PMID- 35997577 OWN - NLM STAT- MEDLINE DCOM- 20220930 LR - 20221108 IS - 1545-5017 (Electronic) IS - 1545-5009 (Linking) VI - 69 IP - 11 DP - 2022 Nov TI - Application of a clinical decision rule and laboratory assays in pediatrics: Adult heparin-induced thrombocytopenia. PG - e29929 LID - 10.1002/pbc.29929 [doi] AB - 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. CI - (c) 2022 The Authors. Pediatric Blood & Cancer published by Wiley Periodicals LLC. FAU - Cohen, Omri AU - Cohen O AUID- ORCID: 0000-0002-8328-9748 AD - National Hemophilia Center, Institute of Thrombosis and Hemostasis, Sheba Medical Center, Tel HaShomer, Israel. AD - Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. AD - Department of Medicine and Surgery, University of Insubria, Varese, Italy. FAU - Lange, Kfir AU - Lange K AD - National Hemophilia Center, Institute of Thrombosis and Hemostasis, Sheba Medical Center, Tel HaShomer, Israel. AD - Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. FAU - Budnik, Ivan AU - Budnik I AD - Department of Pathophysiology, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia. FAU - Tamarin, Ilia AU - Tamarin I AD - National Hemophilia Center, Institute of Thrombosis and Hemostasis, Sheba Medical Center, Tel HaShomer, Israel. AD - Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. AD - The Dworman Automated-Mega Laboratory, Sheba Medical Center, Tel HaShomer, Israel. FAU - Brutman-Barazani, Tami AU - Brutman-Barazani T AD - National Hemophilia Center, Institute of Thrombosis and Hemostasis, Sheba Medical Center, Tel HaShomer, Israel. AD - Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. FAU - Barg, Assaf Arie AU - Barg AA AUID- ORCID: 0000-0002-8329-8409 AD - National Hemophilia Center, Institute of Thrombosis and Hemostasis, Sheba Medical Center, Tel HaShomer, Israel. AD - Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. FAU - Rosenberg, Nurit AU - Rosenberg N AD - National Hemophilia Center, Institute of Thrombosis and Hemostasis, Sheba Medical Center, Tel HaShomer, Israel. AD - Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. FAU - Lubetsky, Aharon AU - Lubetsky A AD - National Hemophilia Center, Institute of Thrombosis and Hemostasis, Sheba Medical Center, Tel HaShomer, Israel. AD - Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. FAU - Kenet, Gili AU - Kenet G AUID- ORCID: 0000-0002-1279-2557 AD - National Hemophilia Center, Institute of Thrombosis and Hemostasis, Sheba Medical Center, Tel HaShomer, Israel. AD - Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. FAU - Levy-Mendelovich, Sarina AU - Levy-Mendelovich S AUID- ORCID: 0000-0003-3971-0336 AD - National Hemophilia Center, Institute of Thrombosis and Hemostasis, Sheba Medical Center, Tel HaShomer, Israel. AD - Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. AD - Talpiot Medical Leadership Program, Sheba Medical Center, Tel HaShomer, Israel. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20220823 PL - United States TA - Pediatr Blood Cancer JT - Pediatric blood & cancer JID - 101186624 RN - 0 (Anticoagulants) RN - 0 (Heparin, Low-Molecular-Weight) RN - 0 (Latex) RN - 9005-49-6 (Heparin) SB - IM MH - Adolescent MH - Adult MH - Anticoagulants/adverse effects MH - Child MH - Clinical Decision Rules MH - Heparin/adverse effects MH - Heparin, Low-Molecular-Weight/adverse effects MH - Humans MH - Latex/adverse effects MH - *Thrombocytopenia/chemically induced/diagnosis/prevention & control MH - *Thrombosis/etiology/prevention & control OTO - NOTNLM OT - heparin OT - heparin-induced thrombocytopenia OT - pediatric OT - platelets OT - thrombosis EDAT- 2022/08/24 06:00 MHDA- 2022/10/01 06:00 CRDT- 2022/08/23 09:43 PHST- 2022/07/18 00:00 [revised] PHST- 2022/05/08 00:00 [received] PHST- 2022/07/24 00:00 [accepted] PHST- 2022/08/24 06:00 [pubmed] PHST- 2022/10/01 06:00 [medline] PHST- 2022/08/23 09:43 [entrez] AID - 10.1002/pbc.29929 [doi] PST - ppublish SO - Pediatr Blood Cancer. 2022 Nov;69(11):e29929. doi: 10.1002/pbc.29929. Epub 2022 Aug 23.