• Gregor Hron, Folke Knutson, Thomas Thiele, Karina Althaus, Christoph Busemann, Sigrun Friesecke, Andreas Greinacher, and Norbert Lubenow.
• Abteilung für Transfusionsmedizin, Institut für Immunologie und Transfusionsemedizin, Ernst-Moritz-Arndt University Greifswald , Germany.
• Ups. J. Med. Sci. 2013 Nov 1; 118 (4): 279-84.

AbstractThrombocytopenia can cause diagnostic challenges in patients who have received heparin. Heparin-induced thrombocytopenia (HIT) is often considered in the differential diagnosis, and a positive screening can be mistaken as confirmation of the disorder. We present two patients who both received low-molecular-weight heparin for several days. In the first patient, clinical judgment rejected the suspicion of HIT despite a positive screening assay, and treatment for the alternative diagnosis of post-transfusion purpura was correctly initiated. In the second patient, the inaccurate diagnosis HIT was pursued due to a positive screening assay, while the alternative diagnosis of drug-dependent thrombocytopenia caused by piperacillin/tazobactam was rejected. This resulted in re-exposure to piperacillin/tazobactam which caused a second episode of severe thrombocytopenia. A positive screening assay for platelet factor 4/heparin-antibody should be verified by a functional assay, especially in patients with low pretest probability for HIT.

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