Page 208 - Critical Care Notes

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HEMA/
ONCO
■ Heparin-induced platelet aggregation assay
■ Platelet activation assay (C-SRA; heparin-induced platelet activation assay)
Management
■ Discontinue all heparin products.
■ Administer IV direct thrombin inhibitor for anticoagulation:
■ Lepirudin (Refludan)
■ Hirudin
■ Fondaparinux ( Arixtra)
■ Argatroban (Acova)
■ Bivalirudin (Angiomax)
■ Danaparoid (not available in the United States)
■ CBC: monitor platelet count.
■ Platelet transfusions may be needed if platelet count is low or spontaneous
bleeding occurs.
■ Once platelet count has increased to at least 150,000/mcL AND the patient
has been stably anticoagulated with a thrombin-specific inhibitor, initiate
Coumadin therapy.
■ Provide a complete skin and neurovascular assessment.
■ Review patient’s medication list to avoid aspirin-containing products,
NSAIDs, and antiplatelet agents.
■ Provide support to patient and family.
■ If a diagnosis of HIT has been made, heparin “allergy” should be included
in patient’s record, and a sign should be posted at bedside.
Neutropenia
Neutropenia is an abnormally low absolute neutrophil count.
Pathophysiology
■ Neutropenia is caused by problems with neutrophil production and/or prob-
lems with neutrophil distribution as a result of infection, treatment, or drugs:
■ Decreased production of neutrophils caused by aplastic anemia, medica-
tions or toxins, metastatic cancer, lymphoma or leukemia, myelodysplas-
tic syndrome, chemotherapy, or radiation.
■ Increased destruction of neutrophils (medication induced), resulting from
immunological disease (e.g., systemic lupus erythematosus), viral dis-
ease (e.g., infectious hepatitis, mononucleosis), or bacterial infection.
■ Interruption of neutrophil production or neutrophil distribution → decrease
in neutrophil count.

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