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.
- What is his pre-probability score for HIT?
- What is your differential for the thrombocytopenia?
- What is the next investigative step?
- 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.
