A fictional 68-year-old on heparin after surgery develops a platelet fall and a new painful swollen leg on day seven.
Listen for the assumption.
The platelet count is low, so I will transfuse platelets and continue heparin until the test returns.
What probability tool and immediate action guide suspected HIT?
I will calculate a 4Ts score, stop all heparin if probability is intermediate or high, send appropriate tests and seek haematology advice on alternative anticoagulation.
Choose an answer below and reveal the reasoning to see consultant feedback at every checkpoint. The full consultant-led synthesis follows after all three decisions.
Go to the first decision ↓The picture develops.
- Platelet fall beginning five to ten days after exposure
- New suspected thrombosis
- No active major bleeding
Commit before you reveal.
After you select an option, reveal the model reasoning and the consultant’s feedback.
Hear the senior team refine the plan.
The registrar tests the plan, the consultant synthesises the key principle, and the SHO confirms the safer next steps.
Check every heparin source—flushes, infusions and prophylaxis—and document the score and time of cessation.
The thrombotic risk is the clinical danger. Test interpretation and alternative anticoagulation need haematology input.
I will hand over platelet trend, 4Ts elements, thrombosis assessment, all heparin sources stopped and the specialist plan.
What must remain explicit.
- Use the current BSH/local HIT pathway.
- Document all heparin exposures and the 4Ts assessment.
- Do not routinely transfuse platelets without specialist indication.
Where reasoning fails.
- Ignoring heparin flushes
- Waiting for tests before acting on high probability
- Treating thrombocytopenia without addressing thrombosis
Possible HIT: platelets [baseline/current/timing], 4Ts [components], thrombosis [status], heparin sources [stopped], tests/haematology plan [details].
How would you explain why a low platelet count can coexist with increased clotting risk?