امرأة عمرها ٦٦ سنة على هيبارين منذ ٧ أيام بعد جراحة. الصفائح نزلت من ٢٨٠ ألفاً إلى ٩٥ ألفاً، وظهرت عندها جلطة جديدة في الساق. ما الأرجح وما الإجراء؟

A 66-year-old has been on heparin for 7 days after surgery. Platelets fell from 280,000 to 95,000 and she has a new leg clot. What is likely and what is done?

1. Ordinary thrombocytopenia; continue heparin
2. ITP; steroids only
3. Heparin-induced thrombocytopenia; stop all heparin
4. DIC; immediate platelet transfusion

Answer: C) Heparin-induced thrombocytopenia; stop all heparin. A platelet fall over 50% 5–10 days into heparin with new thrombosis indicates HIT; all heparin (including flushes) is stopped and an alternative anticoagulant started.