Case 1 – update 1

Welcome back team. Thanks for your comments so far.

On reviewing the case notes you find out the following:

  • Mr X has had simple valve replacement but developed acute kidney injury and has been on CVVH for six days now (he is day 7 post theatre/bypass).
  • He is otherwise reasonably well with no evidence of sepsis.
  • The rest of his FBC is normal.
  • His platelet count was normal on admission (234), fell to 83 on day 3 post surgery, rallied to 175 on day 5 but have now fallen rapidly; today’s result is only 48.
  • He has not had any acute reactions to heparin injections, has no skin abnormality and there is no suggestion of thrombosis.

Please answer one of the following questions.

  1. What is his pre-probability score for HIT?
  2. What is your differential for the thrombocytopenia?
  3. What is the next investigative step?
  4. What should we do with the heparin?

Remember to include #teamhaem in your response. Give us your honest opinion: as in clinical life there are rarely right or wrong answers for teamhaem – just controversial topics for debate.

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Online education and discussion about all things haematological
This entry was posted in Anticoagulation, Platelet disorders, Thrombosis and tagged , , . Bookmark the permalink.

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