Dr Charles Meares1, Dr Derek Liang1, Dr Aruna Wijewardena1, Prof John Vandervord1
1Royal North Shore Hospital, St Leonards Hospital, Australia
Introduction: Heparin induced thrombocytopenia (HIT) is a severe complication of unfractionated heparin (UFH) and low molecular weight heparin (LMWH) therapy. An autoimmune disorder mediated by heparin-dependent IgG antibodies, it has the potential for widespread arterial or venous thrombotic complications. The aim of this study was to review cases of HITs in a severe burns centre highlighting outcomes and HITs management in the setting of burns.
Case Series: This is a case series of two patients who were managed for HITs whilst admitted with severe burns at Royal North Shore Hospital. A 34 year old male presented with 43% total burn surface area following a gas bottle explosion at home. His stay was complicated by HITs on day 16 post heparin infusion for deep vein thrombosis management. The second patient is a 54 year old male who presented with 45% total burn surface area post welding explosion. HITs was diagnosed day 8 during his admission whilst on UFH for deep vein thrombosis prophylaxis. The patients were managed acutely with different medical therapies for anticoagulation highlighting emerging therapies for HITs treatment in the intensive care setting with no bleeding complications during their admissions.
Conclusion: HITs is difficult to diagnose and a potentially devastating complication of UHF and LMWH therapy. The management of HITs also exposes burns patients to further haematological complications. The acute management of HITs is varied and the burns team must be aware of the options and implications for burns treatment.
Charles Meares is an unaccredited trainee at Royal North Shore Hospital, Sydney.