The "white clot syndrome" may be manifestation of heparin-induced thrombocytopenia (HIT) encountered by a surgeon following pre-operative or intra-operative administration of heparin.


Clinical features of the white clot syndrome:

(1) The patient has a history of heparin administration prior to or during surgery.

(2) Usually the patient is having cardiac or vascular surgery. Often the patient is having an acute thromboembolectomy for a thrombus caused by HIT.

(3) The surgeon notices the appearance of intra-arterial white-colored clots.

(4) The clots are platelet-rich.

(5) The patient may show signs of thrombocytopenia and/or DIC.

(6) Testing of pre-operative and/or intra-operative blood samples will show anti-heparin antibodies.


Differential diagnosis: Causes of pseudo-HIT (sepsis, antiphospholipid antibody, PNH, DIC from another cause, etc.) need to be excluded.


Prompt recognition is important since the patient needs to be switched to an alternative anticoagulant.


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