hematology Q.

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hematology Q.

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frontal
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11/25/05 - 07:02 AM

A 55 yr old man goes emergency resection of 40 cm of gangrenous proximal jeju. due to mesenteric venous thrombosis. He has smoked two packs of cigarettes daily for 35 years.

Pre-op labs: HEMATOCRIT 40%, TLC 19,000/cu.mm PLATELETS 240,000/cu.mm P.T. 12 SECS, APTT 30 SECS

Post-op he receives heparin and broad spectrum antibiotics. Labs on day 3 post-op: HEMATOCRIT 32%, TLC 12,000, PLATELETS 30,000, PT 12.8 SECS, APTT 65 SECS.

Which is the most likely diagnosis?

A. ACUTE ADRENAL INSUFFICIENCY

B. D.I.C

C. HEPARIN INDUCED THROMBOCYTOPENIA

D. IMMUNE THROMBOCYTOPENIC PURPURA

E. THROMBOTIC '' ''

Please explain your answer.

ARJ
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11/25/05 - 07:36 AM

C. HEPARIN INDUCED THROMBOCYTOPENIA
The most imp point is prolong APTT 65 SECS.

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DrS
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11/25/05 - 07:59 AM

C. HEPARIN INDUCED THROMBOCYTOPENIA

It cannot be acute adrenal insufficiency as there is no mention of hypotension and it has no affect on platelets and APTT

DIC causes prolonged APTT and PT

ITP and TTP have no effect on APTT

ibraheem
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11/25/05 - 07:02 PM

The answer is C.Heparin induced thrombocytopenia.

heparin use the risk of decrease platelet count + thrombosis.

ibraheem
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11/25/05 - 07:24 PM

Hey friends

you can find HIT discussed nicely at this site:

www.postgradmed.com/issues/2002/09_02/rice.htm

Doc2378
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11/25/05 - 10:26 PM

Thanks Ibraheem...I especially liked reading the pathophys... nod

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frontal
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11/27/05 - 12:32 AM

Well done. C it is. Why can't it be a case of D.I.C?

DrS
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11/27/05 - 09:19 AM

frontal, as mentioned in my earlier post DIC causes reduced platelets, prolonged APTT and prolonged PT. However in this patient PT is normal therefore it is unlikely to be DIC.

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