— 降低風險 · MEDIUM · MCQ —
正在接受肝素（heparin）輸注的病人，下列哪項評估結果需立即通知醫師？
Which assessment finding in a client receiving a heparin infusion requires immediate notification of the provider?
- AaPTT value of 60 secondsaPTT 值為 60 秒
- BPlatelet count of 75,000/mm³✓ 正解血小板計數為 75,000/mm³
- CSlight bruising at the IV site靜脈注射部位有輕微瘀青
- DEpistaxis鼻出血
— Explanation · 中文詳解 —
肝素誘發的血小板低下症（HIT）是嚴重的免疫介導副作用。當血小板數值下降超過 50% 或低於 100,000/mm³ 時，必須強烈懷疑 HIT，需立即停止肝素輸注。選項 D 雖為出血徵兆，但 HIT 的致死率與併發血栓風險更高，故 A 為首選。
A platelet count of 75,000/mm³ suggests Heparin-Induced Thrombocytopenia (HIT), a severe immune-mediated reaction that requires immediate cessation of heparin to prevent thrombotic complications. While epistaxis and bruising are expected side effects of anticoagulation, HIT poses a significantly higher risk of morbidity and mortality. The aPTT value of 60 seconds falls within the typical therapeutic range for anticoagulation.
✦ 台美臨床差異
美國醫護團隊對於 HIT 篩檢非常嚴格，通常有自動化的觸發機制；台灣臨床對於 platelet 數值的警覺性亦高，但針對 HIT 的特別處置流程各有差異。