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Teachable Moment
Less Is More
May 2016

Indiscriminate Testing for Heparin-Induced ThrombocytopeniaA Teachable Moment

Author Affiliations
  • 1Department of Internal Medicine, The University of Texas Health Science Center at Houston, Houston
  • 2Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston
  • 3Section of Benign Hematology, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston
JAMA Intern Med. 2016;176(5):592-593. doi:10.1001/jamainternmed.2016.0363

A 58-year-old man with alcohol abuse, chronic anemia, and a history of peptic ulcers was admitted for sepsis from community-acquired pneumonia. He was started on empirical antibiotics and unfractionated heparin for deep vein thrombosis prophylaxis. Over the first 2 days he did not show any clinical improvement and continued to be hypoxic. On the third day of admission his platelet count dropped to 98 × 109/L from 164 × 109/L at admission. A heparin-induced thrombocytopenia (HIT) enzyme immunoassay for heparin-platelet factor-4 was ordered. Over the next day, his hypoxia and tachypnea worsened. He was transferred to the intensive care unit (ICU) for sepsis with acute respiratory distress syndrome requiring intubation and mechanical ventilation.

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