— 降低風險 · MEDIUM · MCQ —
護理師評估一位正接受肝素（heparin）治療的深層靜脈栓塞病人。下列哪項實驗室數據需要立即通知醫師？
A nurse is assessing a client with a history of deep vein thrombosis (DVT) who is receiving heparin therapy. Which laboratory result requires immediate notification of the provider?
- AINR 1.2INR 1.2
- BHemoglobin 13 g/dL血紅素 13 g/dL
- CaPTT 75 secondsaPTT 75 秒
- DPlatelet count 80,000/mm³✓ 正解血小板計數 80,000/mm³
— Explanation · 中文詳解 —
接受肝素治療的病人，血小板數目顯著下降（<100,000/mm³ 或下降幅度達 50%）是肝素引起之血小板低下症（HIT）的警訊。這是一種嚴重的免疫性併發症，會導致矛盾性血栓形成，必須立即停藥並通知醫師。aPTT 75 秒通常在治療範圍內，INR 則是用於監測華法林而非肝素。
A platelet count of 80,000/mm³ indicates a significant drop, which is a hallmark sign of Heparin-Induced Thrombocytopenia (HIT). This serious immune-mediated complication requires immediate discontinuation of heparin and provider notification to prevent life-threatening thromboembolic events.
✦ 台美臨床差異
美國醫院多由藥師或護理師依 protocol 調整劑量；台灣通常由醫師依數據下醫囑調整。