Medical College of Wisconsin
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Plasma exchange for heparin-induced thrombocytopenia in patients on extracorporeal circuits: A challenging case and a survey of the field. J Clin Apher 2019 Feb;34(1):64-72

Date

11/09/2018

Pubmed ID

30407650

DOI

10.1002/jca.21671

Scopus ID

2-s2.0-85056203793 (requires institutional sign-in at Scopus site)   12 Citations

Abstract

Current management of heparin-induced thrombocytopenia (HIT) involves prompt discontinuation of all heparin products and concomitant initiation of a direct thrombin or anti-Xa inhibitor for anticoagulation. In the setting of HIT complicated by an urgent need for cardiopulmonary bypass (CPB), the safety and the efficacy of short-term heparin-based anticoagulation after therapeutic plasma exchange (TPE) have been previously demonstrated. Patients with HIT requiring TPE are frequently on extracorporeal circuits (either CPB, extracorporeal membrane oxygenation [ECMO] or external ventricular assist devices [VADs]). Performing TPE in parallel with these circuits involves additional consideration for circuit size, anticoagulant/citrate management, as well as flow rates, and risk of air embolus. We report a case of a patient with HIT on external biventricular assist device (BiVAD) requiring urgent CPB who experienced thrombotic and hemolytic complications related to anticoagulation management around apheresis line placement for TPE. We also present results from a national survey of academic apheresis services regarding specific practices in managing patients with HIT on extracorporeal circuits who require TPE. In addition, we demonstrate the utility of TPE in patients with HIT on extracorporeal circuits and the risks of this procedure and the need to develop practice guidelines.

Author List

Cho JH, Parilla M, Treml A, Wool GD

Authors

Angela Treml MD Associate Professor in the Pathology department at Medical College of Wisconsin
Geoffrey D. Wool MD, PhD Professor in the Pathology department at Medical College of Wisconsin




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

Cardiopulmonary Bypass
Extracorporeal Circulation
Heart-Assist Devices
Hemolysis
Heparin
Humans
Plasma Exchange
Surveys and Questionnaires
Thrombocytopenia
Thrombosis