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Heparin-induced thrombocytopenia — SCE Acute Medicine MCQ

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ModerateHaematological EmergenciesHeparin-induced thrombocytopeniaSCE Acute Medicine

A 71-year-old woman presents with fever, bleeding, thrombosis or severe anaemia. Relevant history includes malignancy, chemotherapy, haemoglobinopathy or anticoagulant exposure. On assessment, blood film and coagulation results are abnormal. Investigations show platelet fall by over 50 percent on day 7 with new thrombosis. What is the most appropriate next step in management?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: C — Stop heparin and start a non-heparin anticoagulant

The key discriminator is that platelet fall by over 50 percent on day 7 with new thrombosis, which makes Stop heparin and start a non-heparin anticoagulant the single best answer. Arrange urgent specialist referral is less appropriate because it does not address the dominant acute risk in the vignette; Provide supportive care and close monitoring would fit a different presentation or later stage of care. Give controlled oxygen and senior review and Give analgesia and antiemetic therapy are suboptimal because they would either delay time-critical treatment or follow the wrong acute pathway. Teaching point: SCE-style acute medicine questions usually test prioritisation using physiology, timing and a guideline-defined threshold, rather than isolated factual recall.

Reference: BSH HIT guideline