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  • 3.10.2 - Thrombotic Disorders in Intensive Care

  • from Section 3.10 - Haematological and Oncological Disorders
  • Edited by Ned Gilbert-Kawai, The Royal Liverpool Hospital, Debashish Dutta, Princess Alexandra Hospital NHS Trust, Harlow, Carl Waldmann, Royal Berkshire Hospital, Reading
  • Book:
    Intensive Care Medicine
    Published online:
    27 July 2023
    Print publication:
    01 December 2021, pp 331-332

  • 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.