0
Editorials |

There Is No Such Thing as a “Positive” Antibody TestDiagnosing Heparin-Induced Thrombocytopenia: Diagnosing Heparin-Induced Thrombocytopenia in 2015

Lawrence Rice, MD
Author and Funding Information

From Houston Methodist Hospital and Weill Cornell Medical College.

CORRESPONDENCE TO: Lawrence Rice, MD, Weill Cornell Medical College, 6550 Fannin St, No. 1001, Houston, TX 77030; e-mail: lrice@houstonmethodist.org


FINANCIAL/NONFINANCIAL DISCLOSURES: The author has reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;148(1):1-3. doi:10.1378/chest.15-0737
Text Size: A A A
Published online

Extract

The 65-year-old man with hypertensive renal disease had been on hemodialysis for 3 years. Three days earlier, he underwent procedures for coronary artery bypass grafts and placement of a bioprosthetic aortic valve. Admission platelet count was 210 × 103; now it was 105 × 103. Extubated that morning, he was considered to be doing well. I reviewed the chart while my fellow and the nurse were peeling the “No Heparin” sign off the head of the bed.

The onset of heparin-induced thrombocytopenia (HIT) occurs 5 to 12 days after beginning heparin exposure. Patients may develop HIT in the first 2 weeks after dialysis initiation, but it is very unlikely to occur later with the chronic heparin exposure. (In relatively rare cases, the massive heparin and platelet factor 4 release during cardiac surgery “resets the clock.”) Heart surgery may be the most common precipitating factor for HIT, but there are challenges to establishing the diagnosis in this scenario.1 One challenge is that on-pump heart surgery is expected to lower platelets 25% to 50% with a nadir 2 to 3 days post operation.2 So-called “dilutional thrombocytopenia” likely results from platelets battered in the extracorporeal circuit being removed from the circulation before megakaryocytes react. With long pump runs (such as with valve replacement), platelet counts may fall lower. The patient clearly had a very low risk of HIT (and did not need argatroban).

First Page Preview

View Large
First page PDF preview

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
PubMed Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543