Medical College of Wisconsin
CTSICores SearchResearch InformaticsREDCap

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

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

Authors

Sheila Hanson MD Professor in the Pediatrics department at Medical College of Wisconsin
Peter L. Havens MD Professor in the Pediatrics department at Medical College of Wisconsin
Rowena C. Punzalan MD Associate 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
jenkins-FCD Prod-482 91ad8a360b6da540234915ea01ff80e38bfdb40a