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Reliable, easy-to-read patient information on common medical conditions — written in plain language, free of jargon, and grounded in current evidence. Browse the most frequent diagnoses, understand what they mean for everyday life, and learn which steps and questions help you have a focused conversation with your doctor.

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Heparin-induced thrombocytopenia differential diagnosis

Introduction

Overview

Overview

Heparin-induced thrombocytopenia is diagnosed when the platelet count falls by > 50% typically after 5-10 days of heparin therapy. It should be differentiated by other causes of thrombocytopenia like hemolytic uremic syndrome, thrombotic thrombocytopenia, disseminated intravascular coagulation, post-transfusion purpura, and systemic lupus erythematosis.

Differential diagnosis

Differential diagnosis

HIT must be differentiated from other diseases that present with thrombocytopenia. Please scroll down to view the table.

Characteristic/Parameter HIT DIC HUS[1] Atypical HUS ITP PTP SLE
Symptoms Bleeding, thrombosis, skin necrosis Bleeding, thrombosis, petechiae, sepsis Renal failure, hematuria, bleeding, microangiopathic hemolytic anemia Renal failure, hematuria, bleeding, microangiopathic hemolytic anemia Petechiae, bleeding, other autoimmune diseases Petechiae, purpura, ecchymoses Bleeding, photosensitivity, arthritis, malar rash, discoid rash, renal failure, seizures, psychosis
Platelet count Low but usually more than 20000 per microliter Low Low Low Low; can be as low as 10000 per microliter Low; can be less than 10000 per microliter; sudden onset after transfusion Variable; usually low
PT and PTT Normal Elevated Normal Normal Normal Normal Usually normal
Etiology Heparin exposure Sepsis, delivery of fetus, acute promyelocytic leukemia, other malignancy E.coli strain O157:H7; Shiga-like toxin Dysregulation of complement activation; mutation in complement factor H Idiopathic; can be secondary to chronic lymphocytic leukemia, HIV, viral hepatitis, H. pylori Exposure to transfused products Autoimmunity with development of antibodies to DNA
Drug-related Yes, always Possible No No Yes No; transfusion-related Possible; drug-induced lupus can be caused by medications like hydralazine or isoniazid
Bleeding Possible Usually Usually Usually Yes; spontaneous bleeding if platelet count < 10000 per microliter Yes; spontaneous bleeding if platelet count < 10000 per microliter Rare

Table legend: HIT, heparin-induced thrombocytopenia; DIC, disseminated intravascular coagulation; HUS, hemolytic-uremic syndrome; ITP, immune thrombocytopenia purpura; PTP, post-transfusion purpura; SLE, systemic lupus erythematosis

Reference

Reference

  1. ↑ Jokiranta TS (2017). “HUS and atypical HUS”. Blood. 129 (21): 2847–2856. doi:10.1182/blood-2016-11-709865. PMC 5445567. PMID 28416508.

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Priyamvada Singh, M.B.B.S. [2] Shyam Patel [3]