Heparin-induced thrombocytopenia--a big deal? It should be!

Heparin is the anticoagulant of choice for hemodialysis patients. Risks for developing heparin-induced thrombocytopenia (HIT) are increased in patients regularly receiving heparin. About five to eight per cent of these individuals will develop an adverse antigen-antibody reaction, which will be discussed. As there are many causes of thrombocytopenia, HIT can easily go unnoticed. Tests such as the C-serotonin platelet release assay (SRA) and enzyme-linked immunosorbent assay (ELISA) are available to confirm HIT. Even though these patients may have thrombocytopenia, the threat is not bleeding but thrombosis. In fact, the major concern is that with reexposure to heparin the degree of fibrin clot formation could be severe. Since HIT carries with it a high risk of morbidity and mortality, nurses play a vital role in early diagnosis and prevention of possible life-threatening complications. Management of this heparin allergy includes identifying alternate agents available for use in HIT positive patients. Of the many nursing responsibilities that will be explored, staff and patient education will be emphasized.