Application of a clinical decision rule and laboratory assays in pediatrics: Adult heparin-induced thrombocytopenia.

Autor: Cohen O; National Hemophilia Center, Institute of Thrombosis and Hemostasis, Sheba Medical Center, Tel HaShomer, Israel.; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.; Department of Medicine and Surgery, University of Insubria, Varese, Italy., Lange K; National Hemophilia Center, Institute of Thrombosis and Hemostasis, Sheba Medical Center, Tel HaShomer, Israel.; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel., Budnik I; Department of Pathophysiology, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia., Tamarin I; National Hemophilia Center, Institute of Thrombosis and Hemostasis, Sheba Medical Center, Tel HaShomer, Israel.; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.; The Dworman Automated-Mega Laboratory, Sheba Medical Center, Tel HaShomer, Israel., Brutman-Barazani T; National Hemophilia Center, Institute of Thrombosis and Hemostasis, Sheba Medical Center, Tel HaShomer, Israel.; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel., Barg AA; National Hemophilia Center, Institute of Thrombosis and Hemostasis, Sheba Medical Center, Tel HaShomer, Israel.; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel., Rosenberg N; National Hemophilia Center, Institute of Thrombosis and Hemostasis, Sheba Medical Center, Tel HaShomer, Israel.; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel., Lubetsky A; National Hemophilia Center, Institute of Thrombosis and Hemostasis, Sheba Medical Center, Tel HaShomer, Israel.; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel., Kenet G; National Hemophilia Center, Institute of Thrombosis and Hemostasis, Sheba Medical Center, Tel HaShomer, Israel.; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel., Levy-Mendelovich S; National Hemophilia Center, Institute of Thrombosis and Hemostasis, Sheba Medical Center, Tel HaShomer, Israel.; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.; Talpiot Medical Leadership Program, Sheba Medical Center, Tel HaShomer, Israel.
Jazyk: angličtina
Zdroj: Pediatric blood & cancer [Pediatr Blood Cancer] 2022 Nov; Vol. 69 (11), pp. e29929. Date of Electronic Publication: 2022 Aug 23.
DOI: 10.1002/pbc.29929
Abstrakt: Background: Heparin-induced thrombocytopenia (HIT) is rare among pediatric patients. The diagnosis of HIT depends upon clinical decision tools to assess its pretest probability, supported by laboratory evidence of anti-platelet factor 4 (anti-PF4)/heparin antibodies.
Aims: To compare the use of the 4Ts score clinical decision tool, clinical characteristics, and laboratory findings between pediatric and adult patients with suspected HIT.
Methods: We compiled all pediatric patients in our center for whom HIT testing was performed during the years 2015-2021. These were compared with a cohort of consecutive adult patients. Laboratory diagnosis of HIT was performed with particle gel immunoassay (PaGIA) as screening test and confirmed by an automated latex-enhanced immunoturbidimetric assay (LIA) and/or by functional flow cytometry assay (FCA).
Results: The cohort included 34 children (under 18 years) and 105 adults. Adults mostly received heparins for thromboembolism prophylaxis and treatment (72.4%, n = 76), and were more frequently treated with low-molecular-weight heparin (LMWH). Children were mostly exposed during cardiopulmonary bypass and extracorporeal membrane oxygenation (ECMO, 61.8%, n = 21), and were more frequently treated with unfractionated heparin (UFH). Compared with adults, children had significantly higher 4Ts scores. Nevertheless, adults had a slightly higher rate of a positive diagnosis of HIT. Six out of 16 adults with confirmed HIT presented with thrombosis (37.5%), whereas all three pediatric patients with HIT presented with thrombosis (p = .087).
Conclusions: 4Ts scores are higher in children compared with adult patients for whom laboratory tests for HIT were obtained. A potentially higher incidence of thrombosis in children with HIT may be attributable to the severity of underlying illness.
(© 2022 The Authors. Pediatric Blood & Cancer published by Wiley Periodicals LLC.)
Databáze: MEDLINE
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