Faculty Collaboration Database

Prevalence of heparin-dependent platelet antibodies in children after cardiopulmonary bypass. Pediatr Crit Care Med 2007 Jul;8(4):358-61

Date

06/05/2007

Pubmed ID

17545932

DOI

10.1097/01.PCC.0000269398.10804.7F

Scopus ID

2-s2.0-34447303574 (requires institutional sign-in at Scopus site)   13 Citations

Abstract

OBJECTIVE: To determine the prevalence of heparin-dependent platelet antibodies (HDPA) in children requiring heparin for >5 days after cardiopulmonary bypass surgery.

DESIGN: Prospective, observational study.

SETTING: Tertiary care pediatric intensive care unit.

PATIENTS: Thirty children were enrolled: 15 patients <30 days old and 15 patients between 30 days and 12 yrs of age.

INTERVENTIONS: Detection of HDPA by heparin-platelet factor 4 enzyme-linked immunosorbent assay after 5-10 days of postoperative heparin exposure. Positive or equivocal results were confirmed with serotonin release assay.

MEASUREMENTS AND MAIN RESULTS: There were no confirmed cases of HDPA in this study (95% confidence interval 0-11.6%). Despite the lack of HDPA, the study population was at high risk of thrombosis with symptomatic clot developing in six patients (20%). Clinical models developed in adults to determine the pretest risk of heparin-induced thrombocytopenia were not valid in this study population.

CONCLUSIONS: The prevalence of HDPA in children after cardiopulmonary bypass surgery is low. After bypass surgery, critically ill children are at risk of developing thrombosis from multiple etiologies, and suspicion of heparin-induced thrombocytopenia needs to be confirmed with laboratory testing including a functional assay.

Author List

Hanson SJ, Punzalan RC, Ghanayem N, Havens P

Author

Rowena C. Punzalan MD Professor in the Pediatrics department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Antibodies
Anticoagulants
Blood Platelets
Cardiopulmonary Bypass
Child
Child, Preschool
Enzyme-Linked Immunosorbent Assay
Female
Heparin
Humans
Infant
Infant, Newborn
Intensive Care Units, Pediatric
Male
Platelet Factor 4
Postoperative Complications
Prospective Studies
Thrombocytopenia