Case 18d

Part 4 Answers...and the end
 
Stop heparin, call haematologist, they will almost certainly have looked at the blood film by now which will give them useful information.
Order “HIT” screen

2 main elements to HIT, thrombosis (from platelets) and bleeding from thrombocytopaenia.  Treatment with a thrombin inhibitor (Argatroban) to remove stimulus to consume platelets and at the same time to prevent thrombosis
 
HIT is pretty complicated, confusing (why do you need to anticoagulate some-one who might also bleed)….get help from haematology.  Here are 2 sources of information about HIT
 
http://teamhaem.com/2015/02/20/case-32-summary/
http://www.bloodjournal.org/content/119/10/2209?sso-checked=true