# A client receiving unfractionated heparin for 6 days has a platelet decline from 240,000/mm³ to 92,000/mm³ and new painful unilateral calf swelling. Complete the priority plan.

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> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## Question

A client receiving unfractionated heparin for 6 days has a platelet decline from 240,000/mm³ to 92,000/mm³ and new painful unilateral calf swelling. Complete the priority plan.

The nurse should suspect ::선택::heparin-induced thrombocytopenia with thrombosisan expected heparin responsedietary vitamin K excessbenign bruising only, ::선택::continue the infusion but stop laboratory monitoringstop all heparin products, including heparin flushesgive the next heparin dose earlymassage the swollen calf, ::선택::wait for a final functional assay before notifying anyoneapply sequential compression to the swollen calf before evaluationnotify the provider and anticipate a non-heparin anticoagulant while HIT testing proceedsgive aspirin as the only treatment, and ::선택::avoid starting warfarin before platelet recovery and avoid routine platelet transfusion without bleedingstart warfarin immediately while platelets are fallingtransfuse platelets routinely despite no bleedingresume heparin when calf pain improves.

## Explanation

A platelet decline greater than 50% beginning 5 to 10 days after heparin exposure, together with a new thrombosis, creates a high clinical probability of heparin-induced thrombocytopenia with thrombosis. Stop every source of heparin immediately, including infusions, injections, and heparin flushes. Notify the provider and anticipate a non-heparin anticoagulant while the 4Ts-based diagnostic pathway and PF4 immunoassay proceed; do not wait for confirmatory testing when probability is intermediate or high. Avoid initiating warfarin before platelet recovery, and do not give routine platelet transfusions in the absence of active or high-risk bleeding because HIT is primarily prothrombotic rather than a simple bleeding disorder.

## In-depth explanation

Correct Answer
Suspect HIT with thrombosis, stop all heparin including flushes, escalate for a non-heparin anticoagulant while testing proceeds, and avoid premature warfarin or routine platelet transfusion without bleeding.

Why It Fits
The platelet count fell by more than 50% during days 5 to 10 of heparin exposure, and a new painful swollen calf suggests thrombosis. This pattern is strongly prothrombotic even though the platelet count is low.

Clinical Picture
HIT is an antibody-driven platelet activation syndrome. Platelets are consumed while clotting accelerates, so the danger is a new venous or arterial clot rather than bleeding alone.

Memory Link
HIT: half the platelets, days 5 to 10, new thrombosis; stop all heparin and start a non-heparin anticoagulant.

NCLEX Rule
When clinical probability is intermediate or high, stop heparin and begin the ordered alternative anticoagulant while testing proceeds. Do not massage the swollen calf or wait for a final functional assay before protecting the client.

Why the Alternatives Fail
Continuing a heparin infusion or flush can perpetuate the immune reaction. Warfarin before platelet recovery can worsen thrombosis. Routine platelet transfusion is not the default response when there is no bleeding.

Source
1ASH Guideline: Heparin-Induced Thrombocytopenia

## Clinical scenario

The platelet count has fallen by more than 50% during the typical immune HIT window. The client has no active bleeding, and urgent evaluation for a new venous thrombosis is underway.

## Key concepts

- **HIT** — Immune-mediated heparin reaction causing thrombocytopenia and thrombosis risk.
- **Platelet Count** — Blood test measuring platelets involved in clotting.
- **Thrombosis** — Formation of a blood clot in a blood vessel.

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