TPN and HIT

Q: Total Parenteral Nutrition (TPN) can be a cause of Heparin-induced thrombocytopenia (HIT)? (select one)

A) True
B) False


Answer: A

Although the American Society for Parenteral and Enteral Nutrition (ASPEN) does not recommend it, there is a sizeable practice of supplementing TPN with low dose heparin to decrease the risk of thrombophlebitis and maintain vascular catheter patency. HIT is independent of dosage and even minor exposure can induce it. This is particularly important to address in patients with a high probability of acquiring HIT or when the cause of HIT is ambiguous.

#hematology
#nutrition



References:

1. Lee E, Lee JO, Lim Y, Kim JY, Kim HK, Bang SM. Thrombocytopenia caused by low-dose heparin supplementation of parenteral nutrition solution. Blood Res. 2013;48(2):160–163. 

2. Tighe MJ, Wong C, Martin IG, McMahon MJ. Do heparin, hydrocortisone, and glyceryl trinitrate influence thrombophlebitis during full intravenous nutrition via a peripheral vein? JPEN J Parenter Enteral Nutr. 1995;19:507–509 

3. Joseph I. Boullata & et al, A.S.P.E.N. Clinical Guidelines: Parenteral Nutrition Ordering, Order Review, Compounding, Labeling, and Dispensing . JPEN 2014, Vol 38, Issue 3, pp. 334–377 (table 1)