Heparin induced thrombocytopenia in critically ill: Diagnostic dilemmas and management conundrums

Figure 1 Iceberg model for heparin induced thrombocytopenia syndrome heparin induced thrombocytopenia syndrome as proposed by Warkentin et al[37]. The size of various iceberg sections and the portion seen, can vary in proportion to the other sections depending on the population of patients, preparation of heparin used, etc.

Figure 2 Diagnostic algorithm for Heparin induced thrombocytopenia syndrome. Note that Confirmatory assays for HITS should be considered on the basis of pre test probability rather than ELISA alone. HITS: Heparin induced thrombocytopenia syndrome; SRA : Serotonin release assay. ELISA : Enzyme linked immunosorbent assay.

Figure 3 Suggested approach for patients with heparin induced thrombocytopenia syndrome needing cardiopulmonary bypass. HITS: Heparin induced thrombocytopenia syndrome; CPB: Cardiopulmonary bypass.