Challenges in the Monitoring of Therapeutic Plasma Exchange during Acute Heparin-Induced Thrombocytopenia in Adults under ECMO.

Autor:	Gendron N; Innovative Therapies in Haemostasis, Paris Cité University, INSERM, Paris, France.; Hematology Department, Hôpital Européen Georges-Pompidou, Assistance Publique Hôpitaux de Paris, Centre-Université de Paris (APHP-CUP), Paris, France., Cavalie C; Université de Paris, INSERM U1148, LVTS, F-75018, Paris, France.; Laboratoire d'Hématologie Biologique, AP-HP, Hôpital Bichat, F-75018, Paris, France., Kantor E; Anesthesiology Department and Surgical Intensive Care, DMU PARABOL, AH-HP, Bichat-Claude Bernard Hospital, Paris, France., Provenchère S; Anesthesiology Department and Surgical Intensive Care, DMU PARABOL, AH-HP, Bichat-Claude Bernard Hospital, Paris, France., Sonneville R; Laboratory of Vascular Translational Science, Paris Cité University, INSERM, Paris, France.; Intensive Care Medicine, AP-HP, Hôpital Bichat - Claude Bernard, Paris, France., Gkalea V; Laboratoire d'Hématologie Biologique, AP-HP, Hôpital Bichat, F-75018, Paris, France., Bourrienne MC; Université de Paris, INSERM U1148, LVTS, F-75018, Paris, France.; Laboratoire d'Hématologie Biologique, AP-HP, Hôpital Bichat, F-75018, Paris, France., Faille D; Université de Paris, INSERM U1148, LVTS, F-75018, Paris, France.; Laboratoire d'Hématologie Biologique, AP-HP, Hôpital Bichat, F-75018, Paris, France., Ajzenberg N; Université de Paris, INSERM U1148, LVTS, F-75018, Paris, France.; Laboratoire d'Hématologie Biologique, AP-HP, Hôpital Bichat, F-75018, Paris, France.
Jazyk:	angličtina
Zdroj:	TH open : companion journal to thrombosis and haemostasis [TH Open] 2024 Mar 28; Vol. 8 (1), pp. e141-e145. Date of Electronic Publication: 2024 Mar 28 (Print Publication: 2024).
DOI:	10.1055/a-2277-4404
Abstrakt:	Therapeutic plasma exchange (TPE) has been proposed to remove heparin-induced thrombocytopenia (HIT) antibodies before planned thoracic surgery in patients with acute HIT and to allow brief re-exposure to heparin during surgery. In patients on extracorporeal membrane oxygenation (ECMO), simultaneous administration of TPE and alternative nonheparin anticoagulant therapies is challenging. We report 2 patients on ECMO with acute HIT who underwent repeated TPE to enable cardiothoracic surgery with the use of heparin. In both cases, serial monitoring of HIT antibody titer and heparin-induced platelet activation assay (HIPA) was performed. The effect of adding exogenous platelet factor 4 (PF4) in the HIPA was also tested. Negative anti-PF4/H IgG levels were achieved after 5 and 3 TPE sessions, respectively and patients could beneficiate from surgery with brief heparin re-exposure without any thrombotic complication. Negative HIPA results were obtained before negative anti-PF4/H IgG in one patient but remained positive in the other despite very low antibody titers. The addition of PF4 in HIPA led to more contrasted results for the two patients. Serial HIT screening including immunological and functional assays is necessary to closely monitor TPE in acute HIT patients on ECMO who require surgery. The addition of PF4 in HIPA could help detect clinically relevant platelet-activating antibodies and guide re-exposure to heparin. Competing Interests: Conflict of Interest None declared. (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. ( https://creativecommons.org/licenses/by/4.0/ ).)
Databáze:	MEDLINE
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