Heparin-Induced Thrombocytopenia among Patients Given High Nutritive Fluid

Choi, Soo An; Namgung, Hyoung Uk; Lee, Eun Sook; Park, Do Joong; Han, Ho Seoung; Shin, Whan Gyoon

Abstract

Thrombocytopenia is common in hospitalized patients receiving unfractionated heparin. However, only a minority have heparin-induced thrombocytopenia (HIT). HIT is a serious complication after heparin therapy that can cause serious morbidity and mortality. One or three percent of patients given therapeutic intravenous doses of heparin develop this complication. Although much smaller doses of heparin are also known to cause thrombocytopenia, only a limited number of cases have been reported in the literature and the true incidence is unknown. A recent study reported that 12 out of 19 critically ill surgical patients diagnosed with HIT had been exposed to only 120 to 240 units/day of heparin through a flushs catheter. However, in a clinical environment, the heparin used for flushing vascular access devices, or as components of total parenteral nutrition (TPN) can be overlooked. Even if these cases are rare, the widespread use of TPN suggests that clinicians are likely to encounter this problem. Furthermore, the appearance of thrombosis or thrombocytopenia may not seem surprising because patients receiving TPN usually have serious medical conditions, the appearance of thrombosis or thrombocytopenia may not seem surprising. We encountered three patients with clinical evidence of HIT secondary to daily TPN supplementation. The case studies presented in this study introduce the experience of Nutrition Support Committee (NSC) of Seoul National University Bundang Hospital, which may help readers evaluate and recognize this complicated syndrome. When thrombocytopenia occurs, heparin as a TPN component may either not be initially suspected as a cause of thrombocytopenia or go unnoticed. This oversight may result in delayed treatment for HIT, which can cause serious morbidity and mortality. NSC should consider the occurrence of HIT in patients who experience a decrease in platelet count while receiving TPN. Heparin as a component of TPN should be discontinued if HIT is suspected, regardless of whether there is evidence of thrombosis, and alternative anticoagulation therapy should be started.