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

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.

journal_name

Anesth Analg

journal_title

Anesthesia and analgesia

authors

Mullen MP,Wessel DL,Thomas KC,Gauvreau K,Neufeld EJ,McGowan FX Jr,Dinardo JA

doi

10.1213/ane.0b013e3181734604

subject

Has Abstract

pub_date

2008-08-01 00:00:00

pages

371-8

issue

eissn

0003-2999

issn

1526-7598

pii

107/2/371

journal_volume

107

pub_type

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