3.10.2 - Thrombotic Disorders in Intensive Care

Summary

Key Learning Points

1. 1. Heparin-induced thrombocytopenia (HIT) is very rare.

2. 2. In suspected HIT, a low-risk pre-test probability score has a high negative predictive value, whilst some of the laboratory assays in use have a high rate of false positivity. The 4T score should therefore be calculated first.

3. 3. Thrombotic thrombocytopenic purpura (TTP) is a haematological emergency, with high mortality if untreated. TTP and haemolytic uraemic syndrome (HUS) should be managed in an appropriate tertiary care centre with access to appropriate specialists and where 24-hour plasma exchange facilities are available.

4. 4. Platelets should not be given, unless advised by a haematologist, in acute TTP and HUS, as it may precipitate worsening of the thrombotic complications.

5. 5. Patients who receive eculizumab for HUS should have appropriate meningococcal vaccinations, and commence prophylactic antibiotics for the duration of therapy.