PMID- 18633010
OWN - NLM
STAT- MEDLINE
DCOM- 20080825
LR  - 20121115
IS  - 1526-7598 (Electronic)
IS  - 0003-2999 (Linking)
VI  - 107
IP  - 2
DP  - 2008 Aug
TI  - The incidence and implications of anti-heparin-platelet factor 4 antibody 
      formation in a pediatric cardiac surgical population.
PG  - 371-8
LID - 10.1213/ane.0b013e3181734604 [doi]
AB  - 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.
FAU - Mullen, Mary P
AU  - Mullen MP
AD  - Children's Hospital Boston, Boston, MA 02115, USA.
FAU - Wessel, David L
AU  - Wessel DL
FAU - Thomas, Kristen C
AU  - Thomas KC
FAU - Gauvreau, Kimberlee
AU  - Gauvreau K
FAU - Neufeld, Ellis J
AU  - Neufeld EJ
FAU - McGowan, Francis X Jr
AU  - McGowan FX Jr
FAU - Dinardo, James A
AU  - Dinardo JA
LA  - eng
GR  - M01-RR02172/RR/NCRR NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
PL  - United States
TA  - Anesth Analg
JT  - Anesthesia and analgesia
JID - 1310650
RN  - 0 (Anticoagulants)
RN  - 0 (Immunoglobulins)
RN  - 37270-94-3 (Platelet Factor 4)
RN  - 9005-49-6 (Heparin)
SB  - IM
CIN - Anesth Analg. 2008 Aug;107(2):356-8. PMID: 18633006
MH  - Antibody Formation
MH  - Anticoagulants/*adverse effects/immunology
MH  - Cardiac Catheterization
MH  - *Cardiac Surgical Procedures
MH  - Female
MH  - Heparin/*adverse effects/immunology
MH  - Humans
MH  - Immunoglobulins/blood
MH  - Infant
MH  - Infant, Newborn
MH  - Male
MH  - Platelet Factor 4/immunology
MH  - Reoperation
MH  - Thrombocytopenia/*chemically induced/immunology
EDAT- 2008/07/18 09:00
MHDA- 2008/08/30 09:00
CRDT- 2008/07/18 09:00
PHST- 2008/07/18 09:00 [pubmed]
PHST- 2008/08/30 09:00 [medline]
PHST- 2008/07/18 09:00 [entrez]
AID - 107/2/371 [pii]
AID - 10.1213/ane.0b013e3181734604 [doi]
PST - ppublish
SO  - Anesth Analg. 2008 Aug;107(2):371-8. doi: 10.1213/ane.0b013e3181734604.