4Ts Score for Heparin-Induced Thrombocytopenia


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4Ts Score for Heparin-Induced Thrombocytopenia

Consider that you are running on a street and suddenly fall down after losing balance. If your knee or elbows get bruised, the skin would start bleeding but this would not be for a long time span. Eventually, there would be a hard skin on the wound which would stop the loss of blood. This clot is a result of body platelets. What are platelets and how do they help in reducing blood loss after an injury.

Platelets and their function to create clots

As it is mentioned above, when you fall and the skin gets bruised, it starts to bleed and as soon as the clot is created by platelets, there is no further loss of blood. Now, here, before you go into the details, you should understand what platelets are.

  • Platelets are blood cells without any colour and key role is to stop bleeding irrespective of the cause. People who suffer from Heparin-Induced Thrombocytopenia have loss of platelets also termed as reduced platelet count. Such patients can have blood flowing out for abnormally long durations. In worst cases, the effected person can die as well. The loss of blood can be due to a disease as well. For instance, most patients who suffer from leukaemia also have the Heparin-Induced Thrombocytopenia issue. In worst situations, blood starts coming out from various parts of the body including nose, ears, eyes and gums. The flow of blood cannot be stopped because the platelets are insufficient for creating the required clot.
  • Patients who suffer from the Heparin-Induced Thrombocytopenia issue have to keep a check on their platelet count at all times. The moment it goes below the minimum limit, blood would start flowing from different parts of the body.

Understanding the 4T’s score

Medical professionals reach a conclusion whether a patient is suffering from a medical problem or not after performing certain tests. In other words, an end to end diagnosis is needed so that the specific medical condition. To check whether an individual is suffering from Heparin-Induced Thrombocytopenia or not, the 4 T’s test is performed. On the basis of the score which an individual gets, it becomes more apparent whether he or she has this health issue or not.

The core questions of 4T’s test

As it is mentioned above, before the treatment of a disease is initiated, it is important to get an end to end diagnosis done. A medical expert would only begin treatment when the diagnosis has been completed properly. In case of Heparin-Induced Thrombocytopenia, the 4 T’s test is performed to know whether the patient has a problem or not. Let us go through each of these questions.

1. Checking Thrombocytopenia through platelet count fall

In the first testing stage, the platelet count of the individual is checked. The patient has to provide details and a score is provided against the range he falls in. If the platelet count is greater than 50 per cent, a score of 2 is registered against the question. If the platelet count is between 30 and 50 per cent, a score of 1 is registered against the question. Similarly, if the count is less than 30 per cent, a score of zero is registered. Once this question has been completed, you can move ahead to the next question.

2. Timing of Platelet count fall

This question of the 4T’s test is related to the timing of platelet count fall. Each patient is analysed on the basis of the timing he has. If a clear onset is noticed between days 5 and 10, a score of 2 is placed against the question. If the onset is consistent between 5 and 10 days but there is no clarity, a score of 1 is registered. The best case is when there is no recent exposure and the platelet count is less than or equal to 4 days. In this scenario, a score of 0 is registered against the question.

3. Checking symbiosis and other sequlae

The third question is related to checking symbiosis. Like all other questions, this question of the test also has three benchmarks. If new symbiosis is noticed, a score of 2 is registered against the question. If there is consistent symbiosis, a score of 1 is placed. The third scenario is when no symbiosis is present. For this scenario, a score of 0 is registered. Once the selection is made, you can move on to the last question of the 4T’s test.

4. Checking other causes

This question is related to other possible causes of Thrombocytopenia. If there are any possibilities, a score of 2 is registered against the question. Similarly, if there is a possibility, a score of 1 is registered. The best scenario is that there is a definite conclusion about no causes being present. In that case, a score of zero is registered.

Test Interpretations

When the test has been performed, you can move towards the interpretations. Based on the scores you have attained against each question, a total will be calculated. Each score would have a result interpretation against it.

  • If the overall score is less than or equal to 3, there is a low probability that the patient would be suffering from Thrombocytopenia.
  • It the total score lies between 4 and 5, there is a medium probability of the disease being there.
  • If the total score is between 6 and 8, the patient has a high probability of suffering from Thrombocytopenia.

Symptoms and Causes

It is essential for one to be aware of the causes and symptoms of a disease. This is absolutely necessary if you want the treatment to be done properly without any delays or issues. If you do not have a clear idea about the symptoms, you would not get the assurance about whether you are suffering from the problem or not. Not knowing about the symptoms also means that you may not visit the medical expert. As a result, the condition may worsen. Knowledge about causes should also be there if you want to know why the disease was caused in the first place.

Key symptoms

Here are the main symptoms of Thrombocytopenia. If all or even one is present, you have to take it as an alarming sign.

1. Bruises without strong reasons

It is obvious that the skin gets bruised when you fall on the ground or the skin is rubbed against a hard surface. However, if your skin gets bruised even when it rubs against soft surfaces, it is something which you need to worry about. This can be one of the symptoms that you are suffering from Thrombocytopenia. In such cases, the skin layers break easily when you rub against or even touch a surface. If you notice any of these symptoms, the first thing you need to do is get in touch with a medical expert. Ignoring these signs or overlooking them can worsen your condition. Timely examination is obviously an important task.

2. Continuous flowing of blood without any reason

When we get hurt and the skin is bruised, the affected area may start bleeding. If you are not suffering from Thrombocytopenia, a clot would be formed after sometime by the platelets in the body. This would result in a hard skin covering the damaged area. However, a clot would only be formed when you have platelets in your body. Thus, if you see that there is blood flowing from your gums, nose or an injured area for a long time. There is every chance that there is deficiency of platelets in your body. If you see this symptom, talk to a medical expert. Most medical experts would tell you to opt for the 4T’s test.

3. Blood deposits in urine and tool

The symptoms of various diseases are witnessed through blood and stool. In case of Thrombocytopenia as, keep a check on the urine and stool deposits, if you witness that there are blood deposits in them, you may be having deficiency of platelets in the human body. Do not ignore this symptom and approach a medical expert as soon as this symptom is witnessed.

  • Blood deposits may also occur in the urine due to the internal skin withering off. This happens when you have not consumed enough water or there are stones in the kidney. However, if you are going through these issues, the blood deposits are for a small duration. If you see that this problem is consistent and you are getting these deposits at regular intervals, there is every chance that you may be suffering from Thrombocytopenia. Consulting a medical expert is the best way out when you witness this issue.
  • Patients of Thrombocytopenia have deposits of blood in the urine and stool because they have deficiency of platelets. Thus, the flow of blood is abnormal. When there is deficiency of platelets, blood flows from multiple openings of the body including anus and urinary track. Regular blood deposits increase the probability of Thrombocytopenia.

4. Regular jaundice

Jaundice can turn into a serious complication if not treated properly on time. In some situations, it is more of a symptom than an individual disease. Thus, if you are infected by it, getting regular tests is a necessity. When a person is infected by jaundice, he gets deep yellow urine. Along with that, the ability to digest food gets affected in an adverse manner. People who have this infection should get in touch with medical experts without any delay. Delaying treatment can cause serious health issues for the patient.

5. Heavy flows in mensuration for females

As it is mentioned above, people who suffer from Thrombocytopenia have heavy blood deposits from different body outputs, In case of females, these outputs are also witnessed during the mensuration cycle. When females go through the mensuration cycle, they have deposits of blood. However, there is a maximum quantity benchmark in normal cases. If the blood deposits are overly large, lack of platelets may be a key reason. If you witness that you are getting abnormally high deposits during the mensuration cycle, it is important to see a medical expert for testing and treatment purposes.

6. Heavy blood outflows from gums and nose

People who suffer from Thrombocytopenia have lack of platelets. This basically reduces the process of clotting or even eliminates it completely. In other words, blood becomes overly thing and flows out from every exit available. In most cases, patients witness heavy blood outflows from the gums and nose. If you have this symptom, talking to a medical expert is the first thing that needs to be done. Get in touch with a doctor if you see that blood is outflowing from these two body exits without any injury taking place.

Possible Causes

An individual does not get affected by a disease without proper causes. Thrombocytopenia also has its set of causes. For any patient, it is important to know the factors which resulted in platelet deficiency. This obviously helps in prevention and relapse after the treatment has been completed.
Given below are some core causes of Thrombocytopenia

1. Regular heavy consumption of alcohol

There is no doubt that the consumption of alcohol gives birth to several diseases and Thrombocytopenia is one of them. People who consume alcohol regularly have greater chances of developing deficiency of platelets. If you are an alcohol consumer, it is always better to stop it so that the chances of various diseases including Thrombocytopenia can be decreased. In an overall manner, the consumption of alcohol decreases the immunity of the body due to which the chances of Thrombocytopenia increase automatically.

2. Medication given during cancer treatments

Cancer patients have to undergo serious medication through the process of chemotherapy. These medications do treat cancer but increase body weakness. In addition to that, during cancer treatment, platelets get affected in large numbers. As a result, a lot of cancer survivors have serious deficiencies of platelets. Due to this reason, they get infected by Thrombocytopenia.

3. Patients of Hepatitis C get affected

There is no doubt that Hepatitis C is a serious medical disease. If it is not treated on time, the patient can die within a short span of time. One of the other adverse effects of this disease is Thrombocytopenia. There is no doubt that just like cancer, Hepatitis C has a damaging effect on the overall body immunity. The body immunity depends a lot on the status of platelets in the human body. You need to understand that platelets act as sources of immunity for the human body. Any disease which would have an adverse effect on the immunity of the body would impact the platelet count as well. The moment the platelet count of the body goes below the minimum limit, you would see blood flowing out from different parts of the body.

4. Patients of Leukaemia

There is no doubt that Leukaemia is a serious medical disease that can cause massive damage if proper treatment is not given on time. The disease has several adverse effects as well including the increase of platelet deficiency. This does happen because people who suffer from this disease are physically very weak. Hence, the count of platelets in their body is quite low.


Like other blood related diseases, thrombocytopenia also has its own set of prescribed treatments. The important aspect is that patients should be treated on time and according to the nature of problem being faced.

In most cases, medical drugs are given to increase the count to platelets so that the clot process can be executed normally. However, this option does not work if the condition of the patient has worsened a lot. Medicines slow down the process of blood outflows.

Blood transfusion Alternative

As it is mentioned above, medication does not work for all patients. Hence to handle severe case, the blood transfusion alternative method works well. Through this option platelets are added to the human body to cover the lost blood. In worst case scenarios, this option has to be repeated multiple times until the condition of the patient gets normal.

Using a 4T calculator to check thrombocytopenia

The diagnosis of thrombocytopenia depends a lot on the use of a proper calculator. Now, here you need to be careful and use an option which is completely dependable. Calculators.Tech has one of the best alternatives in this relation. You can access this online calculator and know about the correct condition of platelet count.

Process use the 4T calculator

The overall process of this calculator is very simple. You simply need to enter few core medical details and the probability of having thrombocytopenia would be displayed on your screen. The probability is categorized into low, medium and high. A patient is categorized on the basis of the score that he gets. Patients with high scores are rated as more serious.

The questions asked

You have to provide answers to four key questions.

  • The first question is related to the percentage of platelet count fall. Patients who have a fall rate of more than 50 per cent carry high risks of thrombocytopenia. Similarly, patients that have a percentage of more than 30 and less than 50 have mild risks. In the end, patients that have a fall rate of less than 30 have the lowest risks of ending up with this problem. Thus, it can be said that the percentage determines the risk rate of each patient.
  • The second question is connected to timing of fall. If the onset is clear between 5 and 10 days, a score of 2 is added against the question. Similarly, a score of 1 is added when the onset is consistent but not clear between 5 and 10 days, the third category is a count of less than 4 days without any recent exposure.
  • Through the third question thrombosis is checked. In this question, other sequlae are checked as well.
  • It is important to check the other causes of thrombocytopenia are checked. If no causes are present, the patient would select the “none apparent” option. Similarly, patients would select from “possible” and “definite” options according to their medical conditions.
In an overall manner, this calculator by Calculators.tech is simple to use and provides users with the most accurate results. Once you have used this calculator, you can be absolutely sure about the authenticity of the results.

Summing It up

Some medical complications have very serious effects. If they are not treated on time, the results can be fatal as well. Thrombocytopenia is a serious medical issue in which the patient does not have any blood clots. As a result, blood starts flowing from different openings in the body. For instance, if a female is facing this issue, she would have very heavy discharges. This is one of the signs. Similarly, patients have large blood flows from the nostrils and gums. These are actually warning signs that you have platelet deficiencies.

When you talk about symptoms, if people with this disease get bruised, the blood does not stop flowing. Medications have been prescribed to deal with this issue but in worst cases, blood transfusion options and surgery alternatives are considered as well. It all depends on the medical condition of the patient.

Consumption of alcohol is one the strongest reasons for the development of this medical issue. People who consume alcohol on a regular scale have insufficient platelet counts. When these people get injured, it takes a lot of time for the healing process to be completed. If you are suffering from a disease like cancer, the medications given would reduce platelets. This would reduce the platelet count as well increase the chance of Thrombocytopenia.

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