Heparin-Induced Thrombocytopenia in Pediatrics

Thomas Severin; Anton H. Sutor

doi:10.1055/s-2001-15259

Seminars in Thrombosis and Hemostasis, Inhaltsverzeichnis

Semin Thromb Hemost 2001; 27(3): 293-300
DOI: 10.1055/s-2001-15259

Heparin-Induced Thrombocytopenia in Pediatrics

Thomas Severin, Anton H. Sutor

Universitäts-Kinderklinik, Freiburg, Germany

Abstract

ABSTRACT

As in adult patients, heparin is used for prophylaxis and treatment of thromboembolism in newborns, children, and adolescents. Patients receiving heparin are potentially at risk to develop heparin-induced thrombocytopenia (HIT). HIT type II has been extensively described in the adult population; only a few reports address HIT type II in pediatric patients (total of 15 neonates, 4 young children, 12 older children and adolescents). The available data are discussed, and the case of a patient with recurrent thrombosis and HIT type II without thrombocytopenia is presented. The review of the literature reveals that HIT type II occurs especially in neonates and adolescents, corresponding to the two age peaks of thrombosis in pediatric patients. Risk factors for thrombosis include hereditary factors, immobilization, and surgery. HIT complications are severe and partly lead to life-threatening thromboembolism. In three patients, an increasing heparin demand was found. In five cases, thrombocytopenia was absent. Heparin was replaced mostly by danaparoid sodium; in three patients hirudin was used as an alternative anticoagulant. HIT type II represents a potentially dangerous complication of heparin therapy in pediatric patients and should be taken into consideration whenever heparin is given for prophylactic or therapeutic use in newborns, children, or adolescents.

KEYWORD

Children - heparin-induced thrombocytopenia - HIT - thrombocytopenia - thrombosis

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Referenzen

REFERENCES

1 Sutor A H, Massicotte P, Leaker M, Andrew M. Heparin therapy in pediatric patients. Semin Thromb Hemost . 1997; 23 303-319
2 Greinacher A. Heparin-induzierte Thrombozytopenie-Pathogenese und Behandlung. Hämostaseologie . 1999; 19 1-12
3 Greinacher A. Treatment of heparin-induced thrombocytopenia. Thromb Haemost . 1999; 82 457-467
4 Visentin G P. Heparin-induced thrombocytopenia: molecular pathogenesis. Thromb Haemost . 1999; 82 448-456
5 Fabris F, Ahmad S, Cella G. Pathophysiology of heparin-induced thrombocytopenia. Arch Pathol Lab Med . 2000; 124 1657-1666
6 Warkentin T E, Chong B H, Greinacher A. Heparin-induced thrombocytopenia: towards consensus. Thromb Haemost . 1998; 79 1-7
7 Demir M, Ahmad S, Walenga J M, Fareed J. Laboratory diagnosis of heparin-induced thrombocytopenia. Turk J Haematol 2000(Suppl). 181-190
8 Walenga J M, Lewis B E, Bakhos M. Anticoagulant management of patients with heparin-induced thrombocytopenia. Turk J Haematol 2000. 68-77
9 Almeida J I, Coats R, Liem T K, Silver D. Reduced morbidity and mortality rates of the heparin-induced thrombocytopenia syndrome. J Vasc Surg . 1998; 27 309-316
10 Spadone D, Clark F, James E. Heparin-induced thrombocytopenia in the newborn. J Vasc Surg . 1992; 15 306-311
11 Butler T J, Sodoma L J, Doski J J. Heparin-associated thrombocytopenia and thrombosis as the cause of a fatal thrombus on extracorporeal membrane oxygenation. J Pediatr Surg . 1997; 32 768-771
12 Ranze O, Ranze P, Magnani H N, Greinacher A. Heparin-induced thrombocytopenia in paediatric patients-a review of the literature and a new case treated with danaparoid sodium. Eur J Pediatr 1999 (Suppl 3). 158 130-133
13 Murdoch I A, Beattie R M, Silver D M. Heparin-induced thrombocytopenia in children. Acta Paediatr . 1993; 82 495-497
14 Oriot D, Wolf M, Wood C. Severe thrombocytopenia induced by heparin in an infant with acute myocarditis. Arch Fr Pediatr . 1990; 47 357-359
15 Saxon B R, Black M D, Edgell D, Noel D, Leaker M T. Pediatric heparin-induced thrombocytopenia: management with danaparoid (Orgaran). Ann Thorac Surg . 1999; 68 1076-1078
16 Zöhrer B, Zenz W, Rettenbacher A. Heparin-induced thrombocytopenia type II in three children and anticoagulant therapy with Org 10172 (Orgaran). Proceedings of the 30th Hemophilia Symposium, Hamburg, 1999. Berlin: Springer-Verlag; 2000: 299-302
17 Neuhaus T J, Goetschel P, Schmugge M, Leumann E. Heparin-induced thrombocytopenia type II on hemodialysis: switch to danaparoid. Pediatr Nephrol . 2000; 14 713-716
18 Schiffmann H, Unterhalt M, Harms K. Erfolgreiche Behandlung einer Heparin-induzierten Thrombozytopenie Typ II im Kindesalter mit rekombinantem Hirudin. Monatsschr Kinderheilkd . 1997; 145 606-612
19 Potter C, Gill J C, Scott J P, McFarland J G. Heparin-induced thrombocytopenia in a child. J Pediatr . 1992; 121 135-138
20 Wilhelm M J, Schmid C, Kececioglu D. Cardiopulmonary bypass in patients with heparin-induced thrombocytopenia using Org 10172. Ann Thorac Surg . 1996; 61 920-924
21 Severin T, Ensenauer R, Wiedensohler A. HIT type II without thrombocytopenia in a 15-year-old boy with protein-S deficiency and recurrent deep vein thrombosis. Proceedings of the 30th Hemophilia Symposium, Hamburg, 1999. Berlin: Springer-Verlag; 2000: 114-116
22 Klement D, Rammos S, v Kries R. Heparin as a cause of thrombus progression. Eur J Pediatr . 1996; 155 11-14
23 Sauer M, Gruhn B, Fuchs D, Altermann W, Zintl F. Heparin-induzierte Thrombozytopenie Typ II im Rahmen einer Hochdosis-Chemotherapie mit anschlieβender Stammzellrescue. Klin Pädiatr . 1998; 210 102-103
24 Sutor A H, Uhl M. Diagnosis of thromboembolic disease during infancy and childhood. Semin Thromb Hemost . 1997; 23 237-246
25 Fareed J, Hoppensteadt D A, Bick R L. An update on heparins at the beginning of the new millennium. Semin Thromb Hemost 2000 (Suppl 1). 26 5-21
26 Phelan B K. Heparin-associated thrombosis without thrombocytopenia. Ann Intern Med . 1983; 99 637-638
27 Hach-Wunderle V, Kainer K, Krug B, Müller-Berghaus G, Pötzsch B. Heparin-associated thrombosis despite normal platelet counts. Lancet . 1994; 344 469-470
28 Warkentin T E, Shepard J A, Horsewood P. Impact of the patient population on the risk for heparin-induced thrombocytopenia. Blood . 2000; 96 1703-1708
29 Magnani H N. Heparin-induced thrombocytopenia (HIT): an overview of 230 patients treated with Orgaran. Thromb Häemost . 1993; 70 554-561
30 Greinacher A. Rekombinantes Hirudin zur weiteren Antikoagulation bei Heparin-induzierter Thrombozytopenie. Hämostaseologie . 1999; 19 19-29
31 Greinacher A, Völpel H, Janssens U. Recombinant hirudin (Lepirudin) provides safe and effective anticoagulation in patients with heparin-induced thrombocytopenia. Circulation . 1999; 99 73-80
32 Kadidal V V, Mayo D J, Horne M K. Heparin-induced thrombocytopenia (HIT) due to heparin flushes: a report of three cases. J Intern Med . 1999; 246 325-329