled catheter placed in the right internal jugular vein had been tolerated well initially. In the middle of the second week of treatment, she began to experience shortness of breath associated with hypoxia and hypotension a few minutes after the start of each dialysis, and elevated pressure was noted in the dialysis line at each session. On one occasion, the entire dialyzer was clotted. She had no chest pain, fever, chills, or electrocardiographic changes during these episodes. Although most of her treatments had to be terminated within an hour because the symptoms became intolerable, they abated within 15 to 30 minutes after each session. Fearful of such dialysis-related episodes, the patient was seriously contemplating discontinuing her dialysis treatment.On admission 1 day after the most recent dialysis attempt, physical examination revealed the following: blood pressure, 180/96 mm Hg; pulse rate, 78 beats/min and regular; respiratory rate, 18 breaths/min; and temperature, 36.8°C. Her oxygen saturation was 92% while receiving oxygen at 2 L/min via nasal cannula. Bilateral rales were audible in two-thirds of the lung field bilaterally, and 3+ pitting edema was noted in both lower extremities. . Reaction to the dialyzer or a medication given during dialysisDialysis line infection could be associated with episodic sepsislike illness. In such cases, each dialysis through the infected line results in a transient shower of bacteria from the line into the bloodstream, leading to episodes of fever, chills, and, less frequently, hypotension. For the entire duration of our patient's recurrent dialysis-associated illness, fever and chills were not observed. Therefore, although the possibility of line infection should be ruled out, her presentation is atypical.Fluid overload with pulmonary congestion could cause shortness of breath and hypoxia but should not repeatedly cause hypotension. Dialysis is a well-known efficacious method for removal of excess fluid. In our patient, the removal of excess fluid through dialysis had been curtailed because of the development of hypotension. Thus, fluid overload was a consequence, rather than the cause, of her symptoms.Large-volume uremia-associated pericardial effusion could cause intradialytic hypotension due to tamponade and be associated with shortness of breath and hypoxia. However, this scenario is unlikely in our patient because echocardiography obtained at the onse...

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Section: Discussionmentioning

confidence: 99%

Section: Which One Of the Following Ismentioning

confidence: 96%

Section: At This Point In the Evaluationmentioning

confidence: 99%

Section: At This Point In the Evaluationmentioning

confidence: 99%

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84-Year-Old Woman With Hemodialysis-Associated Shortness of Breath

Kapa

Qian

2009

Mayo Clinic Proceedings

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“…Nevertheless, thrombocytopenia is a common occur rence in 30-50% of ICU patients, so that diagnosis of HIT represents a major challenge [53]. Common reasons for thrombocytopenia in these patients include sepsis, adverse eff ects of drugs, transfusion reactions, and major surgical procedures [54]. Th e development of thrombotic complications under heparin therapy is, there fore, a better indicator of a diagnosis of HIT than uncomplicated thrombocytopenia [3].…”

Section: The Challenge Of Diagnosis and Treatment Of Hit In The Icumentioning

confidence: 99%

Heparin-induced Thrombocytopenia in the ICU: An Overview

Sakr¹

2011

Annual Update in Intensive Care and Emergency Medicine 2011

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Adhesive, Flexible, and Robust Polysaccharide Nanosheets Integrated for Tissue‐Defect Repair

Fujie

Matsutani

Kinoshita

et al. 2009

Adv Funct Materials

166

171

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Recent developments in nanotechnology have led to a method for producing free‐standing polymer nanosheets as a macromolecular organization. Compared with bulk films, the large aspect ratio of such nanosheets leads to unique physical properties, such as transparency, noncovalent adhesion, and high flexibility. Here, a biomedical application of polymer nanosheets consisting of biocompatible and biodegradable polysaccharides is reported. Micro‐scratch and bulge tests indicate that the nanosheets with a thickness of tens of nanometers have sufficient physical adhesiveness and mechanical strength for clinical use. A nanosheet of 75 nm thickness, a critical load of 9.1 × 104 N m−1, and an elastic modulus of 9.6 GPa is used for the minimally invasive repair of a visceral pleural defect in beagle dogs without any pleural adhesion caused by wound repair. For the first time, clinical benefits of sheet‐type nano‐biomaterials based on molecular organization are demonstrated, suggesting that novel therapeutic tools for overlapping tissue wounds will be possible without the need for conventional surgical interventions.

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Contemporary standards for the diagnosis and treatment of heparin-induced thrombocytopenia (HIT)

Cited by 27 publications

References 11 publications

84-Year-Old Woman With Hemodialysis-Associated Shortness of Breath

84-Year-Old Woman With Hemodialysis-Associated Shortness of Breath

Heparin-induced Thrombocytopenia in the ICU: An Overview

Adhesive, Flexible, and Robust Polysaccharide Nanosheets Integrated for Tissue‐Defect Repair

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