Monday April 23, 2007
Proposed iceberg model for HIT and HITT



Heparin-Induced Thrombocytopenia (HIT) still remains one of the most underdiagnosed condition in ICUs. Recently an iceberg model has been proposed for Heparin-Induced Thrombocytopenia (HIT) and Heparin-Induced Thrombocytopenia and Thrombosis (HITT). As there may be many patients who may have HIT but not HITT. There may be patients, who just have seroconversions and others who may have full blown thromboses at other end.


Review article on HIT: When Heparins Promote Thrombosis - Review of Heparin-Induced Thrombocytopenia (Circulation. 2005;111:2671-2683.)


Related previous pearl: 4 Ts of HIT

Saturday April 21, 2007
Resistant (uncontrolled) / Life-threatening diffuse alveolar hemorrhage

Diffuse alveolar hemorrhage remained a condition with high mortality. Usual treatment is high dose IV methylprednisolone (1g/day) for three to five days and in more severe cases to add IV cyclophosphamide (cyclophosphamide has a delayed effect, but may provide synergistic action with steroid). Plasmapheresis has been described to be effective particularly in diffuse alveolar hemorrhage associated with Goodpasture syndrome.

But what if bleeding is non-stop and life-threatening ?

Answer is off label use of activated Factor VII (Novoseven). In 3 cases reported from University of North Carolina at Chapel Hill - bleeding stops and oxygenation improved within minutes 1.


Reference: click to get abstract

Successful Treatment of Diffuse Alveolar Hemorrhage with Activated Factor VII - annals, 16 March 2004 Volume 140 Issue 6 Pages 493-494