Heparin-induced thrombocytopenia physical examination

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Shyam Patel [2]

Overview

The physical exam for HIT focuses on the skin, pulmonary, and musculoskeletal exam. These are the common areas of thrombotic manifestations. Bleeding can also occur in these organs. A complete physical exam can help with evaluation of thrombosis or bleeding in other organs.

Physical Examination

Skin Exam

Appearance of the Patient

Patients with heparin induced thrombocytopenia usually appear flushed.

Vital Signs

Fever
Chill
Tachycardia
Tachypnea

Skin

Skin necrosis from thrombotic physiology^[1]^[2]
Petechiae from thrombocytopenia
Purpura from thrombocytopenia
Ecchymoses from thrombocytopenia

HEENT

HEENT examination of patients with heparin induced thrombocytopenia is usually normal.

Neck

Neck examination of patients with heparin induced thrombocytopenia is usually normal.

Lungs

Pulmonary examination of patients with heparin induced thrombocytopenia is usually normal.

Heart

Musculoskeletal Exam

Leg swelling from deep vein thrombosis^[1]
Calf tenderness from deep vein thrombosis

Other Exam Findings

Mucosal bleeding from thrombocytopenia (i.e. oral, nasal, urinary, menstrual, gastrointestinal, or other)
Abdominal tenderness from mesenteric venous thrombosis
Neurologic deficits from cerebral arterial or dural venous sinus thrombosis

Reference

↑ ^1.0 ^1.1 Linkins LA, Dans AL, Moores LK, Bona R, Davidson BL, Schulman S; et al. (2012). “Treatment and prevention of heparin-induced thrombocytopenia: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines”. Chest. 141 (2 Suppl): e495S–e530S. doi:10.1378/chest.11-2303. PMC 3278058. PMID 22315270.
↑ McKenzie SE, Sachais BS (2014). “Advances in the pathophysiology and treatment of heparin-induced thrombocytopenia”. Curr Opin Hematol. 21 (5): 380–7. doi:10.1097/MOH.0000000000000066. PMC 4232774. PMID 24992313.

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[pmid22315270-1] 1.0 ^1.1 Linkins LA, Dans AL, Moores LK, Bona R, Davidson BL, Schulman S; et al. (2012). “Treatment and prevention of heparin-induced thrombocytopenia: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines”. Chest. 141 (2 Suppl): e495S–e530S. doi:10.1378/chest.11-2303. PMC 3278058. PMID 22315270.

[pmid24992313-2] McKenzie SE, Sachais BS (2014). “Advances in the pathophysiology and treatment of heparin-induced thrombocytopenia”. Curr Opin Hematol. 21 (5): 380–7. doi:10.1097/MOH.0000000000000066. PMC 4232774. PMID 24992313.

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