病人診斷為深層靜脈栓塞並開始肝素治療，下列哪些情況需要護理師立即通知醫師？（選所有適合的）
A client is diagnosed with deep vein thrombosis and started on heparin. Which findings require the nurse to notify the provider immediately? (Select all that apply.)
- APlatelet count decreased from 250,000 to 100,000/mm³✓ 正解血小板計數從 250,000 降至 100,000/mm³
- BHematuria noted in the urine collection bag✓ 正解尿液收集袋中發現血尿
- CPT/INR result of 1.2PT/INR 結果為 1.2
- DDevelopment of epistaxis✓ 正解出現鼻出血
- EActivated partial thromboplastin time (aPTT) is 45 seconds活化部分凝血活酶時間 (aPTT) 為 45 秒
肝素誘導的血小板低下（HIT）是致命併發症，血小板急速下降需即刻停藥。血尿與流鼻血是臨床出血徵兆，代表抗凝血效果過強，有內出血風險。aPTT 45 秒在治療範圍內，無需特別處理。INR 是監測華法林的指標，與肝素無關。
Heparin-induced thrombocytopenia (HIT) is a fatal complication, and a rapid decrease in platelet count requires immediate discontinuation of the drug. Hematuria and epistaxis are clinical signs of bleeding, indicating excessive anticoagulant effect and a risk of internal bleeding. An aPTT of 45 seconds is within the therapeutic range and requires no special action. INR is used to monitor warfarin therapy and is not related to heparin.
美國抗凝血治療 protocol 嚴謹；台灣臨床對於 heparin 引起的 HIT 警覺性同樣高，但常規監測項目在電子病歷系統中更為規範。