Journal of Medicine and Health Sciences

Faculty of Medicine, Srinakharinwirot

/ Review
University
article
Journal of Medicine and Health Sciences (Vol.15 No.3 December 2008) 115

heparin

heparin-induced thrombocytopenia (HIT)

HIT

:
 Journal of Medicine and Health Sciences
Faculty of Medicine, Srinakharinwirot University
116 (Vol.15 No.3 December 2008)

Heparin-induced thrombocytopenia (HIT)

Chantana Polprasert
Department of Internal medicine, Faculty of medicine, Srinakarinwirot university

Abstract

Heparin-induced thrombocytopenia (HIT) can be found in medical, surgical, obstetrical and

gynecological patients. This condition may cause venous and arterial thrombosis if not recognized and
given prompt management. The diagnosis of HIT needs history taking and laboratory investigation so that
drugs of choice can be specified. This article includes incidence, pathophysiology, diagnosis, laboratory
investigation and proper management about HIT to help clinicians understand this disease better.

Key words: Heparin, thrombocytopenia

Chantana Polprasert
Department of Internal medicine, Faculty of Medicine,
Srinakarinwirot University
62 moo 7 Ongkharak, Nakhon Nayok 26120, Thailand
 Journal of Medicine and Health Sciences
Faculty of Medicine, Srinakharinwirot University
(Vol.15 No.3 December 2008) 117

Heparin
ICU Platelet factor 4(PF4)
Heparin-induced thrombocy- HIT PF4 ?-gran-
topenia (HIT) ule PF4
Glycosaminoglycan (GAG)

HIT antibody heparin

HIT antibody PF4
HIT complex heparin/
heparin PF4/HIT-IgG
10 unfractionated Fc RIIa
heparin low-molecular weight heparin endothelial cell
fondaparinux tissue factor coagulation
antibody platelet factor 4 cascade Thrombin 2,3

HIT HIT 1
(orthopedic)
-
1

1 HIT
= Activated platelet = platelet factor 4 (PF4) = Inactivated platelet
= Glycosaminoglycan (GAG) = HIT antibody (HIT IgG)
 Journal of Medicine and Health Sciences
Faculty of Medicine, Srinakharinwirot University
118 (Vol.15 No.3 December 2008)

(<15x109/L)
heparin heparin
HIT 10-20%
HIT microparticles HIT
HIT
microparticle
HIT antibody heparin
monocyte (
GAG ) tissue factor

4 HIT 4T
(Thrombocytopenia, Time of platelet count fall,
PF4 Thrombosis or other sequelae, other cause for
HIT HIT thrombocytopenia) 15-6 6-8
PF4 heparin 1:1 HIT 4-5
HIT HIT 0-3
HIT 2,3 HIT

HIT
gold standard serotonin
heparin 5-10 releasing assay (SRA)
heparin ( 3 ) SRA
antibody negative predictive value 100%6
10 HIT
15
50% lower limit
55x109/L
6
( 3 )
 Journal of Medicine and Health Sciences
Faculty of Medicine, Srinakharinwirot University
(Vol.15 No.3 December 2008) 119

1 HIT

2 1 0
>50% 30-50% <30%
20-100x109/L 10-19x109/L <10x109/L
5-10
1 ( antibody
heparin
100 ) 10

(skin necrosis)

heparin

5-6
2.2 Serotonin release assay (SRA)
1. Serologic assays
gold standard HIT
Antigen assay ELISA Par-
2.1 [14C]
ticle gel immunoassay (PaGIA)
serotonin
antibody heparin platelet factor 4
sensi-
complexes sensitivity
tivity specificity
90% negative predictive
value positive predictive value
2.3 Platelet activation test
IgG, IgM
IgA IgG
heparin
HIT
positive
heparin
2. Functional assays
0.1-0.5 IU/ml
2.1 Heparin-induced platelet activation (HIPA)
heparin
assay
10 IU/ml
serum HIT antibody
2
heparin
(platelet aggregation)
serum HIT antibody
 Journal of Medicine and Health Sciences
Faculty of Medicine, Srinakharinwirot University
120 (Vol.15 No.3 December 2008)

2 Heparin induced thrombocytopenia (HIT) PaGIA =

particle gel immunoassay
1. anti Xa inhibitor
HIT 50% 1.1 Fondaparinux pentasaccharide
HIT
HIT antibody
HIT
9
heparin
HIT
heparin 1.2 Danaparoid heparan sulfate
dermatan sulfate
1,7,8
Danaparoid
(anticoagulant) HIT HIT 1
 Journal of Medicine and Health Sciences
Faculty of Medicine, Srinakharinwirot University
(Vol.15 No.3 December 2008) 121
2. direct thrombin inhibitor HIT
thrombin
antithrombin ( heparin) warfarin 150,000/
mm3 warfarin
thrombin 5
(short half-life) cross-reactivity INR 48
heparin HIT warfarin (warfarin induced skin
necrosis)1,5
2.1 Argatroban
Argatroban HIT
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 Journal of Medicine and Health Sciences
Faculty of Medicine, Srinakharinwirot University
122 (Vol.15 No.3 December 2008)

8. Norbert Lubenow. New Developments in

Diagnosis and Treatment of Heparin-induced
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