NDLI: The incidence and implications of anti-heparin-platelet factor 4 antibody formation in a pediatric cardiac surgical population.

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The incidence and implications of anti-heparin-platelet factor 4 antibody formation in a pediatric cardiac surgical population.

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The incidence and implications of anti-heparin-platelet factor 4 antibody formation in a pediatric cardiac surgical population.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Mullen, Mary P. Wessel, David L. Thomas, Kristen C. Gauvreau, Kimberlee Neufeld, Ellis J. McGowan, Francis X. Dinardo, James A.
Description	Country affiliation: United States Author Affiliation: Mullen MP ( Children's Hospital Boston, Boston, MA 02115, USA.)
Abstract	BACKGROUND: The incidence and implications of anti-heparin-platelet factor 4 (PF4) antibody seroconversion in the pediatric cardiac surgical population remain largely unexplored. We sought to prospectively characterize the incidence of seroconversion in two populations: neonates undergoing primary cardiac surgery and children undergoing reoperative cardiac surgery with a history of unfractionated heparin (UFH) exposure. METHODS: One hundred and thirty-five consecutive patients were studied: Neonatal = 60 neonates, first time cardiac surgery. Reoperative (ReOp) = 75 children, reoperative cardiac surgery. Preoperative and postoperative day (POD) 5 and 10 blood samples were used to determine the presence of PF4 immunoglobulin (Ig)G, IgA, and IgM antibodies with enzyme-linked immunosorbent assay. RESULTS: No anti-heparin/PF4 antibodies were detected preoperatively in either group. On POD 5, antibodies were present in 1 of 60 (1.7%) Neonatal; and in 12 of 75 (16%) ReOp; P = 0.006. On POD 10, antibodies were present in 1 of 60 (1.7%) Neonatal; and in 39 of 75 (52%) ReOp; P < 0.001. Seroconversion in ReOp patients on POD 10 was significantly associated (P = 0.03) with previous UFH exposures. Heparin-induced thrombocytopenia (HIT) was not diagnosed in any Neonatal patients. One ReOp patient (1.3%) seroconverted and developed HIT without thrombosis or skin lesions. CONCLUSIONS: HIT is a rare occurrence in pediatric cardiac surgical patients. The incidence of anti-heparin-PF4 antibody seroconversion in children undergoing reoperation is approximately 50% at 10 days postoperatively, a finding similar to that reported in adult cardiac surgical patients. Both age and previous UFH exposure correlate with this rate of seroconversion. In contrast, the rate of seroconversion in neonates undergoing first time surgery is substantially lower.
File Format	HTM / HTML
ISSN	00032999
Issue Number	2
Volume Number	107
e-ISSN	15267598
Journal	Anesthesia & Analgesia
Language	English
Publisher	Lippincott Williams & Wilkins
Publisher Date	2008-08-01
Publisher Place	United States
Access Restriction	One Nation One Subscription (ONOS)
Subject Keyword	Discipline Anesthesiology Anticoagulants Adverse Effects Cardiac Surgical Procedures Heparin Thrombocytopenia Chemically Induced Antibody Formation Immunology Cardiac Catheterization Female Humans Immunoglobulins Blood Infant Infant, Newborn Male Platelet Factor 4 Reoperation Journal Article Research Support, N.i.h., Extramural
Content Type	Text
Resource Type	Article
Subject	Anesthesiology and Pain Medicine

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