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Semin Thromb Hemost 2001; 27(3): 293-300
DOI: 10.1055/s-2001-15259
Copyright © 2001 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Heparin-Induced Thrombocytopenia in Pediatrics

Thomas Severin, Anton H. Sutor
  • Universitäts-Kinderklinik, Freiburg, Germany
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Publication History

Publication Date:
31 December 2001 (online)

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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

REFERENCES

  • 1 Sutor A H, Massicotte P, Leaker M, Andrew M. Heparin therapy in pediatric patients.  Semin Thromb Hemost . 1997;  23 303-319
    Thieme ConnectPubMedSearch in Google Scholar
  • 2 Greinacher A. Heparin-induzierte Thrombozytopenie-Pathogenese und Behandlung.  Hämostaseologie . 1999;  19 1-12
    PubMedSearch in Google Scholar
  • 3 Greinacher A. Treatment of heparin-induced thrombocytopenia.  Thromb Haemost . 1999;  82 457-467
    PubMedSearch in Google Scholar
  • 4 Visentin G P. Heparin-induced thrombocytopenia: molecular pathogenesis.  Thromb Haemost . 1999;  82 448-456
    PubMedSearch in Google Scholar
  • 5 Fabris F, Ahmad S, Cella G. Pathophysiology of heparin-induced thrombocytopenia.  Arch Pathol Lab Med . 2000;  124 1657-1666
    PubMedSearch in Google Scholar
  • 6 Warkentin T E, Chong B H, Greinacher A. Heparin-induced thrombocytopenia: towards consensus.  Thromb Haemost . 1998;  79 1-7
    Thieme ConnectPubMedSearch in Google Scholar
  • 7 Demir M, Ahmad S, Walenga J M, Fareed J. Laboratory diagnosis of heparin-induced thrombocytopenia.  Turk J Haematol 2000(Suppl). 181-190
    PubMed
  • 8 Walenga J M, Lewis B E, Bakhos M. Anticoagulant management of patients with heparin-induced thrombocytopenia.  Turk J Haematol 2000. 68-77
    PubMed
  • 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
    PubMedSearch in Google Scholar
  • 10 Spadone D, Clark F, James E. Heparin-induced thrombocytopenia in the newborn.  J Vasc Surg . 1992;  15 306-311
    PubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    PubMed
  • 13 Murdoch I A, Beattie R M, Silver D M. Heparin-induced thrombocytopenia in children.  Acta Paediatr . 1993;  82 495-497
    PubMedSearch in Google Scholar
  • 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
    PubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    Search in Google Scholar
  • 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
    PubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 19 Potter C, Gill J C, Scott J P, McFarland J G. Heparin-induced thrombocytopenia in a child.  J Pediatr . 1992;  121 135-138
    PubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    Search in Google Scholar
  • 22 Klement D, Rammos S, v Kries R. Heparin as a cause of thrombus progression.  Eur J Pediatr . 1996;  155 11-14
    PubMedSearch in Google Scholar
  • 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
    PubMedSearch in Google Scholar
  • 24 Sutor A H, Uhl M. Diagnosis of thromboembolic disease during infancy and childhood.  Semin Thromb Hemost . 1997;  23 237-246
    PubMedSearch in Google Scholar
  • 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
    PubMed
  • 26 Phelan B K. Heparin-associated thrombosis without thrombocytopenia.  Ann Intern Med . 1983;  99 637-638
    PubMedSearch in Google Scholar
  • 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
    PubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 29 Magnani H N. Heparin-induced thrombocytopenia (HIT): an overview of 230 patients treated with Orgaran.  Thromb Häemost . 1993;  70 554-561
    PubMedSearch in Google Scholar
  • 30 Greinacher A. Rekombinantes Hirudin zur weiteren Antikoagulation bei Heparin-induzierter Thrombozytopenie.  Hämostaseologie . 1999;  19 19-29
    PubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar