Question

A 45-year-old woman is admitted with deep venous thrombosis and pulmonary embolism. She has received a heparin bolus and has been on a continuous heparin drip for 3 days. If the patient develops heparin-induced thrombocytopenia (HIT), what clinical sign would the nurse expect to see first?

A. Surface bleeding from wounds and IV sites
B. Hematuria
C. Petechiae
D. Bleeding from gums

Answer 1

The nurse should expect to see petechiae as the first clinical sign of heparin-induced thrombocytopenia (HIT). HIT leads to a hypercoagulable state rather than a bleeding tendency, which can cause new thrombotic events instead of excessive bleeding.

Step-by-step explanation:

The question is related to identifying the early clinical sign of heparin-induced thrombocytopenia (HIT) in a patient. Heparin-induced thrombocytopenia is a serious reaction to heparin that involves a drop in platelet count (thrombocytopenia) and, paradoxically, can increase the risk of thrombosis. The clinical signs of HIT typically include new thrombotic events, but petechiae, which are small, non-raised patches that appear on the skin due to bleeding under the skin, are the early signs a nurse may expect to see.

A common misconception is that HIT causes excessive bleeding. However, despite the low platelet count, bleeding symptoms are relatively uncommon in HIT. Instead, patients often present with thrombotic complications due to the hypercoagulable state induced by the formation of antibodies against heparin-platelet factor 4 complexes. Thrombosis can result in embolism, as in the case of pulmonary embolism from a clot or deep vein thrombosis.